oan C. Morgan, MA, OTR/L, Certified LSVT BIG Therapist
Scott Raveling, PT, Certified LSVT BIG Therapist
Marcus Daly Rehabilitation Center
1200 Westwood Drive
Hamilton, MT 59840
Parkinson's disease is a neurological diagnosis that is progressive
and can be debilitating physically as well as emotionally to both the
person diagnosed, as well as their family members. Typically diagnosed
in people over the age of 50, with a higher percentage of men, these people
undergo subtle changes that may not be recognized until they begin to
lose their balance or incur falls or begin to require assistance with
tasks they previously were independent. On occasion the change may be
a perpetual blank stare or expressionless facial features that may be
noticed by others and not recognized by the person themselves.
From the physiological aspect, Parkinson's disease decreases the ability
to move and causes a loss of postural control due to decreased dopamine
(neurotransmitter) production in the basal ganglia (cells deep within
brain tissue), which are critical for producing smooth and coordinated
With Parkinson's disease, a few common physical traits could be:
Tremor: usually in one hand while at rest. Occasionally, people think they have
the "shakes" and expect this will go away. If present, it does
not go away and it can become progressively worse.
- Stiffness of movement with most joints in the body. The joints appear rigid,
however usually not painful.
Hypokinesia: reduced movement of muscles in the body or face. This could present as
a loss of loudness in speech, decreased size of writing, shortened stride
when walking, loss of speed and movement in fingers. Overall, reduced
muscle movement could be the cause of falls or "clumsiness"
resulting in a change in walking pattern and safety awareness.
Bradykinesia: slowness of movement once initiated or becoming "stuck" when
attempting a movement such as moving from sitting to standing or taking
a step. Another example may be increased time it takes the person with
Parkinson's disease to reach for a fork or glass at meal time even
though they have done these movements thousands of times.
In addition to physical signs as above, there may be other changes that
may or may not manifest in an individual. Some of these may be:
Emotional changes: angers easily, inability to connect with loved ones
Loss of higher cognitive function: difficulty performing challenging tasks once performed such as balancing
a checkbook or making a phone call
Depression: sadness, loss of interest in life
Sleep disorders: not feeling well rested after a night's sleep or not being able to
sleep at appropriate times
There are several pieces of good news for people affected by Parkinson's
disease. Vast improvements have been made in medications to reduce the
symptoms of this disease. The first step is a thorough workup by the patient's
primary doctor or neurologist to determine the severity of this condition
and the options of treatment to decrease symptoms.
Along with medications, the person with Parkinson's might consider
the LSVT* LOUD or LSVT* BIG programs. In the 1980's, the family of
Lee Silverman, a patient with Parkinson's disease, generously funded
research, in addition with the National Institute of Health, to focus
on training patients to monitor and control the volume of their voice
(LSVT: LOUD). As Parkinson's disease progresses it can cause a decrease
in voice quality, whereby the patient's perception of loudness becomes impaired.
These patients think they are talking a lot louder than they really are.
This program consists of relearning voice volume and working with the
muscles of the face and throat to improve speech and voice quality.
Oftentimes participants find they have improved their swallowing ability
and occasionally improved memory.
The LSVT BIG program is a similar standardized program for movement, function
and balance. The studies have shown the LSVT BIG participants walk faster
with larger steps, decrease their fall risk and fear of falling, as well
as increase their trunk rotation and ultimately improve their independence
with daily tasks. The exciting results have shown the participants have
maintained improved function for at least 3 months after participation
in this program.
The main emphasis for the LSVT BIG program is intense, amplitude-based
exercise for limb motor system. The key word with all the exercises is
"THINK BIG" using amplitude or large, exaggerated movements
so the brain can be retrained to feel and experience what is "normal"
in movements. The result of using these BIG movements translates into
everyday life tasks. During the therapy time the participant also performs
routine tasks such as walking and standing from a seated position with
large, exaggerated movements so to "re-calibrate" the brain
to feel and experience "moving BIG". "BIG" becomes
the new normal for movement.
The overall result of the LSVT BIG is slowing the progression of Parkinson's
disease by improving posture, flexibility, physical movements and balance.
This could easily translate into smoother more natural movements, less
muscle tightness, fewer falls or feelings of "clumsiness". On
the other hand, it may mean smoother fine motor skills such as holding
onto a utensil when eating, the ability to button buttons at a faster
rate or smoother movements when getting dressed.
The exercises are in the LSVT BIG program are taught through certified
Occupational and/or Physical Therapists. The program itself is 1 hour
sessions (4 consecutive days a week for 4 weeks), with emphasis in on
high effort to gain maximal benefits. The high intensity of this program
can help protect the remaining viable dopamine neurons and cause a slowing
of the progression of the disease. Exercise has been shown to promote
brain health by restoring damaged pathways and improving undamaged pathways
to make the brain more efficient in operation and function. This remodeling
of brain pathways is called neuroplasticity, an exciting and promising
area of research into the brain function.
The exercises for the LSVT BIG program are performed in a 1:1 setting
with the therapist performing the exercises along with the participant.
This allows visual cues for the client, encouragement and hopefully a
more enjoyable time.
Marcus Daly Rehabilitation Department is proud to offer the LSVT BIG program
by certified Occupational and Physical Therapists. In the near future
Marcus Daly Speech Therapists will be certified to offer the LSVT LOUD
program. If more information is required on either of these programs please
call Marcus Daly Rehabilitation Services at (406) 375-4570.
Questions and or comments regarding this week's health column please
contact Joan C. Morgan, MA, OTR/L or Scott Raveling, PT at Marcus Daly
Rehabilitation Center, a service of Marcus Daly Memorial Hospital, 1200
Westwood Drive, Hamilton, MT 59840. Working together to build a healthier
- LSVT is Lee Silverman Voice Training
Anderson, C. (2013, July 12). Big and Loud: Fighting back in the journey
through Parkinson's disease.
MacNeill, PT, DPT, B. (2013, January 2013). THINK BIG! EXERCISES FOR INDIVIDUALS
WITH PARKINSON'S DISEASE. Retrieved from
Singh, P.T., P. (2014, Spring). LSVT BIG-Physical Therapy for Parkinson's.
Retrieved from http://PARKINSONian.org