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DOI 10.1007/s00702-014-1245-8
Abstract LSVT-BIG is an exercise for patients with (Tickle-Degnen et al. 2010). Recently, a technique named
Parkinson’s disease (PD) comprising of 16 1-h sessions ‘‘LSVT-BIG’’, derived from the Lee Silverman Voice
within 4 weeks. LSVT-BIG was compared with a 2-week Treatment (LSVT-LOUD), has been shown to improve
short protocol (AOT-SP) consisting of 10 sessions with motor performance in PD (Farley et al. 2008; Ebersbach
identical exercises in 42 patients with PD. UPDRS-III- et al. 2010). LSVT-BIG focuses on high-amplitude
score was reduced by -6.6 in LSVT-BIG and -5.7 in movements which are trained with multiple repetitions,
AOT-SP at follow-up after 16 weeks (p \ 0.001). Mea- high-intensity and increasing complexity. Intensity of
sures of motor performance were equally improved by training has been postulated to be crucial for success of
LSVT-BIG and AOT-SP but high-intensity LSVT-BIG was LSVT-BIG, but the standard protocol comprising of 16 (4/
more effective to obtain patient-perceived benefit. week for 4 weeks) individual 1-h therapy sessions is not
feasible for most in-patient settings and confers consider-
Keywords Parkinson’s disease LSVT-BIG Exercise able time and economic burden in ambulatory treatment.
Physiotherapy The aim of the current study was therefore to compare the
effects of the LSVT-BIG standard protocol with a shorter
protocol comprising of 10 (5/week for 2 weeks) sessions.
Introduction
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G. Ebersbach et al.
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Amplitude-oriented exercise in PD
performed separately for each group did not show effects with PD that was comparable to the effect reported in our
of treatment (LSVT-BIG: p 0.351; AOT-SP: p 0.534). previous study (Ebersbach et al. 2010). Changes in motor
Patient CGI-C differed between groups (p 0.005, Fish- assessments did not differ between patients following the
er’s exact test) with 70.6 % of patients reporting to be standard LSVT-BIG protocol and those receiving a smaller
‘‘much improved’’ or ‘‘very much improved’’ in LSVT- amount of training sessions. These findings oppose an
BIG and only 17.6 % in AOT-SP (Fig. 1). A corresponding expected dose dependency of therapy that would have
tendency was also found in physician CGI-C (68.8 vs. favored the standard LSVT-BIG protocol.
28.6 %, p 0.090). In contrast to motor examination, clinical global
impression strongly favored the standard protocol. The
dependency of motor performance in PD on attention
Discussion and situational circumstances is a possible reason for
this discrepancy. It has been shown that patients with
In the present prospective controlled, rater-blinded study, PD walk faster and with larger steps when concen-
LSVT-BIG led to improved motor performance in patients trating on their performance but return to bradykinetic
gait when attention is distracted from movement
execution (Morris et al. 1996; Rochester et al. 2010).
The underlying problem is that skill acquisition may
be preserved but the ability to transfer skills to
automatic routines is impaired (Rochester et al. 2010;
Wu and Hallett 2008). Motor assessments in the
present study were, as usual, carried out in a labora-
tory environment. It is therefore conceivable that
patients were more attentive towards motor perfor-
mance under these circumstances. Evidently, patients
in the short protocol were enabled to perform high-
amplitude movements as exercised during the LSVT-
BIG training sessions while being under examination.
Yet, the reduced training intensity of AOT-SP may
not have been sufficient enough to obtain the main
Fig. 1 Patients clinical global impression of change from baseline to
week 16 (in percent). LSVT-BIG standard protocol, AOT-SP ampli- goal of LSVT-BIG, i.e., recalibrating movement
tude oriented training short protocol amplitude to secure improved motor performance in
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G. Ebersbach et al.
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