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LSVT-BIG is a specific exercise program for persons with Parkinson’s Disease (PD) or other Parkinsonian disorders. This program is based upon the development of LSVT (Lee Silverman Voice Treatment) developed for Parkinson’s patients in 1987. Research has shown that exercise can improve brain functioning and slow disease progression. LSVT-BIG is an exercise program which targets the unique movement deficits of these patients. Parkinson’s can include, pathophysiological deficits that interfere with movement include 1) sensory motor deficits, 2) cognitive and executive function & attentional deficits, 3) emotional-motivational deficits.

Sensorimotor deficits include: 1) resting tremor, 2) rigidity (stiffness), 3) postural instability (poor balance), 4) bradykinesia (slow movement), and 5) hypokinesia (small movement).  Patients experience Hypokinesia as speech becoming more and more quiet, handwriting becoming tiny, stride length and arm swing decreasing, and repetitive movements becoming slow and small in amplitude. 

Cognitive deficits include 1) inadequate preparation for moving, 2) slow thinking, 3) slow learning, 4) difficulty maintaining attention, 5) difficulty changing movement strategies, 6) difficulty adapting to different environments, and 7) impaired procedural memory. 

Emotional deficits include 1) reduced “vigor,” 2) loss of self-efficacy, 3) defaulting to low energy, 4) mismatch between perceived cost and reward, 5) reduced motivation.

Essentially, individuals with PD have a calibration problem.  Movements that are normal are perceived as “too big” by the patient. They are unable to self-monitor their movements because PD has caused sensory integration deficits.  LSVT-BIG can recalibrate this sensory-motor problem by providing an individualized exercise program which focuses on improving movement amplitude.  The GOAL is that patients will learn to use bigger movements more automatically and will maintain these bigger movements as the disease progresses – thus improving FUNCTION!  They will learn how to better self-monitor and accept that a movement that FEELS too big, is actually a NORMAL movement.

LSVT-BIG aims to address the slowness and smallness of movement and will help mitigate the cognitive difficulties along the way by using the principle of neuroplasticity. Neuroplasticity is the concept that the brain can form and reorganize connections in response to learning and exercise.  In order to achieve optimal neuroplasticity, the exercise program must have intensity, complexity, specificity, feedback, motivation, and repetition.

The therapist’s role is to model the desired movement, shape the movement, drive the patient to apply BIG effort, stabilize/ingrain the movement through repetition and feedback, apply learning to functional activities, and teach the patient how to self-calibrate.  The patient’s role is to be ready to attend frequent sessions and put in big effort.

“Don’t practice until you get it right.  Practice until you can’t get it wrong.”  -unknown

Fyzical Bellingham now has a certified LSVT-BIG clinician.  Make an appointment if you are ready to improve your movement and slow down the progression of your PD or Parkinsonian disorder.

Juli Groath is certified LSVT-BIG. 

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