LSVT BIG® for people with Parkinson’s Disease

 

LSVT BIG®  program for people with Parkinson’s Disease at The Rehabilitation Medicine Group

The LSVT BIG®  program is a new, specific exercise and educational program for people with mild to moderate Parkinson’s Disease (PD). Using the principles of neuroplasticity, the goal of BIG is to improve mobility, stability and function by increasing a person's movement amplitude, speed and precision in daily life [1].

The program consists of intensive and increasingly complex exercises and movements performed under direct 1-to-1 physiotherapy supervision. Our physiotherapist Darren Lau is accredited to perform the BIG treatment and follows a standardised treatment program. This consists of 16 hour long treatment sessions conducted over 4 weeks. Half of the exercise program consists of highly reinforced, multidirectional whole-body movements performed with maximal amplitude and high intensity (e.g. stepping and reaching). The other half of the exercise program includes improving goal-directed functional activities of daily living according to each individual's needs and preferences.

LSVT BIG®  works

In the Berlin BIG randomised controlled study, people with mild to moderate symptoms of Parkinson’s Disease were randomly allocated to receive the LSVT BIG®  training, nordic walking training (walking using poles) or a home based program [2]. Following 4 weeks of training, those in the BIG group were found to have made larger and significant improvements in 3 measured outcomes, assessed 16 weeks after program completion. These included the United Parkinson’s Disease Rating Scale (UPDRS) with reduced bradykinesia and improved speed on the 10 metre walk test (10MWT) and timed up and go (TUG) test.

Although falling rates were not assessed during this study, with improved mobility and reduced bradykinesia, it is likely that fall rates will reduce. In a systematic review of patients with PD, 65% of patients experienced a fall during the studies with poorer mobility being closely associated with falls [ 3].

More about Parkinson’s Disease and rehabilitation

Parkinson’s disease has been estimated to affect 0.5% of Australians over the age of 50 and almost 1% after the age of 70 [4]. It is a progressive neurodegenerative condition and is one of the leading causes of neurological disability. The hallmarks of PD include bradykinesia (slow movements), rigidity (muscle stiffness), tremor and postural instability (poor balance). This can result in difficulty walking, performing daily activities, exercising and falls.

Whilst medication can alleviate some of the symptoms of Parkinson’s Disease, treatment should be combined with a multidisciplinary treatment approach [5]. An intensive 4 week rehabilitation treatment program conducted in people with the early stages of Parkinson’s disease, when compared with people receiving medication only treatment, demonstrated improvements in motor function, movement and activities of daily life that persisted over the following 2 years. Rehabilitation treatment appeared to have a neuroprotective effect - that is, it reduced the progression of Parkinson’s disease whereas the medication alone therapy did not [6].

In other studies, physiotherapy interventions to improve movement patterns in people with PD such as balance training, cueing, strengthening and aerobic training have been shown to significantly improve balance, reduce disability, improve functional reach and reduce motor symptoms [7].

At the Rehabilitation Medicine Group, we offer comprehensive multidisciplinary treatment programs for people with Parkinson’s Disease and other neurological conditions including Rehabilitation Physician assessment and management, physiotherapy, clinical psychology, neuropsychology and occupational therapy.

See also - Pain Rehabilitation for Parkinson’s Disease.

References

1. Fox, C., et al., LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinsons Dis, 2012. 2012: p. 391946.

2. Georg Ebersbach, A.E., Daniela Edler, Olaf Kaufhold, Matthias Kusch, Andreas Kupsch, and Jo ̈rg Wissel, Comparing Exercise in Parkinson’s Disease—The Berlin BIG Study. Movement Disorders, 2010. 00(00).

3. Allen, N.E., A.K. Schwarzel, and C.G. Canning, Recurrent falls in Parkinson's disease: a systematic review. Parkinsons Dis, 2013. 2013: p. 906274.

4. Mehta, P., et al., Population prevalence and incidence of Parkinson's disease in an Australian community. Intern Med J, 2007. 37(12): p. 812-4.

5. NICE, Parkinson's disease in over 20s: diagnosis and management. 2006. https://www.nice.org.uk/guidance/cg35/chapter/Key-priorities-for-implementation

6. Frazzitta, G., et al., Intensive rehabilitation treatment in early Parkinson's disease: a randomized pilot study with a 2-year follow-up. Neurorehabil Neural Repair, 2015. 29(2): p. 123-31.

7. Tomlinson, C.L., et al., Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev, 2012. 7: p. CD002817.


 


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