How To Be BIG In A Small World: Parkinson Disease And Treatment | Rebound Physical Therapy

Are you, a loved one, or someone you know affected by Parkinson Disease (PD)? If so, have you noticed a resting tremor, off balance, walking/gait difficulties (shuffling), slow movement (bradykinesia), postural instability, and/or stiffness of torso or limbs (rigidity)? These are the cardinal signs of PD. It can be emotionally, physically, and/or psychologically draining to see these changes in someone or to feel them in yourself if you suffer from PD. There is a silver lining for this central nervous system disorder- called the LSVT BIG program, which is an evidence based treatment approach for individuals with Parkinson Disease.
Lucky for those in the Boston area, I am a certified LSVT BIG clinician since April 2015 and have had major success with this treatment program for those with PD at any stage! What is LSVT BIG? Well, it originally started with the family of Lee Silverman assisting in developing LSVT LOUD program following her diagnosis of PD. Family members were unable to hear or understand her. LSVT LOUD was developed to help retrain individuals with PD learn the amount of effort needed to be heard and understood when communicating. Those same principals were then applied to the motor system and LSVT BIG was born.

LSVT BIG is an intensive amplitude-based exercise program for the limb and motor system. LSVT BIG is designed to challenge the impaired system and is based on the principles of neuroplasticity (intensity, complexity, repetition, salience, timing, and specificity). Intensity is key! Based on scientific research of neuroplasticity, exercise has shown to improve brain function and may slow disease progression. This evidence-based program has exhibited improvement of motor function in people with PD, including: faster walking with bigger steps, improved balance, and increased trunk rotation.

How does the program work? LSVT BIG consists of a standardized exercise protocol with a prescribed dosage and method of delivery including: 16 sessions, four consecutive days per week, for four weeks with hour long sessions. In addition to treatment, patient is assigned daily homework. After the program is complete, there is a tune-up every 3-12 months (as appropriate).

The session starts with 7 maximal daily exercises (building blocks to normal movement), followed by 5 functional component tasks (which are tailored to each individual patient), hierarchy tasks (complex multi-step functional activities), BIG walking, and assignment of daily carryover tasks.

The outcomes are truly amazing and inspiring! You will not believe it until you see it, so please check out this short video on one of the thousands of success stories!

Lastly, not only have I used this protocol for those with PD, I have utilized it with those having balance difficulties, walking/gait difficulties, postural instability, etc. and have had huge success as well!

One personal, favorite success story was my 94-year-old patient who fell and broke his clavicle (collarbone), never thought he would be able to walk without a walker or golf again. After his bout of PT, he was able to walk 10 feet without any assistive device in 12 seconds whereas before PT he walked 10 feet with a walker in 42 seconds. This summer I received a photo of my patient on the golf course playing 9 holes and driving a golf cart on his own! That is what this is all about!

Before After

(2016, January). Retrieved October 31, 2016, from
(n.d.). Retrieved October 31, 2016, from