Physiotherapy in early stage Parkinson’s Disease is still an emerging area of practice in Australia, but here at ARC we’re determined to lead the way! Until recently we had the only LSVT (Lee Silverman Voice Treatment) BIG accredited practitioner in the country – since 2011, we have generated so much interest in the program that the LSVT crew decided to come and check out Sydney. Around 40 physiotherapists and occupational therapists participated in the LSVT BIG course, run alongside the more established LSVT LOUD course for speech therapists.
LSVT BIG is an exercise approach developed from a technique used for specific speech training in Parkinson’s Disease. LSVT BIG differs from other exercise approaches as it trains a single target – amplitude. Simply put, bigger movements. The focus of the therapist is to drive high intensity practice, and over the course of the programme teach the individual the amount of effort required to produce normal size movements. This “recalibration” translates into bigger, more effective movements in everyday activities. LSVT BIG targets Bradykinesia (small movements) and hypokinesia (slow movements), but in doing these also helps range of movement, strength, balance and cardiovascular fitness.
The research on the power of exercise in PD has been conducted in a few different ways. Animal studies have shown that exercise can help to improve brain functioning and may slow disease progression. Whilst animal studies don’t necessarily translate to humans, to date exercise is the only treatment for PD shown to have the potential to do this, which as therapists we find incredibly exciting!
In Germany a study looked at different types of exercise on Parkinson’s Disease, comparing LSVT BIG to Nordic walking and Traditional Physiotherapy (balance and walking training), over a 16 week period. LSVT BIG showed an improvement in UPDRS motor score (a common measure used in PD), whereas the other approaches showed a mild deterioration. Common walking tests, such as a 10m walk test, also improved more in the LSVT BIG than in the traditional therapy and Nordic walking groups. Another study found that training bigger movements resulted in increased speed in untrained reaching and walking tasks. These effects were larger in earlier disease stages.
LSVT BIG follows a standardised protocol consisting of 16 individual one hour sessions held over 4 days a week for 4 weeks, alongside daily homework practice and daily carryover exercises, making it a highly intensive exercise programme. The exercises include a combination of set exercises along with a selection of functional tasks personalised to the individual.
The course itself discussed the evidence relating to LSVT BIG, along with techniques to help therapists deliver the protocol in a positive and empowering manner. The course has been taken around the world and it certainly showed – the LSVT team were well prepared and the course laid out in a thorough and logical manner, with the two days packed full of information and practical training. Quite a few of our ARC clients were good enough to come along and polish up on their training whilst helping the therapists to practice their new skills, and what a great job they did!
ARC now has four accredited LSVT BIG therapists: Lynn Tullock, Gilly Davy, Emma Lee and Aimee Barnes.
Farley & Koshland (2005) Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res; 167, (3): 462-467.
Ebersbach et al. (2010) Comparing exercise in Parkinson’s disease – The Berlin LSVT BIG study. Mov Dis; 25 (12): 1902-1908.