Physical Therapist Sonya L. Pearson, PT, DPT, says the protocol was developed specifically to address the unique movement impairments for those patients.
“BIG is a neurorehabilitation approach for people with Parkinson’s disease as well as other neurological disorders,” Pearson says. “It uses a new set of exercises, but the philosophy is based on physical therapy as a whole. For example, if you have knee replacement, we do strengthening exercises for the leg and we may work with the knee joint, the ankle joint and the hip joint. BIG exercises are whole body multidirectional exercises. You are moving your whole body in multiple directions. You may have leg extension or trunk rotation, hip flexion or hip extension along with shoulder and elbow extension. There are a lot of movements at one time.”
The basic principles of LSVT BIG include high effort, progressive movements, continuous activity, and are directly aimed at increasing the amplitude of movement during everyday activities. “The delivery of this innovative physical therapy is a hallmark feature of LSVT BIG,” Pearson says.
The program schedule includes 16 individual therapy sessions delivered four days a week over four continuous weeks. “During a typical one-hour LSVT BIG session, participants perform repetitious exercises which include whole body movements, functional component tasks and BIG walking trials,” Pearson says. “In addition to the high frequency of delivery, participants perform LSVT BIG carryover exercises and practice one to two times a day at home during the course of their treatment. This high level of intensity and frequency assists in increasing the amplitude and speed of movement in their everyday lives.”
Pearson says that the goal of BIG is to increase the size of movement. “The primary manifestations of Parkinson’s disease include bradykinesia, or slowness of movement, and hypokinesia which is decreased amplitude or range of movement,” she says. “Individuals with Parkinson’s often report that they move slower, have greater difficulty getting dressed, write smaller and often are asked to ‘speak up,’ all of which can be attributed to the effects of bradykinesia and hypokinesia.”
The therapy focuses on increasing the size of movements so they are bigger. “When you have bigger movements, they typically translate to faster movements. We don’t want you to be fast so you can qualify for the Olympics, we want you to be fast so you can be functional,” Pearson says. “If it takes you a minute and a half to walk 20 feet to the bathroom, that’s not very functional when you have to go. So we want to have bigger movements so it’s faster also. Bigger and faster movements typically give you better balance as well.”
Another unique feature of BIG is that the therapist does the exercises with the patients. “I’m modeling for them so there are fewer verbal cues given. The reason for that is that we don’t want to inundate their nervous systems because patients with Parkinson’s can have slower cognitive processing time and it’s a lot to take in. It would be like someone giving you 20 directions at one time, and it’s just hard for them to respond,” Pearson says. “Also, we want fewer verbal cues so they will be internally calibrated, meaning they can cue themselves as to what BIG movement, or normal movement, feels like.”
When patients are asked to lift their arms big – meaning shoulder level – they may feel like their arms are up to shoulder level at 90 degrees but they may be only 45 or 60 degrees. “It is not until I place their arms at 90 degrees or they see themselves in the mirror that they realize they are not at 90. When we get them to 90, they often feel the movement is too big,” Pearson says. “So we tell patients that if it doesn’t feel too big, it’s not big enough. Initially it is going to feel awkward because they’ve learned that small feels normal to them.”
Pearson is one of only four therapists in Birmingham who are certified in LSVT BIG, and she understands the commitment that is required of these patients who participate in the therapy. A two-year study showed that people who continued to do their exercises every day after completing the four weeks of treatment maintained the gains they had achieved and also had slowed the progression of the symptoms of Parkinson’s disease.
“It does take a lot of commitment to get yourself here four days a week and also to do the exercises each day at home, but the benefits are substantial. It’s a big bang for your buck,” she says. “Individuals often report an overall increase in confidence with gait and balance, and they verbalize and demonstrate less of a fear of falling. In addition, they may report that standing up and sitting down has improved and that they are experiencing fewer falls. I think BIG also helps to promote accountability and keeps people motivated, because you see quick results to the work. Unfortunately, there’s no magic pill to help you achieve these goals. You just have to put forth the effort.”
