Test 2: LSVT BIG

Question 1

parts of the PD CPG utilized with LSVT BIG

Answer 1

external cueing
aerobic exercise
balance training
task specific training
gait training
behavior change approach

Question 2

what is LSVT BIG

Answer 2

Lee Silverman Voice Treatment BIG

originally developed in 80s for speech

designed specifically around PD impairments (rigidity, postural instability, dyskinesia, resting tremor)

based on neuroplasticity

research based (7 RCTs, 15 systematic reviews, many more)

Question 3

goals of LSVT BIG

Answer 3

1. target = amplitude
2. mode = high intensity effort
3. calibration = carry over/generalization

Question 4

high amplitude addresses which cardinal sign of PD

Answer 4

Bradykinesia

Question 5

which neuroplasticity principles are in use with the high intensity mode of PD

Answer 5

use it or lose it
use it improve it
reps matter
intensity matters

Question 6

calibration targets which symptoms/struggles of PD

Answer 6

community based involvement

targets poor implicit knowledge of performance

calibration starts making them aware that they are moving small and understand what “normal” to the world feels like

also targets bradykinesia

Question 7

which neuroplasticity principles apply to the calibration target of PD

Answer 7

salience

transference; transfer what they are learning about their movement to all scenarios

Question 8

notes on cueing for PD

Answer 8

keep it simple

your cue is BIG

don’s use too many words

keep it external - Model and shape (you as therapist have to model big and loud as well; shape using tactile cues to position body parts/make them more elongated/bigger)

no internal cues about feeling; they do not respond well to implicit cues

Question 9

protocol for LSVT BIG

Answer 9

4 days/wk for 4 weeks

1 hour, 1 on 1 treatment

Hw 1x/day on therapy days and 2x/day on non-therapy days:
- maximal daily exercises
- BIG walking
- functional tasks
- hierarchy tasks
- carry over tasks

training intensity = 8/10 effort throughout sessions

Question 10

maximal daily exercises parameters for LSVT BIG

Answer 10

7 exercises completed for 8-12 reps

2 sustained movements

5 multidirectional repetitive movements

Question 11

what are the sustained MDEs

Answer 11

10 sec holds

floor to ceiling

side to side

Question 12

what are the multidirectional MDEs

Answer 12

forward step
sideways step
backward step
forward rock and reach
sideways rock and reach

Question 13

what are the functional component tasks for LSVT BIG

Answer 13

each pt has 5

1st is STS for all pts

other 4 are of pt choice to help them meet their functional goals (want simple one two step activities)

examples:
- motion of sweeping
- rolling in bed
- reaching overhead

train the same 5 each session; can progress and make harder but the 5 tasks ultimately remain the same throughout the protocol

Question 14

FCTs fall into what component of the ICF model

Answer 14

activity limits

Question 15

what are hierarchy tasks in LSVT BIG

Answer 15

each patient will have around 3 that are addressed each session

will train the same HTs each session and can progress them in difficulty

higher level, more complex activities

examples:
- fly fishing
- loading and unloading dishwasher
- completing laundry
- golfing

Question 16

where in ICF are hierarchy tasks

Answer 16

Activity - i.e. laundry; it is a chore; not part of who you are

participation - i.e. golfing and pt is a professional golfer

Question 17

what are carryover tasks

Answer 17

a new daily hw assignment that tests transference

different each day

makes sure pt is doing hw and transferring what they are learning into daily life

Question 18

what is big walking

Answer 18

part of every protocol

should be done every time the pt is ambulatory

Question 19

outcomes for LSVT BIG

Answer 19

eval is same as traditional PD treatment

still track outcome measures pre and post treatment

can use PD EDGE to decide on outcome measures