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LSVT Big Presenation
1. Jill Werner BScPT
PT for 13 years
Focus on neurological disease and
injury
Currently own a private home care
business and work on call at Cedars
2. Parkinson’s Disease
Common Physical Characteristics:
Tremors
Rigidity
Lack of movement or slowness initiating
movement
Flexed or bent forward posture
Changes in “executive function”
3.
4. The Science and
Practice of LSVT BIG
LSVT Global, Inc.
www.lsvtglobal.com
Supported, in part by research grants:
R01 DC01150, R21 RFA-NS-02-006, R21 DC006078, R21 NS043711
Copyright LSVT Global, Inc. 2011
5. It is a “Stunning Time” to be
in rehabilitation today
Basic science evidence for the value of
exercise in PD (classically drugs, surgery,
today…)
Identified key principles of exercise that
drive activity-dependent neural plasticity
Demonstrated that exercise can improve
brain functioning (neural plasticity) and may
slow disease progression
Exercise is Medicine!
Kliem & Jones, 2008; Ludlow et al, 2008
Copyright LSVT Global, Inc. 2011
6. Legitimate Therapeutic Options
To provide symptomatic relief; improve function
Pharmacological Neurosurgical
(L-dopa) (DBS-STN)
Voice and Body
Exercise
Copyright LSVT Global, Inc. 2011
Zigmond et al, 2009
7. LSVT Programs
Administered in an intensive manner to
to challenge the impaired system.
Techniques specific to PD-specific
deficits!
bradykinesia/hypokinesia
and
kinesthetic awareness
(sensory deficit)
Copyright LSVT Global, Inc. 2011
8. What are the fundamentals of
LSVT BIG?
Standardized, research-based, specific protocol
TARGET: Bigness (amplitude)
MODE: Intensive and High Effort
CALIBRATION: Generalization
Sensory
Internal cueing
Neuropsychological changes
Copyright LSVT Global, Inc. 2011
9. MODE
Delivery
– Certified LSVT BIG Physical/Occupational
Therapist
• 1:1 intervention
Time of Practice
– 4 consecutive days per week for 4 weeks
– 16 sessions in one month
– 60 minute sessions
– Daily carryover assignments (30 days/entire
month)
– Daily homework (30 days/entire month)
Copyright LSVT Global, Inc. 2011
10.
11. CALIBRATION
MISMATCH between
on-line perception of
output and how others
perceive it
“I had no idea how small my
world had become”
“I can’t move like this,
people will think I am crazy!!”
12. Imaging Studies with LSVT LOUD
Liotti, Ramig, et al, 2003
Copyright LSVT Global, Inc. 2011
13. Comparing Exercise in Parkinson’s Disease —
The Berlin LSVT BIG Study (2010, Movement Disorders)
Georg Ebersbach, * Almut Ebersbach, Daniela Edler, Olaf Kaufhold, Matthias Kusch,
1 1 1 1 1
Andreas Kupsch, and Jo¨rg Wissel
2
3
FIG. 2. UPDRS motor score (blinded rating), mean change from baseline (vertical bars 5 standard deviations). Change
between
baseline and follow up at week 16 was superior in BIG (interrupted line) compared to WALK (dotted line) and HOME (solid
line),
14. Walking Improvements
Faster Bigger
Preferred Velocity Preferred Stride Length
14 BIG 14
Absolute Change (cm)
12 TRAD 12
Absolute Change
10 10
Better
(cm/sec)
8 8
6 6
4 4
2 2
0 0
1 T4-T1
- T12-T1 T4-T1 T12-T1
Improvements occurred in both groups and lasted 3 months.
Farley & Koshland, in preparation (Unpublished data)
Copyright LSVT Global, Inc. 2011
15. Trunk Rotation
BIG
Trunk Rotation
TRAD
30 P < .05
P < .05
Absolute Change
25
20
Better
15
10
5
0
T4-T1 T12-T1
-5
Only improved for LSVT BIG
Farley & Koshland, in preparation (Unpublished data)
Copyright LSVT Global, Inc. 2011
16. “It is possible to take charge of
your life, even with Parkinson’s.
It is possible for your will
to override your brain.
It is possible to have
Power Over Parkinson’s”
Sharon Kha, LSVT BIG and LSVT LOUD Graduate
