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Balance | Neurological Recovery

LSVT Big: Empowering Movement in Parkinson's Patients

August 25th, 2023 | 7 min. read

LSVT Big: Empowering Movement in Parkinson's Patients
Caroline Durbin

Caroline Durbin

Licensed Physical Therapist, PT, DPT // Dry Needling Certified // LSVT Big Certified // EW Motion Therapy Trussville

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In healthcare innovations, specific programs stand out for their transformative impact on patients’ lives. One such program is LSVT Big, a specialized approach designed to improve mobility and quality of life for individuals with Parkinson's disease. With a rich history, a certification process, and a range of remarkable benefits, LSVT Big has emerged as a beacon of hope for those facing the challenges of Parkinson's. Physical therapists certified in LSVT Big have a unique opportunity to help Parkinson’s patients improve their daily movement - this is what our LSVT Big-certified therapists do every day at EW Motion Therapy. Even if you decide that our physical therapy does not fit your needs, you can still read on as we delve into the history of LSVT Big, explore the process of becoming certified, and uncover the significant benefits it offers individuals with Parkinson's disease. 


Visit Parkinson's of Alabama for more information!


A brief history of LSVT Big

LSVT Big, a revolutionary therapy program, is a component of the larger Lee Silverman Voice Treatment (LSVT) program. It was developed in the late 1980s by Dr. Lorraine Ramig and her colleagues as a response to the motor issues faced by individuals with Parkinson's disease. Initially, LSVT focused on improving vocal loudness, but its success inspired the creation of LSVT Big, which addresses motor symptoms and movement challenges.


The program was named "Big" to emphasize the significance of large, exaggerated movements, which help counteract the characteristic rigidity and slowness of movement often experienced by people with Parkinson's disease. LSVT Big operates under the principle of "use it or lose it." By encouraging expansive movements, the program aims to recalibrate the brain's perception of motion, allowing individuals to regain and maintain functional mobility.


Becoming certified in LSVT Big

If you're intrigued by the potential of LSVT Big and wish to make a difference in the lives of those with Parkinson's disease, you can consider becoming a certified LSVT Big therapist. The certification process involves steps that equip you with the knowledge and skills necessary to implement the program effectively.


  1. Prerequisites: Before pursuing certification, you must have a background in physical, occupational, or speech therapy and experience working with individuals with Parkinson's disease. This foundation ensures you understand the unique challenges that participants face.
  2. Training workshops: LSVT Global offers intensive training workshops that cover the principles and techniques of LSVT Big. These workshops are typically conducted by experienced LSVT-certified therapists and involve theoretical knowledge and practical application through hands-on exercises. There are also online courses available.
  3. Practice and supervision: After the workshop, you must complete a trial and clinical implementation period. During this phase, you'll work with individuals with Parkinson's disease under the guidance and supervision of an experienced LSVT-certified mentor. This practical experience is crucial for honing your skills and gaining confidence in program delivery.
  4. Certification process: Once you've fulfilled the training, practice, and supervision requirements, you can undergo a certification process. This often involves submitting video recordings of your sessions, demonstrating your proficiency in delivering LSVT Big techniques. You’ll earn your certification as an LSVT Big therapist upon successful evaluation. 


What are the components of LSVT Big? 

LSVT Big focuses on enhancing mobility, balance, and overall functional abilities through specific components. Let's delve into the critical elements of the LSVT Big approach:


  1. Individualized assessment and evaluation: The journey begins with thoroughly assessing the participant's movement patterns, functional limitations, and specific goals. This assessment forms the foundation for tailoring the LSVT Big program to meet individual needs.
  2. Intensive treatment schedule: LSVT Big follows an intensive treatment schedule of 16 sessions over four weeks. This concentrated approach maximizes the impact of therapy and facilitates neuroplasticity—the brain's ability to reorganize and adapt—to create more efficient movement patterns.
  3. Amplitude training: The core principle of LSVT Big is "thinking big." During exercises, participants are encouraged to exaggerate their movements, emphasizing amplitude (size of motion). By practicing more significant movements than usual, participants recalibrate their brain's perception of movement, improving mobility and function.
  4. Functional hierarchy: LSVT Big is structured around a functional movement hierarchy spanning simple to complex activities. Therapists guide participants through maximal daily exercises that mimic real-world tasks like reaching, stepping, and walking. This hierarchy allows participants to build a strong foundation and progress gradually.
  5. High effort and repetition: Participants engage in exercises with increased effort and repetition. This approach is essential for promoting motor learning and retraining the brain to recognize and execute more substantial movements. Repetition helps solidify the new movement patterns, improving motor skills over time.
  6. Sensory awareness and calibration: Individuals with Parkinson's disease often experience diminished sensory awareness, leading to difficulty accurately perceiving movement. LSVT Big includes exercises focusing on increasing sensory awareness and recalibrating sensory feedback, aiding in better movement control.
  7. Home exercise program: Participants receive a home exercise program alongside the in-clinic sessions. This program encourages participants to continue practicing the learned movements and techniques independently, reinforcing the progress made during therapy sessions.
  8. Task-specific training: LSVT Big strongly emphasizes task-specific training, ensuring that the movements practiced during therapy directly relate to the participant's daily activities. This approach enhances the participant's ability to perform essential tasks more efficiently and confidently.
  9. Adaptation to progress: The program adapts as participants progress in their movement capabilities. Therapists continuously challenge participants by introducing complex movements and variations to ensure continued growth and improvement.
  10. Motivational and supportive environment: LSVT Big sessions are conducted in a motivational and supportive environment. Therapists provide positive reinforcement, encouragement, and constructive feedback to help participants maintain their motivation and commitment to the program.
  11. Documentation and progress tracking: Throughout the program, therapists document participants' progress and track improvements in movement quality, functional abilities, and overall mobility. This documentation serves as a record of achievements and guides the ongoing treatment plan.
  12. Long-term maintenance strategies: After completing the initial 16 sessions, participants have strategies to maintain their gains. Therapists offer guidance on incorporating the principles of LSVT Big into daily life to sustain the benefits over the long term.


LSVT Big combines intensive therapy sessions, personalized exercises, and a focus on amplitude to enhance movement patterns and functional abilities in individuals with Parkinson's disease. By addressing the unique challenges posed by Parkinson's, LSVT Big empowers individuals to regain control over their movement, improve balance, and enhance their overall quality of life. 


Benefits of LSVT Big for individuals with Parkinson's

The impact of LSVT Big on individuals with Parkinson's disease is truly remarkable. By addressing motor symptoms and enhancing movement patterns, the program offers a range of benefits that can significantly improve participants' overall quality of life.


  1. Improved mobility: LSVT Big emphasizes large, exaggerated movements that counteract the stiffness and reduced mobility commonly seen in Parkinson's disease. Participants experience increased ease of movement and are better equipped to perform everyday activities.
  2. Enhanced balance: Balance issues can lead to falls and decreased independence for individuals with Parkinson's disease. LSVT Big incorporates exercises that target balance and stability, helping participants regain confidence in navigating their environment safely.
  3. Increased confidence: Parkinson's disease can affect an individual's self-esteem and confidence. Through LSVT Big, participants witness their progress, leading to a renewed sense of self-assurance as they achieve improved mobility and functionality.
  4. Functional gains: LSVT Big focuses on movements that directly translate to real-world tasks, such as getting up from a chair, walking, and reaching for objects. This emphasis on functional activities empowers participants to regain their independence and engage more actively in daily life.
  5. Neuroplasticity: The brain can rewire itself, even in neurological conditions. LSVT Big harnesses the concept of neuroplasticity by encouraging the brain to form new connections that support more fluid and efficient movement patterns.
  6. Long-term benefits: LSVT Big’s benefits extend beyond the program’s duration. Participants often continue to experience improvements in mobility and functionality, enabling them to maintain a higher quality of life in the long run.
  7. Customized approach: LSVT Big is tailored to each individual's needs and challenges. Therapists work closely with participants to create a personalized plan that targets their unique symptoms and goals.


In the landscape of therapeutic interventions for Parkinson's disease, LSVT Big shines as a transformative program that empowers individuals to regain control over their movement and improve their overall quality of life. Through its multifaceted components, LSVT Big offers a comprehensive solution for individuals seeking to overcome the movement difficulties associated with Parkinson's disease, both physical changes and the hope of a more fulfilling and active life. We have multiple physical therapists at EW Motion Therapy certified in LSVT Big, and they can work with you or your loved one to create a custom treatment plan for your needs. If you are curious about what else physical therapy can do for you, click the button below to download our answers to 20 frequently asked questions.


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