Rehab Insights is a weekly blog written by Burke Rehabilitation professionals to offer practical information for patients, families and the community. It's goal is to educate the reader on relevant topics in rehabilitation, general health and wellness.

What is LSVT and How Does it Help Parkinson’s Disease?

June 30, 2015

Speech therapyWhile you’ve likely heard of Parkinson’s disease (PD), many people don’t know exactly what the condition is or how it manifests itself. The condition can occur when there is a loss of brain cells that produce a chemical called dopamine. It usually presents in people over the age of 60, but it can present earlier in life as well. About 500,000 people in the U.S. have Parkinson's disease, with about 50,000 people being diagnosed each year, according to the National Institute of Neurological Disorders and Stroke

The four common symptoms, according to the National Institute of Neurological Disorders and Stroke are: tremors, limb and trunk stiffness, bradykinesia (the slowing down of movement) and weak balance or coordination. Since PD symptoms exacerbate over time, as they become worse, patients can have trouble with simple tasks such as getting in and out of bed or the bathtub— or even walking and talking. People with PD may also experience “freezing,” where they have extreme difficulty starting to walk again after having stopped, or difficulty stopping walking once started. This may lead to falls in the home and when out in the community.

Some other PD symptoms can be: depression, constipation, trouble swallowing or chewing or difficulty sleeping. All of this can impact families and caregivers as well, since the need for constant care increases as the disease progresses. Indeed, Parkinson’s disease is estimated to have an economic burden on families and patients of $14.4 billion—$8.1 billion in medical expenses and $6.3 billion indirect costs, according to the Parkinson’s Action Network.

While there is no cure for PD, medications and other interventions such as Deep Brain Stimulation (DBS) have been found to provide dramatic relief from the symptoms. Physical therapy (PT) is another effective method of conservatively managing the symptoms of PD and improving quality of life.

Traditional PT has included general conditioning exercises, functional training, and gait and balance training, with the use of external cues to reduce the “shuffling” pattern of walking and improve the quality of movements – devices such as a metronome, laser lights, taped markers on the floor, mirrors and simplifying tasks are ways to do this. These methods of treatment have had varying degrees of success based on the severity of the PD symptoms in each patient.

Physical therapy can also help patients with Parkinson’s disease develop strategies to safely transfer to and from the bed, into the bathroom, and other activities of daily living. Caregivers and family members also need to be mindful when caring for patients with PD— it is important for caregivers and family members to take care of themselves physically and seek out groups and other means of emotional support.


What is LSVT and how does it help Parkinson’s disease?
A relatively new approach to treatment of Parkinson’s disease involves the concept of neuroplasticity—the brain's ability to reorganize itself by forming new neural connections throughout life. This approach aims to address the “internal” aspects of Parkinson’s disease symptoms, leading to significant functional improvements.

For decades, the Lee Silverman Voice Technique (LSVT) has been an effective way to treat the symptoms of impaired voice and swallowing from PD (called LSVT-LOUD). In 2002, the LSVT-BIG protocol was initiated, as a research-based exercise approach to be given by specially-trained therapists. Patients are shown specific exercises that involve large amplitude, exaggerated movement patterns, leading to smoother, larger, safer movements and improved quality of life.

Today, there are over 4,000 certified LSVT-BIG practitioners in 24 countries around the world. Here at Burke, several of our therapists are certified to administer this technique.

Treatments delivered by LSVT-certified clinicians consist of the following:

  • Four LSVT-LOUD or LSVT-BIG sessions a week, for four consecutive weeks
  • Sessions are individual one-hour treatment sessions
  • Daily homework practice (all 30 days of the month)
  • Daily carryover assignments (all 30 days of the month)

The goal of all of this work is that patients will learn to use their “big movements” automatically, in everyday living. This will be a result of long term carry-over of the amplitude training. By maintaining larger movements, patients will move better, with more confidence and safety. Similarly, with the LSVT-LOUD program, patients maintain improved speech patterns and volume.  Together, LSVT can help improve the quality of life and potentially reduce the burden of care for people with PD.

If interested in learning more about the treatment of Parkinson’s disease and the LSVT programs at Burke, visit burke.org/outpatient/services.

— Ben Gilbert, PT, MS, OCS, Cert. MDT, Manager, Outpatient Physical Therapy Department

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Burke's Rehab Insights blog is intended to provide general information about rehabilitation and other health care topics. It should not take the place of medical care. Burke staff cannot comment on individual medical cases or give medical advice.

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