Lee Silverman Voice Treatment (LSVT)-BIG to improve motor function in people with Parkinson’s disease: a systematic review and meta-analysis

McDonnell, Michelle N.; Rischbieth, Briony; Schammer, Tenille T; Seaforth, Chantel; Shaw, Alex J; Phillips, Anna

doi:10.1177/0269215517734385

Cited by 40 publications

(38 citation statements)

References 23 publications

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“…9 ). These results are consistent with those reported in previous studies where i10MW and Timed-Up-and-Go times decreased with LSVT-BIG® [ 6 , 9 , 13 , 14 , 47 , 48 ]. By employing wearable sensors to detect gait events, the gait cycle was deconstructed into its constituent time phases, collectively showing significant reductions in step, stride, swing and stance times with therapy (Figs.…”

Section: Discussionsupporting

confidence: 93%

“…By integrating these exercises with functional aspects of daily living, LSVT-BIG® also aims to improve the internal cueing mechanisms that regulate motor control in various environments. While several studies have previously investigated the effect of LSVT-BIG® on motor and non-motor symptoms in PD [ 6 , 9 – 11 , 13 , 14 , 46 , 47 ], no study has yet quantitatively evaluated motor function using wearable sensors at multiple stages before, throughout, and up to 13 weeks post LSVT-BIG® therapy. Additionally, this study provided an examination of balance, postural control and fine motor function through iSTS, QS and FT tasks respectively, and compared outcome measures from all tasks with data from healthy age-matched controls.…”

Section: Discussionmentioning

confidence: 99%

“…Research evaluating the clinical efficacy of LSVT-BIG® in individuals with PD has thus far been limited [ 13 ]. In a study of large amplitude therapy by Farley & Koshland, the first to reference ‘BIG’ exercises, significant increases in gait velocity, stride length, and wrist velocity were observed in 18 PD subjects following therapy [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In a follow-on study examining cognitive aspects of motor preparation, LSVT-BIG® and Nordic Walking were both shown to improve cued reaction times, but not non-cued reaction times [ 14 ]. Despite the various benefits of LSVT-BIG® reported in the literature, issues remain regarding heterogeneity of UPDRS-III scores [ 13 , 15 ], potentially reflecting the subjectivity or inconsistency of such scores. The disparities in clinical scoring emphasize the need for more objective, quantitative measures of motor function to accurately monitor and assess efficacy of therapeutic interventions in PD.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy

Flood

O’Callaghan

Diamond

et al. 2020

J NeuroEngineering Rehabil

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Background LSVT-BIG® is an intensively delivered, amplitude-oriented exercise therapy reported to improve mobility in individuals with Parkinson’s disease (PD). However, questions remain surrounding the efficacy of LSVT-BIG® when compared with similar exercise therapies. Instrumented clinical tests using body-worn sensors can provide a means to objectively monitor patient progression with therapy by quantifying features of motor function, yet research exploring the feasibility of this approach has been limited to date. The aim of this study was to use accelerometer-instrumented clinical tests to quantify features of gait, balance and fine motor control in individuals with PD, in order to examine motor function during and following LSVT-BIG® therapy. Methods Twelve individuals with PD undergoing LSVT-BIG® therapy, eight non-exercising PD controls and 14 healthy controls were recruited to participate in the study. Functional mobility was examined using features derived from accelerometry recorded during five instrumented clinical tests: 10 m walk, Timed-Up-and-Go, Sit-to-Stand, quiet stance, and finger tapping. PD subjects undergoing therapy were assessed before, each week during, and up to 13 weeks following LSVT-BIG®. Results Accelerometry data captured significant improvements in 10 m walk and Timed-Up-and-Go times with LSVT-BIG® ( p < 0.001), accompanied by increased stride length. Temporal features of the gait cycle were significantly lower following therapy, though no change was observed with measures of asymmetry or stride variance. The total number of Sit-to-Stand transitions significantly increased with LSVT-BIG® ( p < 0.001), corresponding to a significant reduction of time spent in each phase of the Sit-to-Stand cycle. No change in measures related to postural or fine motor control was observed with LSVT-BIG®. PD subjects undergoing LSVT-BIG® showed significant improvements in 10 m walk ( p < 0.001) and Timed-Up-and-Go times ( p = 0.004) over a four-week period when compared to non-exercising PD controls, who showed no week-to-week improvement in any task examined. Conclusions This study demonstrates the potential for wearable sensors to objectively quantify changes in motor function in response to therapeutic exercise interventions in PD. The observed improvements in accelerometer-derived features provide support for instrumenting gait and sit-to-stand tasks, and demonstrate a rescaling of the speed-amplitude relationship during gait in PD following LSVT-BIG®.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy

Flood

O’Callaghan

Diamond

et al. 2020

J NeuroEngineering Rehabil

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“…Another LSVT variant is LSVT BIG, which was developed to overcome the problem of deficient speed-amplitude regulation by training amplitude in patients with PD with akinesia (motor symptoms in PD), with different target patients compared with LSVT LOUD (non-motor symptoms in PD) [86,87]. A meta-analysis published in 2018 [88] indicated that LSVT BIG was more effective than other interventions in overcoming motor dysfunctions, such as gait speed. With the development of LSVT, we expect that a series of technologies will provide more comprehensive rehabilitation for patients with PD with dysarthria and akinesia.…”

Section: Discussionmentioning

confidence: 99%

Lee Silverman Voice Treatment for dysarthria in patients with Parkinson’s disease: a systematic review and meta‐analysis

Yuan

Guo

Wei

et al. 2020

Euro J of Neurology

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Approximately 89% of patients with Parkinson’s disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta‐analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained ‘Ah’ phonation, reading the ‘Rainbow passage’, monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31 dB, respectively, after 1 month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained ‘Ah’ phonation, reading the ‘Rainbow passage’ and monologue immediately after treatment (13.39, 6.66 and 3.19 dB). Positive improvement still existed after 24 months. There was no difference in the therapeutic effect between face‐to‐face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.

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The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial

Eldemir,

Saygili

et al. 2024

Brain and Behavior

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BackgroundLee Silverman voice treatment (LSVT) BIG is an exercise program developed for patients with Parkinson's disease (PwPD), consisting of sets of exercises performed for 4 consecutive days a week for 4 weeks. However, the standard protocol suggests a treatment frequency difficult to follow for most patients who have difficulties reaching rehabilitation clinics. Our aim was to compare the standard LSVT BIG protocol with a modified LSVT (m‐LSVT) BIG protocol (twice a week in the clinic for 4 weeks and twice a week at home for 4 weeks).MethodsIn this randomized controlled trial, 16 PwPD (aged 18–80 years, Hoehn and Yahr stages I–III) were recruited into two groups. The LSVT group received standard LSVT BIG training (four times per week for 4 weeks at the clinic). The other group was given m‐LSVT BIG exercises, but unlike the LSVT group, the m‐LSVT group exercised twice a week at the clinic and twice a week at home for 4 weeks. The Berg Balance Scale was used to assess functional balance. Biodex Balance System was used to assess laboratory balance measures. Timed Up and Go test and G‐Walk sensor system were used to assess functional mobility and spatiotemporal gait analysis.ResultsSignificant group‐by‐time interactions on the eyes open‐firm surface score of the modified clinical test of sensory integration of balance (F = 10.138, p = .007) and gait cycle symmetry index (F = 10.470, p = .010) were found to be in favor of the LSVT group. Additionally, post hoc analyses revealed that both groups significantly improved postural stability, gait speed, motor symptoms, and functional mobility (p < .05).ConclusionThe results revealed the beneficial effects of the modified protocol on balance and gait in PwPD, as well as the superiority of the standard LSVT BIG protocol. The m‐LSVT BIG protocol may be an effective intervention method, especially for PwPD who have difficulty adapting to the treatment frequency of the standard protocol.

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Lee Silverman Voice Treatment (LSVT)-BIG to improve motor function in people with Parkinson’s disease: a systematic review and meta-analysis

Abstract: Compared to shorter format LSVT-BIG or general exercise, LSVT-BIG was more effective at improving motor function. This provides preliminary, moderate quality evidence that amplitude-oriented training is effective in reducing motor impairments for people with mild Parkinson's disease.

Cited by 40 publications

References 23 publications

Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy

Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy

Lee Silverman Voice Treatment for dysarthria in patients with Parkinson’s disease: a systematic review and meta‐analysis

The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial

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