What Should SLPs Know About LSVT BIG®?

Most speech-language therapy professionals are familiar with LSVT LOUD®. With over twenty-five years of NIH-backed research and a proven track record for getting results, LSVT LOUD is the gold standard of speech treatment for people with Parkinson’s disease.

But, of course, PD affects more than just the speech motor systems. That’s why the company developed a program to address other motor systems including limb motor, gross motor, and fine motor. This became LSVT BIG®.

Although only physical therapists and occupational therapists can become certified, SLPs will definitely benefit from understanding how it works for their patients.

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1. Amplitude is the Common Goal

LSVT BIG Certified Physical Therapists offer a free, 20-minute exercise program of LSVT BIG exercises. From the Parkinson’s Foundation.

The symptoms of PD affect all aspects of mobility and activities of daily living:

PD’s Impact on Mobility and ADLs

  • Difficulty with dual-tasking (less efficient)
  • Postural instability (less safe)
  • Fear of falling (impacts everyday tasks and movements)
  • Slowed movements (less efficient, harder to initiate, and takes longer to do tasks)
  • Tremor and hypokinesia (affects ADLs, object manipulation, can result in learned non-use)
  • Kinesthetic awareness (less able to recognize changes in posture when moving)

Adapted from the Medbridge course Interprofessional Practice for Parkinson’s: LSVT BIG and LSVT LOUD (Fox, Gusé, Vitek)

Just as amplitude (vocal loudness) is the goal of LSVT LOUD from day one to discharge, it’s also the focus of LSVT BIG.

With the cue, “Move big!” LSVT BIG patients work towards better posture, greater stride length, bigger arm swing, more efficient dressing, greater confidence with mobility, etc.

2. Patients Need to Recalibrate Movement

LSVT LOUD patients often don’t realize that their voice is too soft. The loudness of their voice “feels” normal, and they may need feedback (such as audio or video of themselves) to understand that it’s not.

Similarly, these same patients may not realize that their movements have become smaller or slower. With the help of a mirror or video of themselves, they come to understand that they need to move bigger.

Therefore, the goal of LSVT BIG is to recalibrate what normal is, now that they’re living with PD.

The patient will feel how big normal posture is, how big normal steps are, how big putting on a coat should be, and so on.

3. Moving “Big” Generalizes

Patients treated with LSVT BIG can experience improvements in related but untrained movements.

This implies that the untrained movements have generalized—a sign of motor learning in action.

LSVT BIG generalized motor outputs

4. LSVT BIG’s Framework is the Same

LSVT BIG follows the same basic framework as LSVT LOUD.

This includes the same treatment model, intensive treatment schedule, and follow-up options.

  • Intensive schedule (60-minute sessions, 4 times per week for 4 weeks)
  • Daily carryover assignments
  • Daily homework
  • Optional group programs (LSVT’s LOUD for LIFE & BIG for LIFE)
  • Optional follow-up sessions

5. Refer Early!

Having skilled OT and PT can slow the motor progression of Parkinson’s Disease. Therapies like LSVT BIG don’t only compensate for losses that have already happened. They can actually restore function and slow down future losses.

If your patient doesn’t yet have OT or PT, make the referral as soon as possible. To find an LSVT BIG provider, see their searchable database.

6. What Else Can SLPs Do to Help Parkinson’s Patients?

Refer out to OT and/or PT

A PT referral may be more urgent if your patient has mobility needs, like needing a mobility aid, increased fall risk, needing extra help with stairs, or needing help getting out and about in the community.

An OT referral may be more urgent if the patient needs extra help with ADLs. Think dressing, cooking, showering, etc.

Encourage bigger movements during your sessions

If you notice your patient slumping, for example, you may model a BIG posture and cue, “Think BIG.”

Collaborate with other therapists

If your patient is fortunate enough to have both speech therapy with you (❤️) and LSVT BIG with an OT or PT, take the opportunity to support each other.

How can you incorporate each others’ cues in sessions? How can you support the patients’ goals, together? Remember that creating a “community of care” is a cornerstone of person-centered and culturally-responsive care.


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