LSVT BIG: Exaggerated Movements for Parkinson’s Symptom Relief

Ryan LaCorte Lindsay Walicky, Publications, Specialized Treatments

Approximately one million Americans are currently living with Parkinson’s disease. Men are one and a half times more likely to be diagnosed with Parkinson’s disease (PD) than women. Parkinson’s disease is classified as a movement disorder. Patients with PD lack dopamine, which is a central nervous system (CNS) chemical derived from the substantia nigra portion of the brain. Dopamine works to control smooth movement, which is why patients with PD lack controlled and smooth pursuits of their movements. The most common symptoms of PD can include: tremors, rigidity (stiffness in their trunk/body), postural instability, and balance deficits. Other symptoms that can occur are masked facial expressions and soft speech or slurring.

The cause of PD is unknown and currently there is no cure; however, treatments to control the symptoms are available. Current treatment options include: dopamine replacement medications, the most common being Sinemet and/or the more radical treatment being neurosurgical intervention in which a deep brain stimulator is implanted in the patient’s brain. The stimulator is placed in the location from which the symptoms originate to modify the brain activity.

Many research studies are currently being conducted to assist with management, diagnosis and cause, including the LSVT BIG exercise program. Of that research, LSVT BIG results have shown that exercise in addition to or in lieu of dopamine replacement medication or neurosurgical intervention can slow disease progression and help to manage current symptoms. Patient case studies have proven significant effectiveness of these specified movements geared towards the impairments associated with PD.

LSVT is a program that has been studied for many years originally being used as a speech program implemented by speech therapists (LSVT LOUD). LSVT BIG is a specific exercise program; the protocol consisting of 16, hour long sessions with a certified Physical or Occupational Therapist geared towards improving the symptoms of PD. This program consists of seated and standing exercises including movements that challenge balance, trunk control, rotations and limb mobility. Goals are set specifically for each patient throughout the program focusing on the activities of daily living (ADL’s) and the functional limitations patients with PD have. These can include simple things like getting in and out of the car or bed, rising from the couch, or reaching on a high shelf. During each session the therapist will work on these issues as well as walking and balance. A detailed home exercise program (HEP) will also be provided for each patient to assist with carry-over post-therapy session.

Patients with PD have an abnormal perception of normal movement sizes. Small steps, decreased body rotation and arm swing with shuffling steps are typical. The LSVT BIG exercises are specific to address these deficits. The intensity of this program enhances the carry-over to change the normal movements, not just during the therapy sessions but throughout the patient’s daily lives.

The LSVT BIG program works because the exercises specifically target the movement deficits patients with PD are affected with. The program is called “BIG” because the exercises require actual big movements, using large steps with the legs and reaching and swinging movements of the arms and upper body. These movements assist with increasing the patient’s mobility as well as working on their balance, causing them to shift their weight forward, backwards and to both sides. The exercises can be modified for different physical functioning levels to perform with the therapist in the safest manner. The repetition of these exercises and the consistency of this program work to enhance the long-term effects from the therapy clinic to home and ultimately life.

Research has shown significant improvements in the brain through these studies. Positive changes in image results before and after completing this program have been found. There is no cure for PD, but through the LSVT BIG program the symptoms can be managed. There are multiple stages of PD, and catching patient’s at the optimal stage can highly assist with the symptom recovery process leading to a better outcome and quality of life for the patient and family. No matter what stage of disease progression a patient with PD is in, increasing the amount of daily activity and participating in a regular exercise program can improve the quality of life and movements. If you would like to know if LSVT BIG is right for you or a loved one, contact your doctor and mention the LSVT BIG program at All-Care Physical Therapy Center.

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