LSVT BIG® was built for Parkinson’s disease — but emerging research suggests its principles of amplitude and recalibration may be transformative for stroke survivors too.
When LSVT BIG first emerged as a rehabilitation protocol for Parkinson’s disease, its core insight was deceptively simple: train the nervous system to move bigger, and daily function follows. The intensive, amplitude-focused program, sixteen one-hour sessions over four weeks, works by retraining sensory perception alongside motor output, helping patients recognize that movements which feel exaggerated are, in fact, simply normal. That principle, it turns out, may travel well beyond Parkinson’s disease.
Since 2018, researchers have been asking a quiet but important question: could LSVT BIG work for people living with the aftermath of a stroke? Five published studies now exist to help answer that question, and while the evidence base is still young and modest in scale, a consistent story is beginning to emerge. Here is what we now know.
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Understanding the Case for LSVT BIG in Stroke
Stroke and Parkinson’s disease are very different conditions, but they share at least one rehabilitative challenge: the neurological system that once generated normal-amplitude movement is compromised, and over time, the brain can adapt in ways that entrench smaller, compensatory patterns. In stroke, “learned nonuse”, the well-documented phenomenon where the affected limb is sidelined in favor of the intact one, is a persistent obstacle to recovery.
LSVT BIG’s neural plasticity-principled approach targets movement amplitude directly and pairs it with intensive repetition and sensory recalibration training. These are precisely the ingredients that motor learning research tells us drive neuroplastic change. The logic of applying it after stroke is therefore sound, but logic alone doesn’t make evidence. Researchers set out to test it.
“The neurological system learns what it practices. LSVT BIG asks stroke survivors to practice moving bigger, and the evidence is beginning to confirm that the brain responds.”
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The Five Studies: A Cumulative Picture
STUDY ONE
The First Case Study — Proffitt et al. (2018)
AMERICAN JOURNAL OF OCCUPATIONAL THERAPY · SINGLE CASE STUDY
This pioneering study was the first to explore LSVT BIG in the stroke population, noting at the outset that no prior literature existed on this application. Researchers examined the program’s effects in a 52-year-old community-dwelling woman with mild-to-moderate upper extremity hemiparesis two years post-stroke, also evaluating whether a game-based virtual reality platform could support the home exercise component.
KEY FINDINGS
The participant showed large improvements in upper extremity motor function, with a 45% decrease in average task time on the Wolf Motor Function Test, well above the minimal detectable change threshold. She reported meaningful improvements in occupational performance and satisfaction as measured by the Canadian Occupational Performance Measure (COPM). Active range of motion improved to within normal or functional limits, shoulder and wrist strength increased modestly, and elbow spasticity decreased.
STUDY TWO
LSVT BIG in Late Stroke Rehabilitation — Metcalfe, Egan & Sauvé-Schenk (2019)
CANADIAN JOURNAL OF OCCUPATIONAL THERAPY · SINGLE-CASE EXPERIMENTAL DESIGN
This Canadian study was the first to use a single-case experimental design with replication, examining whether LSVT BIG could improve client-identified occupational goals and reduce impairment in two adults who had experienced strokes three and twelve years prior, a notably chronic population in whom further functional gains are often considered unlikely. Participants selected up to six personal occupational goals, and the intervention was applied to half of them to allow comparison of trained versus untrained activities. Repeated measures were taken using the Canadian Occupational Performance Measure (COPM) and the Rating of Everyday Arm-Use in the Community and Home (REACH).
KEY FINDINGS
Performance improved on either self-assessment or blinded-rater assessment for all but one activity — including activities that had not been directly trained during the program, demonstrating meaningful generalization of gains. The study concluded that LSVT BIG is a promising intervention to improve occupational performance even years after stroke onset, and called for further research to clarify which elements of the program are essential to driving those improvements.
STUDY THREE
Feasibility in Chronic Stroke — Proffitt et al. (2021)
OTJR: OCCUPATION, PARTICIPATION AND HEALTH · WAITLIST CROSSOVER DESIGN
Recognizing that a single case study, however promising, could not establish feasibility at a program level, this study was specifically designed to ask: can LSVT BIG actually be delivered to the chronic stroke population in a real-world clinical context? The researchers contacted 888 potential participants. Of the 35% who expressed interest, most were ultimately ineligible — the most common barrier being lack of transportation to the clinic. Five individuals were eligible and enrolled.
KEY FINDINGS
All five participants completed 100% of their in-clinic sessions, demonstrating excellent adherence to the intensive protocol. Four of the five participants rated their occupational performance as higher following the LSVT BIG intervention. The study concluded that delivery of LSVT BIG in the chronic stroke population is feasible, and that those who complete the protocol demonstrate clinically relevant improvements. Crucially, the recruitment challenge, primarily transportation, offered a clear mandate for telerehabilitation-based delivery or therapy provided in a person’s home.
STUDY FOUR
LSVT BIG Across Neurological Conditions: A Mini Review — Won, Jang & Park (2025)
BRAIN SCIENCES · SYSTEMATIC MINI REVIEW
This was the first review study to specifically examine the effectiveness of LSVT BIG for neurological diseases other than Parkinson’s disease. Published in Brain Sciences in March 2025, the authors, occupational and physical therapists at Kangwon National University in South Korea, searched Google Scholar, PubMed, and ScienceDirect through December 2024 using terms including ‘Neurological disease’, ‘LSVT BIG’, ‘Treatment or Rehabilitation’, and ‘Intervention’. Eight studies met the inclusion criteria and were analysed in full.
KEY FINDINGS
Of the eight studies reviewed, four focused on stroke, all conducted by occupational therapists, and four examined other neurological conditions: two on progressive supranuclear palsy, one on idiopathic normal pressure hydrocephalus, and one on Huntington’s disease (the latter four all conducted by physical therapists). Across all populations, LSVT BIG had a positive effect on improving physical function and overall motor control. The review specifically noted that the stroke studies demonstrated meaningful gains and that the program shows strong potential as an intervention tool beyond its Parkinson’s origins. The authors called for future studies with higher-level evidence-based designs and larger sample sizes to further establish effectiveness.
STUDY FIVE
Telerehabilitation-Delivered LSVT BIG in Chronic Stroke — Jeong, Hong & Choi (2026)
OCCUPATIONAL THERAPY INTERNATIONAL · SINGLE-SUBJECT EXPERIMENTAL STUDY
The most recent addition to the evidence base, published in Occupational Therapy International in early 2026, examined the effects of telerehabilitation-delivered LSVT BIG on physical function, occupational performance, and activities of daily living in three patients diagnosed with chronic stroke (more than six months post-onset). Using an ABA single-subject design across 24 sessions over six weeks, four sessions of baseline, sixteen intervention sessions via ZOOM at four times per week for 60 minutes each, followed by four re-baseline sessions, the study applied the standardized LSVT BIG protocol in full. Outcome measures included the Timed Up and Go (TUG) and Box and Block Test (BBT) at each session, with the Canadian Occupational Performance Measure (COPM), Modified Barthel Index (MBI), and Fugl-Meyer Assessment (FMA) assessed pre- and post-intervention.
KEY FINDINGS
All three participants demonstrated improvement in physical function across every domain measured. TUG performance time decreased session by session, reflecting progressive gains in gait and balance. BBT and FMA scores for the affected upper limb both increased, indicating meaningful improvement in upper extremity motor function. COPM performance and satisfaction scores and MBI scores all improved post-intervention, confirming gains not only in motor capacity but in real-world occupational performance and independence in daily activities. The authors concluded that telerehabilitation-delivered LSVT BIG has positive clinical applicability for patients with chronic stroke, and called for follow-up studies expanding the telerehabilitation model to broader populations.
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What the Evidence Tells Us: Five Consistent Themes
EMERGING CONSENSUS
- Upper limb function improves. Across the stroke studies, motor function of the affected upper limb improves on validated tools including the Wolf Motor Function Test (Study 1), Fugl-Meyer Assessment (Study 5), and Box and Block Test (Study 5) — a pattern consistent enough that Won et al.’s (2025) review formally concluded LSVT BIG has a positive effect on physical function in stroke.
- Generalization beyond trained tasks. Metcalfe et al. (2019) found that gains extended to activities not directly practiced during treatment — a hallmark of neuroplastic change and a particularly meaningful result for daily life carryover.
- Occupational performance gains. The COPM is used as a primary outcome across multiple studies, with scores improving consistently — reflecting that clients notice real-world changes in their ability to perform the activities that matter most to them personally.
- Works in chronic stroke. Participants as far as twelve years post-stroke have shown meaningful improvement (Metcalfe et al., 2019), and all stroke participants in Jeong et al. (2026) were more than six months post-onset — collectively challenging the assumption that the window for functional recovery closes early.
- Telerehabilitation is viable. Jeong et al. (2026) confirmed that LSVT BIG delivered entirely via ZOOM produces improvements in gait, balance, upper limb function, and ADL in chronic stroke — directly addressing the transportation barrier Proffitt et al. (2021) identified as the primary obstacle to access.
- Evidence spans stroke and beyond. Won et al.’s (2025) review found positive outcomes not only across all four stroke studies but also in progressive supranuclear palsy, normal pressure hydrocephalus, and Huntington’s disease — strengthening the case that LSVT BIG’s amplitude and recalibration principles translate broadly across neurological diagnoses.
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Limitations and What We Still Don’t Know
It would be a disservice to the evidence to overstate what five studies, predominantly single-case and small-group designs, can tell us. The current body of research is promising, but preliminary. There are no randomized controlled trials in the stroke population specifically. Won et al.’s (2025) mini review synthesized the available evidence helpfully, but noted that the studies it examined had small sample sizes and called explicitly for higher-level evidence-based designs. Questions about optimal dosing, timing post-stroke, which stroke presentations respond best, and the durability of gains at long-term follow-up remain largely unanswered.
The notable concentration of this research within occupational therapy also reflects an opportunity for physiotherapy colleagues to engage with the question — gait, balance, and whole-body amplitude training through the LSVT BIG framework have yet to be examined systematically in stroke as they have been in other neurological conditions including multiple sclerosis and progressive supranuclear palsy.
The recruitment challenges documented in the 2021 feasibility study are themselves an important finding: the individuals most likely to benefit from intensive stroke rehabilitation are often those facing the greatest access barriers. Telerehabilitation or therapy provided in a person’s home may be not just a convenience, but a necessity if this intervention is to reach the people who need it most.
“Five studies in, the signal is consistent and clinically encouraging. LSVT BIG does not yet have a randomized trial in stroke — but it has something rarer: a coherent mechanistic rationale, a growing pattern of positive findings, and a research team that has progressively addressed its own identified limitations.”
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The OT Perspective: Why This Matters for Practice
All five studies to date have been conducted by occupational therapists, and this is not accidental. LSVT BIG’s emphasis on client-identified occupational goals, its use of the COPM as a primary outcome measure, and its explicit focus on the carryover of intensive motor retraining into daily life align naturally with occupational therapy’s theoretical foundations. The program asks not just “can this person move their arm further?” but “can this person do what they want and need to do?”
For clinicians working in neurological rehabilitation, the evidence offers a thoughtful provocation: an intervention that was developed for a fundamentally different disease mechanism is producing consistent, occupation-centered gains in a stroke population that is often considered to have plateaued. The intensive format, sixteen sessions over four weeks, is demanding to schedule and resource, but the adherence data suggest that patients who begin the program commit to it. That clinical reality is worth noting.
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The Bottom Line
Five published studies, beginning with a single case report in 2018, building through single-case experimental designs and a feasibility trial, synthesised in a 2025 multi-neurological mini review, and confirmed in a 2026 telerehabilitation trial, now collectively support LSVT BIG as a promising intervention for adults living with the effects of stroke. Improvements in upper limb motor function, occupational performance, gait, balance, and activities of daily living have been documented across participants ranging from two to twelve years post-stroke, in both clinic-based and telerehabilitation formats.
The evidence is not yet definitive, randomized controlled trials are needed, but the pattern is coherent, consistent, and clinically meaningful. For stroke survivors who have been told there is little more to gain, LSVT BIG’s simple directive may be the most important thing a therapist can offer: Think BIG.
REFERENCES
Proffitt, R. M., Henderson, W., Scholl, S., & Nettleton, M. (2018). Lee Silverman Voice Treatment BIG® for a person with stroke. American Journal of Occupational Therapy, 72(5), 7205210010p1–7205210010p6. https://doi.org/10.5014/ajot.2018.028217
Metcalfe, V., Egan, M., & Sauvé-Schenk, K. (2019). LSVT BIG in late stroke rehabilitation: A single-case experimental design study. Canadian Journal of Occupational Therapy, 86(2), 87–94. https://doi.org/10.1177/0008417419832951
Proffitt, R., Henderson, W., Stupps, M., Binder, L., Irlmeier, B., & Knapp, E. (2021). Feasibility of the Lee Silverman Voice Treatment–BIG intervention in stroke. OTJR: Occupation, Participation and Health, 41(1), 40–46. https://doi.org/10.1177/1539449220932908
Won, C., Jang, W., & Park, S. (2025). Effectiveness of Lee Silverman Voice Treatment (LSVT)-BIG for neurological diseases other than Parkinson’s disease: Mini review. Brain Sciences, 15(4), 367. https://doi.org/10.3390/brainsci15040367. PMID: 40309838; PMCID: PMC12026423.
Jeong, S. A., Hong, D. G., & Choi, I. T. (2026). Effectiveness of telerehabilitation-delivered LSVT-BIG on motor function in chronic stroke patients: A single-subject experimental study. Occupational Therapy International, 2026, 2901762. https://doi.org/10.1155/oti/2901762. PMID: 41766752; PMCID: PMC12947247.
AI (Claude) assisted in the creation of this blog, edited by humans of course.