LSVT and OT: Advice from an LSVT BIG OT

If you work with adults, especially older adults, you are almost sure to encounter someone with Parkinson’s disease. Parkinson’s disease (PD) is a progressive neurological disease that often begins with a tremor or subtle change in gait. PD is known for affecting each person in a unique way, meaning not everyone will experience the same symptoms.

For example, some people experience difficulty in their ability to communicate due to changes in speech, vocal volume, and inflection. This can further limit desire for social interaction and increase isolation. As OTs, we can work to remediate some deficits that may impact ADL performance, through interventions like LSVT. This article will cover the basics about LSVT and OT for those interested in this approach.

What is LSVT?

The Lee Silverman Voice Treatment (LSVT) is a behavioral treatment geared towards creating neurobiological changes associated with therapy for people with Parkinson’s. It was developed in the 1980s for Mrs. Lee Silverman, and it is designed specifically to create sustained improvement in speech and voice function.

LSVT LOUD is a training program that teaches people with Parkinson’s to recalibrate their voices. Research has shown improvements in volume, pitch and inflection following treatment.

LSVT BIG is an intensive, effective, one-on-one treatment created to help people with PD and other neurological conditions address walking, balance, and other activities of daily living or even job-related tasks. LSVT BIG is based on the same idea of “recalibration” – in retraining the brain and how it perceives movement.

The LSVT BIG program is a standardized treatment protocol of exercises and movements that are focused on the AMPLITUDE of movement, in an effort to retrain the way your patient performs tasks. The plan of care is also uniform – to be the most effective, the patient should be seen four days in a row for four weeks. The patient is also instructed in the “homework” they will perform at home, which includes performing additional exercises and tasks to facilitate carryover of the BIG ideas that are practiced while in the clinic.

As occupational therapists, we are trained to analyze client factors that affect our patient’s performance in daily activities. Parkinson’s disease presents differently in each person, but the most common symptoms include the decreased gait speed, the small, shuffling steps, and the tremors.

Just one of these symptoms would affect performance of ADLs, but because of the slower progression of the disease, patients may not notice how much their performance has changed, or how they have adapted to compensate for their declining motor performance. Our skills in observation help us identify the functional areas to address, as often they are unaware or sometimes just reluctant, to admit the areas in which they may have declined.

Who is LSVT appropriate for?

LSVT is appropriate for both new and seasoned practitioners. When you are certified in LSVT, you are provided a manual – an extensive, important resource that includes a ton of information – from information to be gathered in the evaluation to sharable pictures and resources that can be copied and provided to the patient to take home for practice.

Between this manual and all of the information provided on the site, the team behind LSVT provide wonderful resources to your practice. Included are suggestions of what objective measures to collect and a list of functional tasks from which the patient can choose and then rate the degree of difficulty – laying out a list of areas to choose from when making goals.

One of the most important parts of our LSVT treatment here is the collaboration between OTs, PTs and SLPs when setting up the patient schedule and goals – and how this collaboration is essential for the success of the patient. The OTs and PTs communicate the patient’s performance of exercises as well as goals for tasks to practice during treatment.

As we work to carryover the vocal projection that is addressed in speech, so does the speech therapist, to watch for the patient’s “BIGness,” or amplitude of movements, when performing functional tasks and when walking in/out of therapy. These dynamic exercises can be used with other patients who do not have a Parkinson’s diagnosis, as well. I have used these same ideas and amplitude-based exercises for patients with other neurological deficits, with good results.

Take a look at this story about Anders Lienes who uses LSVT BIG to fight Parkinson’s:

How can I use LSVT with my patients?

Only PTs and OTs are certified to perform LSVT BIG with their patients, and you must hold a certification to deliver this type of treatment. You can become certified in LSVT BIG either in person, at a weekend conference, for example; or online – especially since the start of the pandemic. I had an awesome experience in New Orleans, for a weekend conference.

The instructors scheduled volunteers, community members with Parkinson’s, to come to the training for demonstrations and this provided us the opportunity to try out LSVT with actual patients, with the instructors within reach if we had a question.

If you are considering exploring LSVT certification as a student, DO IT. It is significantly cheaper to attend the conference, and there is no additional fee when transitioning to a licensed OT.

How much does it cost to get certified?

As mentioned above, there are several ways to get certified as an LSVT OT. You can do their online training, which will take approximately 16 hours and costs $580 for occupational therapists and $300 for students. 

You can also get certified in-person at their two day course for the same rates as above. Both options can also count towards your continuing education requirements. Be sure to check their website for the most current in-person and virtual training course information.

What is BIG 4 LIFE?

BIG 4 LIFE is an additional certification that be attained after receiving the initial LSVT BIG certification. BIG 4 LIFE is a group that is attended by patients that have completed at least one full 4 week LSVT program, and is an effective way to maintain the gains made and establish a community of people that can encourage one another and keep each other accountable to keep doing their “homework.”

Social distancing has changed the way these groups meet, but the idea of a community to hold you accountable is effective not only to enforce the importance of the homework but as a social support for the patient and their families.

Final thoughts about LSVT and OT

LSVT is not a “one and done” concept; patients are recommended to check in at least every 6 months for a “tune up”. “Tune ups” involve coming back in to the therapist to complete an LSVT BIG regimen, however the duration is usually less than the 4 week duration of the first LSVT experience.

Performing LSVT as an OT is a work of collaboration, with the patient, family and other therapists. Certification is thorough, the resources and support is impressive and the relationships you build with LSVT patients will grow as they come back for “tune ups” for years to come.