Specialty Programs


LSVT Big Program

The LSVT Big program is an intensive amplitude-based exercise program for the limb motor system that re-educates the sensorimotor system. What that means in everyday terms is that as Parkinson’s progresses, movements get smaller and this program helps to retrain the brain to make normal-sized movements. For example, with walking, a person with PD will often shuffle their feet or even appear to freeze since their movements are so small but the goal of LSVT BIG is to teach them how to take normal sized steps through exercise and repetition. This program focuses on advancing the idea of treating amplitude in neurological disorders as a single focus. Make your movements BIG!

Parkinson’s disease Facts

  • Parkinson’s disease affects 1 million people in the United States with 60,000 people diagnosed each year.

  • Men are 1.5 times more likely to have PD than women.

What is Parkinson’s disease?

PD is a disorder of the central nervous system that affects primarily movement, often including tremors. This occurs due to nerve cell damage in the brain which causes dopamine levels to drop, leading to the symptoms. Common symptoms include tremor in one hand, slow movement, stiffness, loss of balance, and loss of smell.

There are no specific medical tests that are used to diagnose PD. A neurologist will make the diagnosis of PD based on the patient’s medical history, a review of their signs and symptoms, and a neurological and physical examination.

Medications are used to increase the level of dopamine in the brain to help decrease symptoms. Therapy also plays a big role in treating the symptoms of PD and teaching a person how to manage their symptoms and improve movement patterns.

LSVT BIG has a standardized exercise protocol of prescribed dosage with a method of delivery based on the patient’s functional level:

  • The program consists of 16, 1-hour individualized sessions, 4 days per week for 4 weeks done with a certified therapist.

  • It requires daily homework practice sessions of 30 minutes for the treatment to be successful and a lifelong habit of practice to maintain the program gains.

  • A typical treatment session includes performing 7 maximal daily exercises completing 8-10 reps in either lying, seated, or standing position based on the patient’s functional level (demonstrate floor to ceiling and forward step and reach).

  • There is also a functional component task portion which includes 5 functional tasks performed x 5 reps of activities decided by the therapist and patient together. Examples include sit to stand, pulling keys out of pocket, rolling, opening a refrigerator door, brushing hair, or signing name (demonstrate sit to stand).

  • Walking BIG and Hierarchy tasks complete the program. Hierarchy tasks are patient identified tasks that build in complexity over the course of 4 weeks. They are designed to bring amplitude rescaling into everyday living. Examples may include getting in/out of the car, performing laundry, going out to church or restaurant, getting the mail, or gardening.

  • The key to retraining the brain for larger amplitude movements are repetition, repetition, repetition!

In conjunction with receiving the LSVT program, other home health services may be beneficial for a patient. A registered nurse can be brought into the home for medication management, a speech therapist for difficulties with cognition and swallowing as well as an occupational therapist and or a home health aide to assist with daily activities and care.

As part of the LSVT program, tune-up therapy interventions can also occur after completing the 4-week program to make sure the patient is staying up with the routine and continuing to make gains in mobility skills. If this program sounds like something you or your loved one is interested in, please ask your neurologist for an LSVT home care referral to Pure Home Health Care.

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