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Think BIG

Sep 08, 2016

As a physical therapist, I have seen a significant number of patients and clients with Parkinson’s Disease (PD).  This disease can have a significant impact not only on the patient’s quality of life, but the patient’s family as well.  Many patients with PD state that their world has become “smaller” than it was in the past.  Parkinson’s Disease is a chronic, progressive neurological disease with cardinal features of:

  • Stiffness of muscles in the limbs and trunk (rigidity)
  • Slowness of movement (bradykinesia)
  • Tremors
  • Impaired posture and balance (postural instability)
  • “Freezing” episodes

PD may cause movement and gait disturbances; sensory changes; speech, voice, and swallowing dysfunction; cognitive and behavioral changes; gastrointestinal changes; and cardiopulmonary dysfunction.  Disruption in daily function, roles, and activities as well as depression are common in individuals with PD.  Onset is approximately 50-60 years of age.  Over 1 million people in the United States currently have PD (estimated 4-6 million worldwide) with prevalence expected to double by 2040.  PD is slowly progressive.  There is no cure with medical management directed at slowing disease progression and symptomatic treatment of motor functions, complications, and non-motor features.  Surgical management, such as Deep Brain Stimulation, has been found to be effective.

Physical rehabilitation and exercise has a very important role in reducing functional limitations while promoting activity participation and independence.  Exercise is medicine!  One treatment approach that has been found to be effective is LSVT (Lee Silverman Voice Treatment) BIG®.  LSVT BIG® is a research-based exercise approach developed from principles of the effective speech treatment LSVT LOUD®.  The programs have been developed and scientifically researched over the past 20 years.  Research has documented improved ratings on tests of motor functioning with PD following treatment including:

  • Faster walking speeds with bigger steps
  • Improved balance
  • Increased trunk rotation

LSVT BIG® is a standardized treatment protocol consisting of 16 sessions: 4 consecutive days/week for 4 weeks with each session lasting approximately 1 hour in length.  Daily homework practice and carryover assignments are prescribed after each treatment.  LSVT BIG® treatment:

  • Trains a single target of amplitude (bigger movements)
  • Drives intensive and high-effort practice
  • Teaches the amount of effort required to produce normal movements
  • Translates bigger movements into everyday, functional activities
  • Empowers people with PD with their potential to improve
  • Teaches how to avoid inactivity and keep movements ALIVE during everyday activities.
  • Helps people with PD to participate fully and improve their quality of life.

Research suggests that people with PD should not wait until they begin to experience disability, impaired function or loss of balance to start physical or occupational therapy.  LSVT BIG® techniques train individuals with PD and other neurological conditions to use bigger movements anywhere, anytime in daily living.  It is essential that LSVT BIG® treatments are delivered by physical or occupational therapists who are certified in this method.  Our physical therapists at the new St. Bernard’s Villa are certified in this treatment approach.  Please call (870) 207-6215 for more information.  Talk to your doctor for referral to physical therapy.  To find out more about LSVT BIG®, visit



This article was written by Jason Edwards, physical therapist who sees patients at the St. Bernards Rehabilitative Services Clinic at The Villa, 2217 West Parker Road, Jonesboro. He holds a bachelor’s degree in biological sciences as well as a Masters in Physical Therapy from Arkansas State University. The Pine Bluff native is a certified clinician in LSVT BIG® therapy which is designed to help Parkinson’s patients.


LSVT is a trademark of LSVT Global, Inc., registered in the U.S. and other countries.