Unique Therapy Addresses Parkinsons Disease In ‘big’ And ‘loud’ Ways
How a concentrated therapy program uses a team approach to easing movement and speech symptoms in people with PD.
If you have movement or speech problems because of Parkinsons disease, a specialized therapy program can help.
LSVT BIG and LOUD® therapy was developed for people with Parkinsons disease. It also can be used for people who have other neurological conditions. LSVT programs are administered in an intensive manner four times per week for four weeks and are tailored to each patient.
The emphasis is on exaggerated activity to compensate for PDs movement and speech symptoms. For movement issues, therapists ask patients to move in BIG or amplified ways, whether theyre walking, buttoning shirts and pants, getting keys or change out of pockets, or writing. For speech, the focus is on a single goal: LOUD speaking. Activities may include sustaining a vowel sound such as ah, oral reading and speaking activities that increase in complexity .
The majority of PD patients I send for therapy find it to be extremely helpful, says Kelvin L. Chou, M.D., professor of neurology and neurosurgery at Michigan Medicine and co-director of the STIM Program.
What Type Of Exercise Should I Do If I Have Parkinson’s Disease
Exercise is a planned, structured, repetitive activity that is intended to improve physical fitness. There is no right exercise for people with Parkinsons. Everyones regimen will differ, depending on overall health, symptoms and previous level of activity. Any exercise helps, and a variety of exercise types may provide well-rounded benefits.
Aerobic exercise involves activities that challenge your cardiorespiratory system such as walking, biking, running, and activities in the pool. Participating in aerobic exercise at least three days a week for 30-40 minutes may slow Parkinsons decline.
Strength training involves using your body weight or other tools to build muscle mass and strength. Strength training two days per week, starting with low repetition and weight, may be beneficial in Parkinsons disease. A focus on extensor muscles, or muscles in the back of the body, can help with posture.
Stretching two or more days per week can be beneficial to maintain range of motion and posture. Holding each stretch of major muscle groups for 30 to 60 seconds can improve muscle length.
Balance and agility training
This type of training often combines aerobic exercise, strength training, and flexibility training. Examples include:
- Tai chi, yoga or Pilates.
How Do I Get Started With Lsvt Big
To get started with the LSVT BIG program, you first need a prescription for the program from your doctor. This may come from your primary care physician or your neurologist. Then contact a facility that has LSVT BIG trained therapists. You can search for an LSVT Certified Clinician near you on the LSVT Global website.
Danielle Albin, PT, DPT, CSRS, LSVT BIG, is a physical therapist in the outpatient department at Gateway Rehabilitation Hospital. She has been a physical therapist for over 5 years with experience in inpatient rehab, outpatient, and skilled nursing facilities. She graduated from University of Kentucky with her Doctorate in Physical Therapy in 2013. Danielle is certified in LSVT BIG and also has her stroke certification . Danielle is passionate about improving the way in which patients with Parkinsons Disease move and perform their daily activities.
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Adapts For Patient Fatigue
Controlling Parkinsons Disease symptoms is primarily achieved with medication timing and rehabilitation therapy. The link between these two treatments is undeniable. Once dopamine replacement medication has been given, there is a short window when the PD patient has optimal energy and will get the most physical and emotional benefit from rehab. Finding a rehabilitation program that can be tolerated by a PD patient, and that understands and works with medication timing is critical.
Many Parkinsons sufferers cannot tolerate the three hours a day, five days a week rehabilitation requirement of an acute rehab facility as laid out by the Centers for Medicare & Medicaid Services . Fatigue is the issue, so the specialized rehabilitation program Big and Loud can be a better fit. It has a manageable pace, works to improve mobility, balance, endurance, and strength, and has a higher success rate for the Parkinsons Patient.
What is Big and Loud?Big and Loud, called LSVT, started in the 1980s with a speech therapy program developed by Lee Silverman of Voice Treatment Gobal. Later, the same concepts were applied to limb movements calling it Big.
Physical Therapy LSVT certification for BIGRe-educates the sensorimotor system with an intensive amplitude-based exercise program for the limb motor system. These exercises are Parkinsons disease specific based on neuroplasticity and research.
Are There Any Parkinsons Specific Exercises
There are a number of Parkinsons specific programmes that aim to improve movement. Overall there is limited research evidence on the specific benefits of these programmes, and we dont yet know if they are more beneficial than other types of exercise, but people have told us they found them to be of use.
We have provided examples below of the more common programmes specific to the needs of people with Parkinsons, but you may find classes with different names that are run by physiotherapists near you and offer similar exercises by trained therapists.
LSVT®BIG training is administered over the course of a month by a qualified physiotherapist or occupational therapist. It involves repetitive intensive high-amplitude movements and aims to restore normal movement amplitude. Studies into LSVT BIG training have been small in size but there is some evidence it may improve daily activities and motor symptoms.
It is claimed that this training provides greater improvements in motor performance than either Nordic walking or non-supervised in-home exercises. However, another study found that an 8-week Nordic walking course and a 4-week LSVT BIG course produced similar improvements in reaction time.
PD Warrior is exercise treatment designed to slow Parkinsons down. It was developed by Australian physiotherapists but practitioners can now be trained in the UK. Its a complete rehab program designed to improve your function, quality of life and long term exercise behaviour.
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When Is The Lsvt Big Program Appropriate
Patients with Parkinsons Disease can participate in the LSVT BIG program at any time during their disease process. However, research suggests that the earlier a patient gets into the program, the more beneficial it can be. The exercise program can be modified to accommodate patients at different levels of mobility.
Live Large With Parkinson’s At The Countryside Y
Publisher: Countryside YMCA
These two 25-minute exercise classes are designed for people with Parkinson’s. The exercises may be done seated or standing, supported by a chair. These videos were created in March/April 2020.
Purchase Info: www.lsvtglobal.com or email
Cost: $28 for DVD or download $15/year streaming
Videos are designed for people with PD to use as an adjunct to LSVT BIG treatment delivered by an LSVT BIG certified clinician. The videos can also be used during the month of therapy and after therapy as a motivation to practice and keep moving. Volume 1 contains standard exercises while standing. Volume 2 contains exercises adapted to seated and supine positions, plus a chapter for caregivers. Available in English, German and Japanese.
Publisher: Ohana Pacific Rehab Services and Hawaii Parkinson Association, 2009
Purchase Info: Ohana Pacific Rehab Services, 808-262-1118, online
Cost: $24.50 for DVD $19.50 for book $40 for DVD and book
This program focuses on exercises, flexibility, and pragmatic solutions for walking, moving, falling, and getting up off the floor. Adaptive equipment is reviewed. Demonstrators have PD. Three levels of exercise shown. Designed by a physical therapist.
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What Type Of Exercises Will I Be Doing
The LSVT BIG program consists of seven maximal daily exercises, five functional tasks, and one-to-three hierarchy tasks. The maximal daily exercises are standard exercises that all patients perform. There are two seated and five standing exercises. These exercises focus on sustained posture, trunk rotation, balance, and stepping. The five functional tasks are made custom to the patients needs. These are one step tasks, such as sit-to-stand, turning, backwards stepping, etc. The hierarchy tasks are also custom to the patients needs. These are more complex tasks, such as getting on-and-off the floor, getting in-and-out of bed, getting in-and-out of the car, etc.
What Is Lsvt Loud
Nearly 90% of individuals with PD have speech and voice disorders that negatively impact communication abilities . These disorders include reduced vocal loudness, monotone, hoarse, breathy voice quality, and imprecise articulation, perceived as mumbling, and other rate-related features, such as hesitations and short rushes of speech . In contrast to previous medical chart review literature suggesting a mid- or late-stage onset of speech and swallowing symptoms in PD , more recent investigations with sensitive and valid measures consistently report speech symptoms in early PD . Further, self-report data from individuals with PD have indicated that voice and speech changes are associated with inactivity, embarrassment, and withdrawal from social situations .
In contrast, traditional speech therapy typically involves multiple speech system targets , is low intensity , and does not systematically address the sensory processing deficits related to self-perception of loudness by individuals with PD . The LSVT LOUD protocol is summarized in .
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Improving Mobility Strength And Balance
Staying mobile and self-sufficient is top of mind for people living with Parkinson’s disease. Stiffness is also a known problem with the disease. This rigidity can cause poor posture and pain that leads to other functional problems. A physical therapist can help with these problems. PTs guide people with Parkinson’s through moves and stretches to increase mobility, strength, and balance.
Do Studies Support Using Lsvt Big Therapy
At Bon Secours Memorial Regional Medical Center, we use LSVT BIG because we have seen how it can improve the lives of our patients. LSVT BIG therapy can help you feel more in control of your movements and feel more positively about your health.
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Big Movements For Big Improvements In Parkinsons Disease Symptoms
A progressive neurological disorder, Parkinsons disease can affect the quality of every move you make. It can make you move more slowly, take smaller steps and cause tremors.
LSVT BIG, an intensive therapy program, helps patients with Parkinsons disease reduce their symptoms and slow the progression of the disease. The specially designed program helps you improve your balance, move faster and make larger motions.
Other Strengthening And Flexibility Activities
There are many more activities that help to build strength and flexibility that may be of use to people with Parkinsons, but many have not been researched to find out about their specific benefits in the condition. You can visit our forum to read experiences of exercise programmes people have tried, and join in the conversation.
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Lsvt Loud Outcome Data
Two randomized controlled trial studies have been conducted . Data have documented that training increased vocal loudness results in a statistically significant and lasting increase in vocal sound pressure level and frequency variability during speech as compared to a matched treatment focusing on training increased respiratory support . Effect size data for the primary outcome variable of vocal SPL in conversational speech were highly significant immediately posttreatment and were maintained at 24 months posttreatment . Data providing initial external validation of LSVT LOUD outcomes have been reported by independent labs and reviews .
In addition, various physiologic changes such as increased movement amplitude of the rib cage during speech breathing , increased subglottal air pressure , and improved closure and larger/more symmetrical movements of the vocal folds have been documented in individuals with PD immediately after LSVT LOUD. These findings are supported by perceptual data demonstrating listeners rated improved loudness and voice quality in individuals with PD immediately posttreatment . Subjects in these studies were predominately Hoehn and Yahr stages 13 with moderate speech deficits.
Mode: Intensive High Effort Therapy
The training mode of LSVT Programs is consistent with some principles that promote activity-dependent neuroplasticity including specificity, targeting bradykinesia/hypokinesia through increasing amplitude of motor output, intensity, increased dosage of treatment, repetition, increased repetition of tasks within treatment sessions and home practice, and saliency of treatment tasks, individualized hierarchy and carryover assignments for active practice of desired goals, interests and abilities of each person . Further, we recognize that acquisition of the motor skill alone may not be sufficient for sustained neuroplasticity or for carryover and long-term maintenance outside the therapeutic environment. Therefore, a direct translation of the structured motor exercises into functional daily activities is emphasized in treatment with the goal of facilitating generalization outside of the treatment room . In addition, emphasis is placed on establishing life-long habits of structured homework practice of voice/movement exercises that continue beyond the one-month of treatment. Finally, simply using the louder voice or bigger movements in daily living provides additional practice, as summarized by this patient quote,
in my normal everyday life, I just exaggerate my movements. I keep things big when I reach for things, or when I bend or when I walk and when I talkI keep my voice loud.
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Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinson’s Disease
Talk to your neurologist and your primary care provider before starting a new exercise regimen. They can:
- Counsel you on how intense your exercises can be.
- Recommend exercises appropriate for your individual health.
- Refer you to a physical therapist to create a personal exercise program.
- Warn about exercises to avoid based on your particular challenges or limitations.
Weight And Resistance Training
It is known that the extensor system the muscles that keep the body upright against gravity become weaker in Parkinsons, making it more likely that the body will become stooped and flexed. Lifting weights or using resistance equipment can be the simplest way to work on muscle strength, however it is important you know what you are doing so you dont hurt yourself, and so that you strengthen the right set of muscles.
These exercises normally focus on building strength in sets or muscles or improving certain movements. And can often be done at home without the need of expensive equipment. If you are interested in doing weight and resistance exercises we advise getting professional advice about what muscles or movements to work on from a qualified physiotherapist.
There is evidence that this type of exercise can improve strength and flexibility in Parkinsons. For instance, resistance training focusing on the legs was seen to improve legstrength and mobility of the knee joint in people with Parkinsons. But the researchers in this study noted it may not be superior to treadmill or balance training, which provided many of the same benefits.
Other researchers have demonstrated that a combined strengthening, stretching and balance training programme, carried out 2 days a week over 24 months, may be more effective than weight lifting alone in reducing Parkinsons motor symptoms.
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Re+active Pt Videos For Home Exercising
Publisher: re+active PT
Publisher: Rock Steady Boxing Indianapolis Headquarters
This is a series of 66 short videos. There are stretches, warm ups, workouts, fitness challenges, tai chi, and tips & tricks videos. The idea is by the time you’ve followed along with one video in each category, you’ve done a whole body workout.
Publisher: APDA Greater St. Louis Chapter
Three short videos include quick chair exercises, exercises for stronger legs and glutes, and exercises for better balance.
Publisher: Patrick LoSasso
Cost: $14.95/month or $135/year after a free one week trial
A growing library of workouts for those with Parkinson’s, including: 5-minute workouts, Undefeated Boxing, Rise & Shine morning blast, exercise ball, Brain & Body Bar, and Parkinsons’ workout with towel and ball.
Publisher: U-Turn Parkinson’s
This collection of pre-recorded exercise videos includes three 20-minute warm up/stretching videos, four 20-minute seated workouts, one 20-minute upper body boxing video, a 9 minute boxing basics video, two one-hour Rock Steady Boxing Winnipeg workouts, two advanced RSBW workouts, and two yoga Parkinson’s workouts.
Publisher: Neuro Challenge Foundation For Parkinson’s
Publisher: Yoga for Parkinson’s
Ways Physical Therapists Help Slow The Progression Of Parkinson’s Disease
It is well-known that exercise of any kind is good for each person’s health, both body and mind. But did you know that it is even more important for those living with Parkinson’s disease? Physical therapy is key to slowing down the disease. And it helps those affected to stay as independent as possible.
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Big And Loud Program For Parkinsons Disease
LSVT Global offers both speech therapy, and physical/occupational therapy programs for individuals with Parkinsons disease or other neurological conditions. Bellin Health is pleased to offer both the LSVT BIG and LOUD programs at multiple sites within Sports Medicine.
LSVT BIG techniques train individuals with Parkinsons disease and other neurological conditions to use bigger movements anywhere, anytime in daily living. This empowers individuals with the potential they have to keep moving and stay active.
LSVT BIG treatment consists of:
- 16 sessions: 4 consecutive days a week for 4 weeks
- Individual 1 hour sessions
- Trains a single target of amplitude
- Drives intensive and high-effort practice
- Teaches the amount of effort required to produce normal movements
- Translates bigger movements into real-world, everyday activities
- Empowers people with Parkinsons disease with their potential to improve.
LSVT BIG will help you establish a LIFE-LONG HABIT of BIG PRACTICE! It will teach you how to avoid inactivity and keep your movements ALIVE during everyday activities. It will help you participate fully and improve the quality of your life.
The Big and Loud program is available at the following sites: