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Health Matters 6/28: Thinking BIG to treat Parkinson’s

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Health Matters 6/28: Thinking BIG to treat Parkinson’s

By Kelly Gray, P.T.

Approximately 60,000 Americans are diagnosed with Parkinson’s disease each year, according to the Parkinson’s Foundation.

And by 2020, nearly one million people in the United States will be living with Parkinson’s, a disease that affects the neurons in the brain that control movement.

Though there is no standard treatment for the disease, exercise and specialized physical therapy – often along with medication – can help prevent its progression.

At Princeton Rehabilitation, a unit of Penn Medicine Princeton Health, patients have access LSVT BIG, an evidence-based physical therapy program for the treatment of Parkinson’s.

Damage to nerve cells

Parkinson’s disease occurs when certain nerve cells in the brain become impaired or die. These cells produce chemicals called dopamine and norepinephrine that help control movement and many automatic bodily functions.

It’s unknown what causes the nerve cells to die, but researchers suspect a combination of genetic and environmental factors may lead to the disease.

While both men and women can develop Parkinson’s, the National Institute on Aging reports the disease affects about 50% more men than women. Most people with Parkinson’s first develop the disease around age 60.

Subtle and gradual

Symptoms of Parkinson’s typically start out subtly and develop gradually. In many cases, the first signs may be a mild tremor or difficulty getting out of a chair. Handwriting may become slow and look cramped or small, and a person may speak too softly.

In its early stages, the disease may affect only one side of the body. Symptoms include:

  • Trembling of hands, arms, legs, jaw and face
  • Stiffness of the arms, legs and trunk
  • Slowness of movement
  • Poor balance and coordination

Over time, symptoms may affect both sides of the body, and people with Parkinson’s may experience:

  • Trouble walking
  • Difficulty talking
  • Trouble performing simple tasks
  • Depression
  • Sleep problems
  • Trouble chewing, swallowing or speaking

As the National Institute on Aging notes, people with Parkinson’s often develop a parkinsonian gait characterized be the tendency to lean forward, small quick steps and reduced swinging of the arms. Initiating or continuing movement may be difficult.

In general, for people with Parkinson’s, movement shrinks and continues to become smaller and smaller over time.

Going BIG

In addition to medication, and sometimes surgery, exercise plays an important role in treating Parkinson’s and halting its progression.

Research has shown exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination. The Parkinson’s Foundation points to one study that showed people with Parkinson’s who exercised regularly for 2.5 hours a week had a smaller decline in mobility and quality of life more than two years.

While any type and amount of exercise is beneficial, targeted exercises can address specific symptoms. Moreover, specialized rehabilitation and physical therapy programs, such as LSVT BIG can treat the balance, gait and other movement challenges associated with Parkinson’s.

LSVT BIG is an evidence-based exercise treatment program founded on the principle the brain can learn and change. The program grew out of the Lee Silverman Voice Training (LSVT) program for patients with Parkinson’s and is focused on increasing amplitude of limb and body movements to improve gait, balance and function.

In other words, the program reconditions the brain to make movements big to counter the diminishing affects of Parkinson’s.

Patients participating in the LSVT BIG program at Princeton Rehabilitation receive one-on-one therapy for an hour a day, four days a week for four weeks. The program aims to restore movement so patients can lead a more active and independent life whether that means being able to return to the golf course or getting up from a chair without assistance.

The intensity of the program is different for every patient depending on the severity of the disease, but includes specific exercises studied and designed to address coordination, range of motion, flexibility and balance in patients with Parkinson’s.

The program reteaches patients how normal movement should feel by encouraging them to think big and move big. Though at first these movements may seem too big, the brain begins to recognize them as normal. Repetition and progressive challenges, along with daily practice at home, help the brain remember the movements.

Treatment has been proven to help patients walk faster with bigger steps and arm swings, improve balance and improve the ability to twist at the waist.  Additionally, treatment may help patients with smaller movements, like buttoning a shirt or hand-writing a note, as well as large movements like getting out of bed and dressing.

Patients at all stages of Parkinson’s disease can benefit from LSVT BIG therapy. Even though some patients may not have serious symptoms at first, the brain has still undergone significant changes. LSVT BIG can help preempt symptoms associated with those changes and slow the progression of Parkinson’s so patients can move easily for years to come.

For more information about the LSVT BIG program at Princeton Rehabilitation or to find a physical therapist call 609-853-7840 or visit

Kelly Gray, P.T., is a physical therapist certified in LSVT BIG. She is a rehabilitation manager with Princeton Rehabilitation, a division of Penn Medicine Princeton Health.   



(1) comment


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