What is LVST BIG Therapy for Parkinsons Patients

Dr. Bobbie Roberts discusses the LSVT BIG Therapy program and how it can help Parkinson's patients. 

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What is LVST BIG Therapy for Parkinsons Patients
Featured Speaker:
Barbara "Bobbie" Roberts
Barbara “Bobbie” Roberts, PT, DPT is a physical therapist who provides specialized treatment for Parkinson’s Patients.  Bobbie is Lee Silverman BIG certified which provides intensive exercise therapy to improve the motor functioning of patients with Parkinson’s disease and other neurological conditions. She incorporates strength and motor learning to improve walking speed and step size, balance, and improve the quality of life.
What is LVST BIG Therapy for Parkinsons Patients

Prakash Chandran: Welcome to Palmdale Regional Radio. I'm Prakash Chandran. And today, we're discussing a treatment therapy called LSVT BIG, what it is and how it can help Parkinson's patients. We're joined today by Dr. Bobbie Roberts, a physical therapist and a member of the medical staff at Palmdale Regional Medical Center.

So, Dr. Roberts, really great to have you here today. Let's just start by you answering what exactly is LSVT BIG therapy and why is it used.

Barbara "Bobbie" Roberts: Yeah. LSVT BIG, its main goal is to move big, given the fact of its name. You're trying to move big in different planes, different movements throughout every day. Some people have difficulty with walking or just fine movement, and so the goal is to move big, because some of those movements are like shuffled gait or poor posture or even possible freezing. And so when you move big, it will help to get out of those moments of possible fall risk.

And so with LSVT BIG, you're trying to work through those particular issues. So say, a patient has difficulty getting out of bed, so you work on those small little bits. You know, breaking it apart into small practice and then putting it all together and trying to move fast. One of the main goals is a large amplitude. So they might be able to walk fast, but their steps might be short. So the goal is to have a bigger stride and so it turns into like a bigger gait.

So that's just like a snapshot of what it does, but the goal with LSVT BIG is to do it four times a week for four weeks straight, so 16 sessions for about an hour each covering those things that they have issues with, whether it's getting out of a car or getting out of bed. And then there's also like something called your maximal daily exercises that you'll do during the treatment and then also the exercises you'll have to do at home for 30 days straight. And so over those 30 days, the goal is to get through a bigger movement. And if say someone is able to walk normal, then you make it harder.

Prakash Chandran: So, before I get into my next question, what exactly does LSVT stand for?

Barbara "Bobbie" Roberts: Yeah, LSVT stands for Lee Silverman Voice Treatment. It is created in 1989 by a lady named Lee Silverman who had Parkinson's and that's how it began. And then over time, the last 20 plus years from then on, it like created what was LSVT BIG to what it is today.

Prakash Chandran: Yeah, I had heard about LSVT LOUD before. Can you talk about differences between LSVT LOUD and LSVT BIG?

Barbara "Bobbie" Roberts: Yeah. So LSVT BIG is for physical therapists and occupational therapists and LOUD is for speech therapists. So, just like you would with your normal gait getting smaller, so does speaking, it could become softer. It could have like more tremors and stuttering. And so I can't speak for speech therapist because I'm not a speech therapist, but from what I do know, it does help with their everyday speech and getting louder. So hopefully that helps break it down quickly.

Prakash Chandran: Yes, definitely. So moving back specifically to LSVT BIG, do you find that the treatment actually helps people accomplish their goals, whether it be getting out of the car or getting out of the bed? Can you talk a little bit about that?

Barbara "Bobbie" Roberts: Yes, for sure. Yeah, we have a target of a certain area that they're having difficulty with. A particular patient I have right now is having difficulty getting out of the car. So we would change an exercise within the clinic. You know, bringing his legs over something tall and then doing it faster and faster and then fully go into sit to stand without using his hands and then putting it all together. And so he has definitely made progress with that and he's able to walk without an assistive device and now with obstacles in the way. So he has definitely progressed and I would definitely say that LSVT BIG is beneficial to the Parkinson's population.

Prakash Chandran: Yeah, that sounds amazing. So LSVT Big as a treatment, is the treatment alone enough or does it need to be coupled with another treatment in order for it to be successful?

Barbara "Bobbie" Roberts: I wouldn't say it has to be coupled. I would say that it comes with like three different areas. So you're given the maximal daily exercise, which is like you're basically sitting or standing and trying to move as big as possible. And then you have your simple movements with one task movement, like sit to stand and you're trying to do that as big as possible or even walking, trying as big as possible. And they do something that's much bigger, which is called a hierarchy task. So putting them all together, like playing golf or like getting out of the car or getting out of bed, it takes a couple of things to do. And with that particular patient, you would gear the treatment accordingly. And so I wouldn't say that you would need additional treatment with that because you're already working towards the PT goals and the patient's goals at the same time.

Prakash Chandran: Yeah. So, maybe this is an oversimplification, but it seems like you're taking what might feel like a simple task to someone, like, for example, getting out of a car and breaking it up into like the simplest pieces of what needs to happen. So one piece of it might be getting up or even just moving your leg from one area to the other. And then in working on those like micromovements, people are able to piece everything together and eventually do what the goal is over time. Is that correct?

Barbara "Bobbie" Roberts: Yeah, exactly. And it could be something as hard as like unbuckling or buckling your seatbelt and has a really hard time, so you work on that piece and then you add them all together and hopefully it becomes easier as time goes on.

Prakash Chandran: So you mentioned four times, four weeks, 16 sessions total, is that like the minimum amount required to get the most out of LSVT BIG therapy? What else should patients do to maximize the effect of this treatment?

Barbara "Bobbie" Roberts: Yeah, also doing it in everyday practice at home. So they're given some daily exercises to do as well at home. So for 30 days straight, they do it. So even on their off days, they do it; in the days they come in, they do it WITH PT. and then practicing those within the world, like, you know, opening a door or walking on grass and going places. Like you practice it, it has to be in the back of your mind of, "I need to be big. I need to do big." And some people will even put post-its all around their house. "Walk bigger," "Stand bigger." If they have issues getting out toileting, so sit to stand from the toilet and transferring over to the sink and getting out because it's a smaller space. They put post-its everywhere saying, "Walk bigger." And so, yeah, you're doing the treatment inside the physical therapy clinic, but you are doing it at home too. So it has to be a cognitive awareness because even with Parkinson's, there's also a cognitive deficit. So it has to need that reminder all the time.

Prakash Chandran: Okay, understood. And because this feels like a pretty intensive therapy, you know, 16 sessions total, is it not a good idea to also do LSVT LOUD at the same time, given that the fact that's also an intensive therapy?

Barbara "Bobbie" Roberts: No, they could do both. Sometimes PTs and OTs will split the treatment. So because it's four times a week for four weeks straight, as long as it's BIG, you can do two times with PT and two times with OT that weekend. It's still considered LSVT BIG. And then on top of that, they can do LSVT LOUD, which would help like the whole body throughout everything.

For instance, I will put an example together. I used to help with a Parkinson's boxing class and they would help with their initial movement, you know, hitting the punching bag, initial steps being big. And at the same time, they're shouting their numbers and shouting the commands that's necessary. And so you're working on the big and you're working on the loud. And so with that, I think doing BIG and LOUD at the same time would be a great combo.

Prakash Chandran: Yeah, it makes a lot of sense. So just as we start to close here, are there any resources that you'd like to share with regards to LSVT BIG?

Barbara "Bobbie" Roberts: I think getting involved in a community that has Parkinson's is very beneficial. A lot of people think that they are alone in it. Their family feels like they're alone in it and finding other community members or people who have Parkinson's is a great asset to their rehab. And there should be a local Parkinson's awareness program to help those who it is new to them or new to their family member and help to get involved and understand how Parkinson's works or their rehab and whatnot, or who to seek out for doctors or therapists and stuff. So it just depends on where your location is, I guess.

Prakash Chandran: Well, Dr. Roberts, that is really great advice and I think the perfect place to end. Thank you so much for your recommendations and for educating us today.

Barbara "Bobbie" Roberts: Okay. No problem. Anytime.

Prakash Chandran: And that concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical center. Please visit our website at palmdaleregional.com/roi for more information on the Rehabilitation and Orthopedic Institute and to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all other Palmdale Regional Medical Center podcasts. And for more health tips and updates, follow us on your social media. Please share on your social media and be sure to check out all the other interesting podcasts in our library.

Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians.

Thanks again for listening. My name is Prakash Chandran, and we'll talk next time.