Imagine what it would be like to go from being a once active person to someone for whom it now takes 10 slow, deliberate steps just to get out of the car or five minutes to put your jacket on. And while navigating the aisles of the grocery store used to be easy, these days it feels more like you’re a snail climbing Mount Everest.

These are just a few of the scenarios patients living with Parkinson’s disease can face as the neurological illness takes its toll. Parkinson’s, which is a cluster of motor system disorders caused by a loss of dopamine in the brain, can create a debilitating tremor, rigidity in the limbs and trunk, a slowness of movement and a loss of balance or coordination. According to the National Parkinson Foundation, there is no cure for the disease and a doctor’s goal when treating Parkinson’s is to minimize symptoms through prescription medications.

Traditional physical therapy can play a part in assisting Parkinson’s patients who are suffering from a loss of balance or chronic falls, but that type of treatment isn’t geared toward tackling the neurological causes for those problems. However, in recent years, a new type of physical therapy has emerged that focuses less on remedying musculoskeletal impairments, and instead helps patients think about the art of moving.

Image of senior man suffering from dizziness

The treatment, referred to as LSVT (Lee Silverman Voice Treatment) BIG, is based on another Parkinson’s related treatment that helps patients who have had a decline in speech due to a loss of vocal volume. While the voice treatment encourages patients to talk louder, LSVT BIG tasks patients with thinking big – big movements that is.

In addition to causing a slowing of movement, Parkinson’s can distort a patient’s sense of movement, making him or her feel like they’re moving at a regular pace, when in actuality they are making small, jerky motions. Training patients to make larger, more fluid movements can actually normalize their motions and make it safer for them to do things like exit a car or walk through a crowded hallway.

So how does it work? It really is as simple as teaching patients larger movements as a mechanism to complete daily tasks. And the technique can help with either gross motor function or fine motor skills. LSVT BIG treatment typically includes four sessions a week for four weeks. Exercises focus on creating big postures, big hand movements, big steps and big fluid motions, such as swinging or pivoting the arms or legs to exit a car or put on a jacket. The goal is to help patients feel more comfortable moving in a larger pattern and navigating different tasks using those techniques.

Success happens when a patient for whom it once took 10 steps to get out of the car, can now do so in one fluid movement. For others, improvement may mean a general boost in confidence when they feel reassured they can easily stand up on their own and walk to the kitchen, bathroom or mailbox with ease.

Over time, those big movements will come naturally, and Parkinson’s patients can enjoy the art of moving comfortably through their day.


Ken Morris, PT, DPT, CMTPT, LSVT-Big currently serves as the Clinical Director for Tidewater Physical Therapy’s Hidenwood Clinic. Sarah Zeisler, PT, DPT, LSVT-Big came to Tidewater Physical Therapy as a physical therapy student, before joining the Hidenwood Clinic full-time as a physical therapist. Tidewater LSVT-Big therapy in Williamsburg, Magruder, Powhatan, Ironbridge and Franklin clinics as well.


Many of the physical therapists at Tidewater Physical Therapy Inc. hold Direct Access Certification through the Virginia Board of Physical Therapy.