Thinking BIG improves function for some Parkinson’s patients

A new physical therapy program at Christiana Care, dubbed BIG, is helping patients with Parkinson’s disease to improve function and slow motor deterioration by retraining sensory, motor and cognitive functions through intensive exercise and patient empowerment.

“Even patients with slight deficits show measurable improvements within the first 50 minutes of BIG therapy,” said Jay Kogon, DPT, ATC, one of two Christiana Care therapists certified in the program.

The BIG program is an adaptation for muscular disorders of the clinically proven Lee Silverman Voice Training (LSVT) LOUD method, which was developed in 1987 to improve voice and speech in individuals with Parkinson’s disease. Those principles that made LSVT LOUD an effective treatment for the speech motor system have now been successfully applied to the limb motor system.

Parkinson’s disease is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and increasingly smaller movement (hypokinesia). Symptoms are the result of decreased stimulation of the motor cortex by the basal ganglia, normally caused by dopamine produced in the brain.

LSVT BIG therapy includes repetitive, exaggerated movements to increase dopamine production in the brain and recalibrate muscle function. Therapists model the structured movements while giving simple commands such as “do what I do” or “move bigger.” This creates an automatic response in the patient’s brain that results in larger, more normalized movements by the patient.

“Patients with Parkinson’s disease may shuffle, appear stooped over, or struggle with transitions of movement,” said Laurie Scott, OTR/L, site manager at Springside Plaza Rehabilitation Services, where BIG therapy is becoming a big hit. “But the more my patients ‘think BIG,’ the more confidently they move and the greater ability they have to transition and move safely in their environment.”

BIG is also effective with other conditions including stroke, multiple sclerosis, cerebral palsy, and Down syndrome. LSVT BIG protocols recommend incorporating therapy into treatment at the time of diagnosis, which is a “huge paradigm shift for physicians and therapists with patients who don’t exhibit traditional therapy needs,” says Kogon. “Previously, therapy focused on compensating for existing deficits and helping patients maintain current status,” she said.