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Big Movements Help Parkinson's Patients
Monday March 15, 2010


The principles behind a successful speech therapy for patients with Parkinson’s disease are now being applied to a new physical therapy approach for this patient group and others. The original LSVT (Lee Silverman Voice Treatment) Loud program was founded 15 years ago and helps participants enhance sound and articulation by speaking at an exaggerated volume. LSVT Big uses that same idea of exaggeration, asking PT participants to make exaggerated motions. In a Big session, the patient mimics or mirrors the therapist through a series of stepping or rocking movements while in a lunge position. The arms are spread in all directions.

“It’s kind of like Tai-Chi, but it’s accelerated,” says the inventor, Becky Farley, PT, PhD, a research assistant at the University of Arizona. “It trains for both speed and amplitude.”

The protocol is both intensive and complex, with many repetitions of core movements that are used in daily living. The schedule for the intense therapy is one-hour, four days a week for four weeks, in individual one-on-one sessions with a PT or OT.

The therapy can be delivered to patients either standing or, if unable to stand, in a sitting position, Farley says. In a new exercise gym for Parkinson’s patients Farley has developed, some patients do LSVT Big suspended in a harness so they will not fear falling, she says.

Positive Reviews
“This treatment technique has done wonders for my patients,” says Chloe Roderick, PT, at Pardee Rehabilitation and Wellness Center in Hendersonville, N.C. “I’ve had patients that were frozen — that couldn’t walk 15 feet or get out of a chair — now walking half a mile and getting out of chairs independent of armrests.”

Roderick, who sees four to six Parkinson’s patients a day, says the LSVT Big therapy works on all stages of the disease, from early onset to later stages. In addition, she’s been able to use the therapy on patients with other neurological disorders, including stroke, and even orthopedic issues, such as joint replacements.

“Before I had the LSVT Big training, I was doing a combination of exercises for flexibility, endurance [and] balance,” she says. “This incorporates everything, and you get a good aerobic workout. I have patients who work up a sweat.”

Physical therapists in home health settings also are becoming trained in LSVT Big.
“It’s still too early to track outcomes, but we anticipate with this approach to see a reduction in falls and improvement in activities of daily living,” says Mark Heitchu, MPT, therapy director at Residential Home Health in Madison Heights, Mich.

The home health agency, which serves a clientele numbering 2,000, has trained nearly 100 of its home health therapists in LSVT Big for patients with Parkinson’s, multiple sclerosis and strokes, as well as other movement issues, says Heitchu.

Clinical Studies
While in her doctoral program at Arizona, Farley learned about LSVT Loud from her classmate, Cynthia Fox, PhD, CCC-SLP, research associate at University of Colorado-Boulder, and co-founder and chief clinical officer of LSVT Global (, which offers training and certification in these proprietary techniques.

“I told her we should apply those principles to PT,” says Farley, who then went on to develop the exercises and name her program LSVT Big.

Farley has since completed two studies on the therapy, including a randomized clinical trial funded by the National Institute of Health to document the efficacy of an exercise approach that targets the Parkinson’s symptoms of slow/small movements (bradykinesia/hypokinesia) using LSVT Big. The results will be published sometime this year, Fairley says.

“We compared Big to an outpatient control intervention,” she says. “Both groups improved with intensity, but Big had more improvement in trunk rotation and stride length.” The therapy also can have positive outcomes on speed, balance and quality of life, she adds.

Big and Loud Crowd
To further reach more patients at Pardee, Roderick has started the Big and Loud Crowd for Pardee Parkison’s patients and those in the local community. The group meets once a week and goes through 15-20 minutes of LSVT Big exercises with Roderick, then 40 minutes of LSVT Loud speaking with a speech pathologist. Roderick also is planning a video of the LSVT Big exercises to give to patients upon their release.

LSVT Big has been an inspirational therapy for Roderick, she says. “I’ve been a PT for 30 years, and I’ve trained in a number of therapies,” she says. “LSVT Big has excited and rejuvenated me, as well as the patients.”

An integrated treatment program that simultaneously targets speech and limb motor disorders in people with Parkinson’s recently has been developed by LSVT Global, Farley says. Results from pilot work revealed all pilot subjects with Parkinson’s increased vocal volume and improved gait. This program is undergoing further development and testing. •

Teresa McUsic is a contributing writer for Today in PT.

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Monday March 15, 2010
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