Like many other physiotherapists, my interest in the profession was piqued as a young person with a personal connection. My grandfather had Parkinson’s disease (PD) and then suffered a devastating stroke when I was thirteen years old. I witnessed his rehabilitation and thought to myself, “What a marvelous profession, helping people learn to walk again and get back into life. I want to do that.” Little did I know that 20 some years later, I would make helping people with Parkinson’s my life’s work.
Even while studying to become a physiotherapist, I knew my passion and purpose was to help adults living with neurological conditions. I directed my studies both during and after university to pursue that passion. Although I loved working with patients who had PD, I was perplexed and admittedly frustrated that I could get them moving so much better during therapy, but then watched them revert to short, shuffling steps soon after treatment was over.
After eleven years of practice, my speech and language therapy colleague told me about a very new treatment at that time called LSVT BIG. She had just become certified In the parallel speech treatment, LSVT LOUD. I will admit I was skeptical, but always one who is up for learning new things, I signed up for the two-day course.
I was forever changed, and so were my patients.
As the only LSVT BIG therapist In an area larger than the UK, I was lucky to have a close relationship with an excellent, progressive movement disorders specialist neurologist. She referred scores of patients to me who received LSVT BIG, and as my skill and expertise grew, my patients’ outcomes kept getting better and better. I finally discovered the missing links which gave my patients incredible and lasting results.
Two years later, in 2011, I was fortunate to be added as one of the LSVT BIG Training and Certification Faculty. This led to a whole new level of learning and reward, teaching other therapists how to achieve this same success with LSVT BIG.
Since 2014, I have been serving as the Chief Clinical Officer of LSVT BIG. It has been so exciting to see the expansion of LSVT BIG Certified Clinicians from around 500 in a small handful of countries when I started teaching, to over 30,000 physio and occupational therapists in 70+ countries today. And, although I am not a researcher myself, it has been validating to see continued research on LSVT BIG published every year. As a therapist myself, we always strive for evidence-based practice, and this a treatment that is not only evidence-informed, having a foundation built upon well-researched principles of motor learning and neuroplasticity in PD, but also evidence- based. with numerous articles supporting the efficacy of this specific protocol.
How does LSVT BIG work?
As the name suggests, LSVT BIG retrains movements that are “bigger” in amplitude, more like typical movements. People with PD have movements that progressively become smaller as the disease progresses. This can lead to falls and disability over time.
They can also experience a range of what are called “non-motor symptoms” such as apathy, depression, cognitive changes, autonomic dysfunction, pain and sensory changes. These non-motor symptoms can be huge barriers to exercising and making lasting changes in function.
LSVT BIG is an intensive four-week physio and occupational therapy program which addresses many of these symptoms comprehensively. Therapists drive patients to use more effort to move bigger through a series of whole-body exercises, which at the same time improve balance, flexibility, coordination, the ability to start/stop movement and change direction. They also emphasize extension and rotation, whereas PD is known to contribute to a flexed posture with rigidity in the trunk and limbs. Exercises are performed intensively, repetitively and challenged progressively over the four weeks of treatment. Therapy sessions are one hour long, four days a week for four weeks and are always one on one to tailor the therapy to the patient.
With that said, the LSVT BIG program offers much more than intensive PD-specific exercises. The second half of the 60-minute session trains the patient how to incorporate bigger movement into skills and tasks that are meaningful and specific to the patient. In this way, the treatment is highly individualized, and the patient is very motivated when they can learn how to do things better which have been affected by PD. For some patients, these are very basic skills, like putting on a pair of trousers, buttoning a shirt, or getting in and out of the car, while for others, it relates to activities they love to do, such as making a meal, playing with grandchildren, or dancing. Still others have work-related goals, so they can keep doing their job as long as possible. And LSVT BIG always trains walking, whether it is across the room for those with more advanced PD, or long distances outdoors for high level patients, always with the goal of normalizing arm swing, posture and stride length.
One of the key things that I believe generates lasting success for patients is a concept called “calibration” training in LSVT BIG. People with PD have reduced kinesthetic awareness, meaning they do not perceive or feel how small their movements really are. LSVT BIG retrains patients’ perception of what normal movement feels like so, in essence, they are “recalibrated”. This is an intensive process that is woven into each and every session so that by the end of the month, the patient is operating under a new normal in terms of their movement and posture in everything they do.
LSVT BIG and LSVT LOUD
You may be wondering what LSVT stands for – Lee Silverman Voice Treatment. The original treatment, a speech therapy treatment which we now designate as LSVT LOUD, was named after a woman with PD in the late 1980’s. After years of research which established the efficacy of LSVT LOUD, the principles and framework were used to develop a parallel treatment for the limb motor system, called now LSVT BIG. Because of this, as speech, physio and occupational therapists, we now have a tightly integrated, patient-centered way to comprehensively improve voice, communication, mobility and activities of daily living. As therapists, this allows us to “speak the same language”, share goals, and truly collaborate like never before. To see an example of shared goals in LSVT, click here.
Delivery with a UK context
Although this treatment approach was developd in the US, Parkinson’s symptoms are universal, regardless of the culture or nationality. We have trained speech, physio and occupational therapists from over 80 c0untries, and they have been able to take these Interventions to address the needs of their own patients wherever they live.
There is a common perception that Americans are a bit loud and crazy. (Well sometimes that may be true!), it is important to remember that LSVT LOUD does not teach people to shout, and LSVT BIG does not make people move in an exaggerated fashion. We are simply driving effort to rescale amplitude to levels that are within normal limits. For humans, volume of normal speech and amplitude of normal movement is fairly standard across cultures.
In every country, there are LSVT “pioneers” who are passionate about offering these treatments to their patients, and every country has a unique health care system. Through over 30 years of teaching LSVT LOUD and now LSVT BIG, we have learned that regardless of the system, there are always ways to successfully offer these treatments. We also know that when there are challenges, both patients and therapists are important movers and shakers! And lastly, our large family of LSVT Certified Clinicians learn from each other and support each other.
Here is a story of one LSVT BIG Certified Therapist in the UK who made a huge difference in his area.
Impact on lives
I could tell you countless stories of people not only with PD but with other neurological disorders whose lives have been forever changed through LSVT BIG.
One of the people I have been blessed to know for just a year now is named Margie. She received both LSVT LOUD and LSVT BIG eight years ago, and you’d hardly notice she has PD. She particates in our weekly virtual “LOUD for LIFE” and “BIG for LIFE” group exercise classes for LSVT “graduates”. She also volunteers to help with our LSVT Training and Certification Courses, so you may be lucky enough to meet her someday too!
Margie never ceases to inspire me with her determination and dedication. She is an avid exerciser and loves dancing and living life to its fullest. She still walks without difficulty, and is independent with everything. Her voice is strong and she knows that her daily LSVT LOUD exercise practice keeps it that way.
In a recent interview with Margie, she offered these comments on life before and after LSVT LOUD and LSVT BIG.:
“Before, I didn’t feel like I was being acknowledged. And now that I know that I’m using a louder voice that I’ve worked hard to maintain, I’m getting response back. And that makes me feel emotionally so much better. You know, when you feel like you’re not being heard, then you feel like you’re not being seen also. We have to fight our way back sometimes, so in order to be able to communicate with people effectively, I have to continue to speak louder.
I made that commitment to go to therapy four days a week four weeks early on. And that’s kind of how I taken my road with Parkinson’s. I realized right away that there are two ways I could go; I could take the high road or the low road, and I didn’t like where the low road was going to take me. So I just jumped in both feet right from the beginning, and just took that attitude that I was going to, be the one running this boat.
I think having completed the sixteen sessions of both LSVT BIG and LSVT LOUD early on, definitely laid a strong foundation as I came to regard exercise as my primary medication.”
To read more about Margie’s story, click here.
The LSVT international ‘family’
There are at least 10 million people worldwide living with PD, and it is the second most common neurodegenerative disorder behind Alzheimer’s disease. It takes more than a village; it takes an international army of people with one common goal, to improve the lives of people with PD. LSVT Global is proud to serve in that army, but we know that there is always more work to be done!
Although our main goal is to equip and train more therapists with expertise to then go out and help people with their world, our other goal is to directly educate and empower people with PD and other neurological conditions. We offer free monthly webinars, a clinician directory where they can search for LSVT Certified therapists in their area, information on the LSVT programs and exercise support tools. A growing number of LSVT certified therapists now also offer post-discharge group exercises classes, called LOUD for LIFE and BIG for LIFE. LSVT Global offers a virtual form of these classes.
For our LSVT Certified Clinicians, we are not a one and done continuing education course. After they are certified, they can keep learning as much as they wish through our advanced courses, monthly professional webinars, access to LSVT faculty at any time, and more. Every two years, we encourage them to take our short two-hour renewal course to keep them up to speed on new research and to reinforce core principles. Lastly, we have private Facebook groups where LSVT Certified clinicians can connect and learn from each other.
Accessible pathways leading to certification for UK practitioners
LSVT BIG Training and Certification is open to physiotherapists, occupational therapists and university students enrolled in those professional degree programs. LSVT LOUD Training and Certification is open to speech and language therapists and university students enrolled in this program.
Currently, there are two convenient ways to become LSVT Certified. You can take the course online anytime. Both courses are available on demand, so as long as you have a strong internet connection, you can do it anywhere! We provide 60 days of course access, and the training takes around 15-16 hours for each course. Although everything can be downloaded, we will also ship a binder kit to you.
The other option is to take our virtual live course. This is a blend of pre-recorded content like the online course and two 5-hour days of “live” instruction using Zoom. The instructors will provide demos and live instruction, you will see tons of videos, and you can practice exercises With other course participants. Learners like that they can receive immediate answers to their questions through Zoom chat and also receive feedback on their performance. On the second day of each course, we invite volunteers With PD to participate so you can have some experience seeing how LSVT works with a person who has PD.
We have upcoming virtual live LSVT LOUD and LSVT BIG courses this June, hosted by Course Beetle.
Hope you can join us. We’d love to meet you!