Wesley was four, mostly nonverbal, and just learning to walk. Two summers of LSVT BIG® and LSVT LOUD® later, his family can’t get him off the stairs or get him to stop talking.
LSVT BIG and LSVT LOUD have spent nearly three decades helping people with Parkinson’s disease move bigger and speak louder. But what happens when therapists apply the same protocol to a four-year-old who says only two words and is not yet walking? On a recent episode of Think BIG and LOUD, host Beth Peterson sat down with Erica Vitek, Wesley’s LSVT BIG certified occupational therapist, and Jessica Czajka-Glisch, mother of Wesley, to talk about it.
What follows is the story of how a pediatrician’s offhand message turned into two summers of intensive therapy, and how a boy who once had four consistent sounds now doesn’t stop talking.
BACKGROUND
A Protocol Built for Parkinson’s, Adapted for a Preschooler
Vitek has delivered LSVT BIG in the clinic since 2009 and has been part of the LSVT BIG faculty since 2013. Her caseload is almost entirely adults with Parkinson’s, whose small, shuffling movements and soft speech reflect a kind of sensory mismatch where they often don’t perceive their own movements or voice as being as small as they actually are.
LSVT BIG uses high-repetition, high-intensity practice, four sessions a week for four weeks, built around large-amplitude movement to retrain that mismatch. LSVT LOUD applies the same neuroplasticity principles to voice, training people to talk louder and articulate more clearly.
Vitek’s first pediatric case came in 2021, when a mother sought her out for a teenager who’d heard about the program. It worked so well that Vitek made it her mission to reach out to local pediatricians and offer the intensive model for kids with conditions like Down syndrome, cerebral palsy, and ataxia. One of those pediatricians was Wesley’s.
THE BEGINNING
“We Don’t Have Anything to Lose”
Wesley’s pediatrician sent his mom Jessica a message through the patient portal: a local therapist was looking for kids with Down syndrome to try an intensive program called LSVT BIG and LSVT LOUD. It would be a big time commitment. Was she interested?
Jessica and her husband already said yes to nearly any therapy that might help Wesley. He was doing occupational and physical therapy once a week, but speech had been discontinued at age two after showing little progress. At four years and two months old, Wesley was largely nonverbal, he had two consistent words, “good” and “up,” plus a couple of sounds.
“You know what? We don’t have anything to lose from him trying it, so let’s just try.” — Jessica Czajka-Glisch
Erica remembers being struck immediately by the family’s motivation. “It was very clear right from the beginning when I met Jessica and her family how motivated they are for Wes to improve,” she said. From there, the two built a shared set of functional goals.
THE GOALS
Fitting In at School
Jessica’s north star was simple: she wanted Wesley to be able to do as much as possible alongside his classmates. That translated into concrete, everyday targets — navigating around objects, walking fast enough not to fall, kicking, pulling, reaching across his body, twisting open a cap, and eventually holding scissors, markers, and pencils correctly for school.
Vitek and the LSVT LOUD certified therapist built goals around three areas:
- Gross motor & safety — kicking, running, jumping, and navigating stairs safely to keep up with his sisters
- Fine motor — squeezing, opening a sippy cup, a two-point pincer grasp, and eventually scissors and writing tools
- Voice & communication — imitating sounds and building toward word approximations his family could understand
IN THE ROOM
Barefoot, Spinny Toys, and the Itsy Bitsy Spider
Staying true to the LSVT protocol while working with a four-year-old meant getting creative. On the advice of a physical therapy colleague, Wesley did sessions barefoot instead of in his ankle braces, a small change that significantly boosted his balance and proprioceptive work.
Sessions opened with reaching exercises — floor to ceiling, side to side — using noise-making and spinning toys Wesley loved, then progressed from a stable chair to a bolster and a therapy ball as his trunk control improved. Singing “Itsy Bitsy Spider” carried him through stepping exercises; “Wheels on the Bus” became part of the routine he came to recognize and lean into.
Not every rep happened in order. When Wesley got tired or distracted, the team adapted on the fly rather than forcing the sequence, a flexibility Jessica says was key to keeping him engaged.
“It’s not just Wes but me too… it was fun. It was good times.” — Erica Vitek, on the echoing toy cactus Wesley brought from home
Speech sessions were harder at first. Sitting in a chair making sounds on command didn’t come naturally to Wesley, who preferred to hand the microphone back and make his mom or the therapist do it instead. “I win,” his mother laughed, describing his four-year-old logic. Eventually, that same echoing cactus became a genuine speech tool, Wesley still yells into it at home, listening for the sound to come back.
THE BREAKTHROUGHS
“Wow, We Don’t Have to Hold Him Up”
The first sign of change came at the pool. About two weeks in, Wesley’s grandparents noticed him holding himself up in the water in his life jacket far more independently than before, purely from the repetition of the exercises.
Then came the stairs. Wesley’s bedroom was upstairs, and safe stair navigation had been an explicit family goal. One morning, Jessica watched from the bottom step as Wesley climbed on his own, using both feet and holding the railing with both hands, something she’d been coached not to intervene in.
“Come on, man. You know how to go down now. We practiced this.” — Jessica Czajka-Glisch, watching Wesley scoot back down on his own
By the following spring, Wesley was jumping, both feet off the ground, unassisted, in the middle of the kitchen. He sat for his school pictures on a rolling stool with no one holding him steady, something that stunned Vitek when she heard about it. At school, his educational assistants began independently reporting progress — pulling up his own pants, using adaptive scissors, holding a pencil correctly, eating snacks one at a time with a proper pincer grasp — without knowing those were direct carryovers from therapy.
Speech came slower, and unevenly. But it came. From “good” and “up,” Wesley moved toward sounds for B, P, and the beginning of words “pop,” “hot,” and an attempt at his dog’s name, Scar. Car blinker noises. Random bursts of speech from the back seat that had his mother turning around, startled, saying, that’s exactly what his speech therapist had been trying to get out of him.
THE COMBINATION
Why BIG and LOUD, Together, in the Same Month
Vitek’s clinic runs adult patients through LSVT BIG and LSVT LOUD in the same month as a matter of tradition, reinforcing the same intensity and neuroplasticity principles from two directions at once. They kept that structure for Wesley, alternating which discipline he saw first each day so fatigue wouldn’t always fall on the same session.
The crossover effects were real. Vitek noticed Wesley would produce sounds in her session echoing in a stairwell, for instance that his speech therapist had been working toward without success in a quieter office setting. The two therapists used similar sensory tools, like pulley tubes, to reinforce the same vocalizations from both sides.
The tradeoff was fatigue: two hours of combined therapy is a lot for a four-year-old used to 30-to-45-minute outpatient sessions. For Wesley, success meant staying flexible, following his cues, and finding creative ways to keep him engaged while working within the intensive format.
THE REALITY
Not Every Family Can Do This — And That’s Okay
Jessica is candid about what made two summers of intensive therapy possible for her family: she’s a teacher with summers off, and her husband, a process server, sets his own hours. Her cousin, a single mother whose daughter also has Down syndrome, found the same two-hour daily commitment far harder to manage, working from the clinic waiting room with her other kids in tow, driving 30 minutes each way.
“It works for somebody in my position where I have the time in the summer… but it’s definitely not for everybody, because not everybody can do that every day for four weeks.” – Jessica Czajka-Glisch
Her advice to families weighing whether to try it: don’t say no before you’ve had the conversation. “Just say yes to sitting down and talking about it,” she said. The goals are collaborative, if a family doesn’t want to prioritize a particular skill, the therapist will build around what they do want.
LOOKING AHEAD
Building a Pediatric Program
One detail stands out: Wesley was four when he started, by Erica’s account, the youngest person to go through the program at her clinic. Jessica, thinking like a teacher, sees value in that early start: repeated summers build a dataset and a familiarity with the process that a child starting later, like her cousin’s ten-year-old daughter, simply doesn’t have yet.
Vitek is now working to train her clinic’s pediatric therapists, physical and occupational therapists, to run LSVT BIG themselves, using Wesley’s case and a handful of others as before-and-after examples. As an adult-focused therapist, she’s candid that pediatric specialists bring a toolkit for play-based engagement she’s still building. “I feel like it could be exponentially even better with someone that really understands pediatrics even more than I do,” she said. The hope is to expand referrals beyond Down syndrome to cerebral palsy, ataxia, and other pediatric conditions where intensive, high-repetition therapy could produce the same kind of gains.
This article is adapted from an episode of Think BIG and LOUD, the LSVT Global podcast, featuring Erica Vitek, MOT, OTR, BCB-PMD, PRPC, and Jessica Czajka-Glisch.
Claude assisted in the translation of this content from a podcast to a blog, edited by humans of course.
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