You may be a therapist who already sees many patients with Parkinson’s and are looking for a specialized treatment, or perhaps you are curious whether LSVT BIG could be used with other types patients.
Below are answers to some common questions we receive from people deciding whether or not to become LSVT BIG Certified.
1. Can LSVT BIG be used in any treatment setting?
Yes! We have therapists in outpatient therapy departments, home health, private practice, hospitals and nursing homes, and more settings using LSVT BIG. Because of our large network of LSVT BIG Certified Clinicians, the 4-week LSVT BIG protocol can often be started in one setting and finished in a different setting.
For example, sometimes patients start in home health with one LSVT BIG Certified Clinician, improve to the point where they are no longer “home bound”, and finish LSVT BIG with another Certified clinician in an outpatient setting.
2. Can you use LSVT BIG with patients with conditions other than Parkinson’s?
For example, is there application to patients with atypical Parkinson’s, Huntington’s Disease, Stroke, Traumatic Brain Injury, Multiple Sclerosis, etc. who may have some overlapping symptoms such as smaller and slower movements, or balance impairments?
Absolutely! While the clinical research thus far has focused on idiopathic Parkinson disease, LSVT BIG is an intensive treatment built on the solid foundation of principles of motor learning and neuroplasticity, and LSVT BIG can be applied to many diagnoses other than PD.
In the LSVT BIG Training and Certification Course, you will learn how to make the determination through your examination, observation and stimulability testing, and reassessment as to whether you can apply LSVT BIG to patients other than those with PD.
“I have already made a list of 22 residents at my facility where I work who will benefit FOREVER because of this.”
3. Does Medicare or other insurance pay for intensive treatment like LSVT BIG?
LSVT BIG is billed under typical therapy billing codes. Thus, if a patient’s policy has coverage for physical or occupational therapy, and if the therapy meets the requirements set by the insurance company, treatments are typically covered. As with all therapies, we strongly advise that you and your patients understand the benefits and check with the insurance provider for questions.
To learn more, watch this free On Demand webinar titled
4. Can LSVT BIG be delivered by Physical Therapist Assistants or Occupational Therapy Assistants?
Yes, PTAs and COTAs who are certified in LSVT BIG can deliver LSVT BIG under the direction and supervision of an LSVT BIG Certified Therapist of their same profession.
5. What individual factors should be taken into account for the treatment to be successful?
Like all physical and occupational therapy interventions, the skill of a therapist is necessary to examine the patient to identify underlying co-morbidities and medical complexities, impairments and disabilities and then formulate a plan of care that considers their roles in life, ability to learn, social support, motivators and barriers to participation as well as other factors.
You will be the one to help set a safe level of exercise intensity, determine how to adapt movements and functional tasks as needed, and engage caregivers or support persons in homework and long term carry over for those patients who may need additional help because of physical or cognitive changes.
To achieve these gains, patients are expected to not only work hard during therapy but also at home daily as follow up after treatment is over. If a caregiver is necessary, we will train you how to “coach the coach” for long-term success, carryover and maintenance!
6. Are there any contraindications for this type of intervention?
Yes, there are contraindications or precautions as with any exercise-based intervention. No two people with Parkinson’s or other any neurological condition are the same. That is why evaluation and treatment from licensed physical or occupational therapists that have specialty training in PD are keys to success. We encourage clinicians, however, to keep an open mind. A thorough evaluation and trial treatment will often reveal potential precautions or contraindications. We have a motto, “give everyone a chance”!
There are definitely things to consider in determining if someone is appropriate for LSVT BIG. Patients with PD often have comorbidities. As part of the certification course, we will teach you how to make any necessary adaptations to the movements or intensity within the session based upon each individual’s needs.
7. Is a physician prescription required?
Although in the US, patients have direct access to physical therapists without needing a referral from a physician, we still recommend that your patients request an order for Physical or Occupational Therapy evaluation and treatment from a referring physician for insurance reimbursement purposes.
8. Will I need special equipment or “space” for LSVT BIG?
Because LSVT BIG is a treatment whose goal is to improve real world function, functional training in context is ideal. Therefore, the ideal “equipment” are things like “real chairs”, “real beds”, cupboards, doors, cars, coats, shirts, etc.! Therapists in outpatient or hospital based therapy departments may have to be creative when practicing tasks, while therapists in the home health setting will have the luxury of training in the patient’s home!
If you do work in a therapy department (i.e., not in the patient’s home), you can deliver LSVT BIG wherever both you and your patient have room to move big and walk big. Treatment should not be confined to a small treatment room when the goal is to gain confidence in moving bigger.
LSVT BIG is really applicable in all environments with the appropriate patient. LSVT BIG Certified Clinicians work in a wide range of practice settings including out-patient rehab, private practice and home health.
9. Can the treatment be graded down if it is too hard for the patient to perform? Or graded up if it is no longer a challenge?
Absolutely! The treatment itself can be adapted or progressed to allow for functional application to patients of all stages of PD. Our goal is that the treatment is always challenging and appropriate for each individual. We talk in detail about this in the course.
“I was very pleased with this course and all the info given to us during training and beyond. I feel like I have all the tools needed to successfully improve patient’s way of living with PD.”
What you can see from the information above is that while LSVT BIG is a standardized protocol based on research and principles that drive neuroplasticity, there is also the ability to be very flexible to individualize to each person’s individual goals and needs. Clinicians often report that not only did they learn new skills that helped to improve functioning of their patients with Parkinson’s but they learned skills that improved their overall delivery of treatment. In fact, in a survey study of all participants who took either the Online or Live LSVT BIG Training and Certification Course in 2017, many respondents reported an impact in their clinical practice as a whole.
