LSVT BIG: Amplitude Training for Parkinson's Disease

The Lee Silverman Voice Treatment (LSVT) BIG program is a standardized, intensive, and evidence-based approach to physical and occupational therapy for individuals with Parkinson's disease. The core principle of LSVT BIG is to improve movement amplitude and function through a series of high-amplitude, repetitive exercises. The protocol is based on the idea that people with Parkinson's disease have a faulty sensory perception of their own movement, leading to small, slow, and shuffling movements. LSVT BIG aims to recalibrate this sensory perception by training the brain to accept bigger, more explosive movements as normal. A 2022 systematic review of 15 RCTs found that LSVT BIG was effective in improving motor function, balance, and gait in people with Parkinson's disease. The standard LSVT BIG protocol consists of 16 one-hour individual sessions, four times a week for four weeks. The sessions are divided into two parts: maximal daily exercises and functional component tasks. The maximal daily exercises are a set of seven standardized, large-amplitude movements that are performed with maximal effort and repetition. The functional component tasks are patient-driven and focus on improving performance in everyday activities, such as getting in and out of a car, walking, or dressing. The therapist works with the patient to identify five functional tasks that are important to them and then incorporates these tasks into the treatment sessions.