By Marti Webb Slay
Until a cure is found for Parkinson’s disease, a physical therapy protocol called LSVT BIG is helping patients improve the quality of their movements and slow progression of the disease.
“Parkinson’s makes people move smaller,” said Nick Stanton, PT, DPT and LSVT certified clinician at Radius Physical Therapy in Trussville. “Their movements become small, their steps become small, their posture becomes small. It makes them become drawn in. The BIG protocol gets people to move bigger. After four weeks of treatment, we see larger amplitude arm swings and increased stride or step length, which all helps gait speed, decreases fall risk, and improves function overall.”
LSVT, which stands for Lee Silverman Voice Treatment, began as a speech therapy approach, which is referred to as LSVT LOUD. “People with Parkinson’s disease (PD) often have difficulty with their speech and their ability to be properly understood in conversation,” Stanton said. “Their voice may not be as loud, or their articulation as clear as it once was. They may speak in a monotone voice which does not convey the emotion that listeners expect to hear. LSVT aims to recalibrate the perception of loudness that a person with PD has of their voice, prompting participants to speak at a more normal volume.
“LSVT started out as a way to help Parkinson’s patients speak louder and more clearly. It was helping train larynx muscles to speak, and that led therapists to wonder whether this could be applied to protocols for other muscles in the body, to help them with daily activities.”
The physical therapy treatment, referred to as LSVT BIG, consists of four one-hour sessions each week for four weeks. “It’s an intensive treatment,” Stanton said. “It’s hard work to get the brain to calibrate to larger movements. Historically, treatment for Parkinson’s was low intensity and low frequency, as therapists worried about wearing the patients out. But that’s not really what’s beneficial for them. They need that high intensity to make lasting neuroplastic changes. Moving big is how we get calibration with these patients. We encourage them to move bigger with reaching, standing, and stepping.
“It’s up to the physical therapist to provide the patient with movements that are challenging, but not overwhelming. We are going to meet somebody where they’re at. It’s our job to find where it’s challenging and make them work, but so hard that they want to quit. We have to use our best judgment, and a big part of that is encouraging people and giving them the confidence to work through the difficult things. It’s been pretty significant to see changes in people’s gait. And not only in the quality of their gait, but also in their gait speed, and their balance.”
The sessions consist of seven daily maximal exercises, along with functional movement tasks and hierarchy tasks. Functional tasks are basic movements like standing up from a chair, something people do every day. Hierarchy tasks, on the other hand, are more complex and take multiple steps, but are still movements that people do daily. An example of a Hierarchy task would be getting in and out of a car, which involves walking to the car, turning toward the seat, and sitting down. This obviously requires more movements than standing up from a chair.
In addition to the four sessions per week with a therapist, patients are expected to do the daily maximal exercises at home once daily on therapy days and twice a day the other three days of the week. Those personal workouts continue when the organized therapy sessions end after four weeks.
“When the patient feels like they are starting to move smaller again or having difficulty with daily activities or seeing a progression in the disease, they are encouraged to return for a tune-up,” Stanton said. “That doesn’t mean they have to do four times a week for four weeks again. They’ve completed the program and don’t need the recalibration. They usually only need a couple of visits to get moving better again. One of my patients just came in for his third tune-up.
“I recommend my patients continue with some other activity in addition to the exercises, such as dancing or Tai Chi. One of my patients participates in a PD fight club, a boxing group. That’s a really good way to progress from LSVT.
“Parkinson’s is a progressive disease, and this treatment doesn’t cure it. But it does, according to the evidence, slow down the progression. Sometimes it can even cause a stop of the progression, even if only for a year or two. It gives the patient confidence to have something they can help themselves with.”
