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HIT Me With Your Best Shot: A Parkinson’s Management Model

Written by Carolyn Lawless PT, DPT, Cert. MDT
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Carolyn MurraryThis blog is sort of a sequel to one of my previous blog posts I wrote on Parkinson’s Disease (PD) a few years back. The one where I talked about how I was watching a Sunday morning news program that was promoting boxing for management of Parkinson’s and how it was motivating me to start working with this population again. Well, nearly 2 years later, I finally became certified in LSVT- BIG for Parkinson’s treatment.

I’m sure you’ve heard about HIT (High Intensity Training), exercise that is performed with a high level of effort, or intensity, to stimulate the body to produce an increase in muscular strength and size. I found LSVT BIG to be a very similar idea, but for managing PD instead of your typical athlete.

 LSVT BIG is an intensive exercise program targeting the production of larger amplitude, whole body functional movements with an intensive and high effort delivery. People with PD tend to produce very small, slow movements. The intensive effort and “bigness” with LSVT BIG is very purposeful and required to override these slow and small movement characteristics in those with PD. The high intensity and high effort in LSVT BIG is important for receiving maximal plasticity (or changes in the brain) in people with PD, while in HIT effort and intensity are performed to see maximal change in muscle strength and size. Though the HIT and LSVT BIG training principles are similar, the purpose and results are very different in these two populations. While the purpose for HIT in an athlete is to see optimal change in muscle strength, size, and perhaps weight loss, high intensity and high effort in PD is for optimal movement size, function and quality of life.

sit to standImagine someone with very small, slow movements attempting to rise from a chair or sofa. They might find themselves getting stuck, attempting to use momentum, requiring assistance from a family member or avoiding certain chairs all together because they know they can’t get out of them. We see this often in our patient’s with PD, other neurological and non-neurological conditions. A functional sit-to-stand is a task we use daily as an intervention in physical therapy. It’s also a very important component in LSVT BIG. The first day of treatment, a good portion of our time is spent on teaching a proper sit-to-stand, much like a trainer might teach an athlete on proper squat form. Except, with LSVT BIG we’re not worried so much about the form but how much effort is being used and how big or amplified the movement is. We put our patient’s on a surface or chair we know they will have success with and then eventually challenge them on softer or lower surfaces. Our instructions might be “Scoot BIG (edge of chair), BIG Posture, Reach BIG, Push up BIG”. In addition, we’re modeling or demonstrating how these movements should look. By the time they’re finished with 10 repetitions of this they might feel tired, but they also feel improved confidence and empowered by what they can accomplish with bigger, intentional movements.

 This is just one example of how LSVT BIG can be very successful in treatment for Parkinson’s. We also address other functional components they may be challenged with. For example, maybe it’s rolling over in bed, getting out of bed, getting dressed, walking or hygiene care. You can imagine how these might be difficult movements to perform for someone with a movement disorder. However, with retraining the brain on HOW to move with high intensity, high effort, and BIG amplitude, normal movements can be restored and their quality of life significantly improved.

 LSVT is administered by a certified PT or OT over 16, 1-hour sessions, 4 days per week for 4 weeks. If you would like more information on LSVT BIG or view patient testimonials please visit https://lsvtglobal.com or contact me!

Sources: https://lsvtglobal.com

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