Online LSVT BIG Training and Certification Workshop Syllabus

Course Description:
The Online LSVT BIG Training and Certification Course trains physical and occupational therapy
professionals and students in an evidence-based, intensive treatment protocol for individuals with
Parkinson disease. The fundamental treatment principles and rationale, key treatment elements,
efficacy data supporting treatment outcomes, details of treatment tasks, and practical delivery and
marketing considerations will be covered. Teaching techniques include pre-recorded lecture, 99 video
demonstrations, and case study presentations. Discussion will be included on application to other
neural disorders and customization of treatment delivery to meet the unique functional goals of each
patient. Knowledge review questions after each module and scheduled practice times ensure the
highest levels of learning.

Learning Objectives:
Upon conclusion of this workshop, participants (Physical and Occupational Therapy Professionals
and Students) will be able to:
• Describe three paradigm shifts unique to LSVT BIG treatment
• Provide rationale for using a single target of amplitude when working with patients with
Parkinson’s disease.
• Correctly identify at least three key principles used in LSVT BIG that drive activity dependent
neuroplasticity.
• Discuss efficacy findings that support use of LSVT BIG for persons with Parkinson’s disease.
• Provide the rationale for each of the Maximal Daily Exercises
• Describe the correct performance techniques of the LSVT Maximal Daily Exercises
• Given patient scenarios of patients with Parkinson’s disease with various levels of function,
describe how to adapt or progress LSVT BIG treatment.
• Correctly list 5/5 teaching techniques unique to LSVT protocols.
• Differentiate between Functional Component Tasks, Hierarchy Tasks, and Carryover tasks.
• Identify the purposes of Functional Component Tasks, Hierarchy Tasks, and Carryover Tasks.
• Provide an example of calibration in LSVT BIG.
• Synthesize data from patient interview, examination, stimulability tests and results of standardized
tests to determine if the patient will benefit from LSVT BIG treatment.

Course Index:
Module 01: Introduction (27:50)
• Resources: Slides, Course Syllabus, LSVT BIG Policies and Procedures, Clinician Practice
Agreement
• Knowledge Review Questions: 3
• Learning Objectives:
o Identify key elements of the Learning Management System (LMS) that will allow you to
effectively progress through the course
 o Describe the important points in the LSVT BIG Clinician Practice Agreement and what you
can and cannot do as an LSVT BIG Certified Clinician

Pre-knowledge Assessment
Module 02: Background on LSVT (24:00)
• Resources: Slides
• Knowledge Review Questions: 4
• Learning Objectives:
o Define LSVT BIG
o Identify how advances in neuroscience have impacted the field of rehabilitation

Module 03: Definition of LSVT BIG and Focus of Amplitude (14:33)

• Resources: Slides
• Knowledge Review Questions: 3
• Learning Objectives:
o Compare and contrast traditional therapy methods for PD with LSVT BIG
o Identify the rationale for treating amplitude Parkinson Disease
o Describe the value of a single treatment target in maximizing outcomes and efficiency in
treatment

Module 04: LSVT BIG Paradigms Mode and Calibration (22:03)

• Resources: Slides
• Knowledge Review Questions: 5
• Learning Objectives:
o Understand the rationale for intensive and high effort delivery of LSVT BIG
o Define calibration in LSVT BIG

Module 05: Overview of Parkinson disease (19:55)

• Resources: Slides, Modified Hoehn and Yahr Scale, UPDRS
• Knowledge Review Questions: 4
• Learning Objectives:
o Identify major medical treatments for Parkinson disease
o Recognize diagnostic criteria for PD

Module 06: Origin of PD: Motor and Non-motor symptoms (26:38)

• Resources: Slides
• Knowledge Review Questions: 4
• Learning Objectives:
o Identify both motor and non-motor symptoms of Parkinson disease
o Identify which motor deficits LSVT BIG targets
o Demonstrate an understanding of the three underlying non-motor deficits in Parkinson
disease that calibration addresses
o Describe the motor, sensory, and neuropsychological deficits in Parkinson disease and
how LSVT BIG addresses them
Module 07: Patient demonstration video (46:30)
• Resources: Slides
• Knowledge Review Questions: 3
• Learning Objectives:
o Correctly describe the best method for shaping amplitude during “BIG walking”
o Identify the way that modeling is used to teach motor tasks in LSVT BIG
o Be able to recognize the seven Maximal Daily Exercises used in LSVT BIG

Module 08: Activity Dependent Neuroplasticity in PD (29:54)

• Resources: Slides
• Knowledge Review Questions: 4
• Learning Objectives:
o Identify key principles of exercise that drive activity-dependent neuroplasticity
o Understand the importance for repetition in driving activity dependent neuroplasticity
o Discuss the rationale for early intervention in Parkinson disease
o Identify how LSVT BIG adheres to key principles that optimize neuroplasticity

Module 09: Background of LSVT LOUD, and evolution of LSVT BIG (24:52)
• Resources: Comparison Chart (LSVT LOUD to LSVT BIG), Slides
• Knowledge Review Questions: 4
• Learning Objectives:
o Explain the efficacy data supporting LSVT LOUD
o Understand what is meant by the “spread of effects” of amplitude based training
o Detail the general breakdown of an LSVT BIG treatment session

Module 10: Research on LSVT BIG (23:45)

• Resources: Slides, Berlin LSVT BIG articles (2)
• Knowledge Review Questions: 3
• Learning Objectives:
o Explain the efficacy data supporting LSVT BIG

Module 11: Introduction to LSVT BIG Methods (14:42)

• Resources: Slides, LSVT BIG Standard Maximal Daily Exercises
• Knowledge Review Questions: 4
• Learning Objectives:
o Understand the ideal distribution of time of an LSVT BIG treatment session throughout the
four week protocol
o Describe LSVT BIG methods in relation to principles of motor learning and neural plasticity

Module 12: Seated and sustained exercises (19:13)

• Resources: Slides
• Knowledge Review Questions: 2
• Learning Objectives:
 o Identify the KEY purposes of the seated and sustained exercises
o Correctly perform the seated and sustained exercises
• LIVE PRACTICE TIME

Module 13: Repetitive Stepping and Reaching Exercises (22:01)

• Resources: Slides
• Knowledge Review Questions: 2
• Learning Objectives:
o Correctly perform all three stepping and reaching exercises
o Identify the KEY purposes of the repetitive stepping and reaching exercises
• LIVE PRACTICE TIME

Module 14: Rocking and Reaching Exercises (17:45)

• Resources: Slides
• Knowledge Review Questions: 2
• Learning Objectives:
o Correctly perform both of the rocking and reaching exercises
o Identify the KEY purposes of the repetitive rocking and reaching exercises
• LIVE PRACTICE TIME

Module 15: Adaptations of Seated Maximal Daily Exercises (23:17)

• Resources: Slides, Adapted Maximal Daily Exercises
• Knowledge Review Questions: 4
• Learning Objectives:
o Identify reasons for choosing to adapt the Seated and Sustained Maximal Daily Exercises
o Describe methods of adapting the Seated and Sustained Maximal Daily Exercises

Module 16: Adaptations of Repetitive Standing Exercises (10:47)

• Resources: Slides
• Knowledge Review Questions: 2
• Learning Objectives:
o Identify reasons for choosing to adapt the Stepping and Rocking Maximal Daily Exercises
o Describe methods of adapting the Stepping and Rocking Maximal Daily Exercises

Module 17: Maximal Daily Exercises Broken into Components and/or Adapted to a Seated or
Supine Position (12:00)
• Resources: Slides, LSVT BIG Exercises Adapted to Sitting and Supine
• Knowledge Review Questions: 3
• Learning Objectives:
o Identify reasons for choosing to adapt the Stepping and Rocking Maximal Daily Exercises
into upper and lower body components or to a seated or supine position
o Describe methods of adapting the Maximal Daily Exercises to a seated or supine position
or broken into components.
Module 18: Progression of Maximal Daily Exercises (15:04)
• Resources: Slides
• Knowledge Review Questions: 3
• Learning Objectives:
o Discuss rationale for progressing performance requirements in LSVT BIG
o List various methods of progressing the treatment or adding challenge

Module 19: Teaching Techniques – Model and Shape (18:26)

• Resources: Slides
• Knowledge Review Questions: 4
• Learning Objectives:
o List 5 key teaching techniques used in LSVT BIG
o Define “modeling” as it pertains to LSVT BIG treatment
o Understand rationale for modeling as a teaching technique
o Define “shaping” as it pertains to LSVT BIG treatment
o Describe how to perform shaping

Module 20: Teaching Techniques – Drive, Stabilize, Calibrate (20:32)

• Resources: Slides, Perceived Bigness Effort Scale
• Knowledge Review Questions: 3
• Learning Objectives:
• Understand purpose of driving muscle activation
o Correctly identify a statement that could be used to stabilize a movement
o Define “stabilize” as it pertains to LSVT BIG treatment
o Correctly identify a calibration statement that could be used during the Maximal Daily
Exercises
• LIVE PRACTICE TIME

Module 21: Functional Component Tasks (17:34)

• Resources: Slides, Functional Task Recording Form, Functional Task Identification
• Knowledge Review Questions: 3
• Learning Objectives:
o Define Functional Component Tasks
o Understand the rationale for Functional Component Tasks
o Explain implementation of generating Functional Component Tasks
o Correctly identify five potential Functional Component Tasks

Module 22: Adaptations and Progressions of Functional Component Tasks (13:46)

• Resources: Slides
• Knowledge Review Questions: 3
• Learning Objectives:
o Discuss rationale for choosing to adapt Functional Component Tasks
o Identify how LSVT BIG treatment applies to fine motor tasks
 o Be able to effectively train Functional Component Tasks using prescribed teaching
methods

Module 23: “BIG” Walking (15:41)

• Resources: Slides
• Knowledge Review Questions: 6
• Learning Objectives:
o Identify the goal of “BIG walking” with LSVT BIG
o List potential progressions of “BIG walking” with LSVT BIG
o Understand how to implement teaching methods with “BIG walking”

Module 24: Hierarchy Tasks Introduction (13:25)

• Resources: Slides
• Knowledge Review Questions: 3
• Learning Objectives:
o Correctly define a “Hierarchy Task”
o Identify purposes of Hierarchy Task training
o Explain process of generating Hierarchy Tasks

Module 25: Hierarchy Task Implementation (32:17)

• Resources: Slides, Hierarchy Example, Hierarchy Worksheet,
• Knowledge Review Questions: 4
• Learning Objectives:
o Explain progression of Hierarchy Task training
o Discuss the importance of making a link between the Maximal Daily Exercises and the
Hierarchy Tasks
o Differentiate between Hierarchy Tasks and Functional Component Tasks
• LIVE PRACTICE TIME

Module 26: Summary of LSVT BIG Treatment Sessions (13:42)

• Resources: Slides
• Knowledge Review Questions: 5
• Learning Objectives:
o Identify at least five areas of improvement one can expect to see over time with LSVT BIG
o Correctly describe key points to focus on when providing LSVT BIG
o Define “positive spin” and be able to provide an example
o Understand importance of correct amplitude scaling
o Discuss habits to avoid with the daily exercises and Hierarchies
o Explain the role of feedback across treatment sessions
o Explain the rationale for “pushing” the patient

Module 27: Treatment of Freezing using LSVT BIG (16:14)

• Resources: Slides
• Knowledge Review Questions: 5
• Learning Objectives:
o Understand how LSVT BIG targets freezing
o List at least five situations in which freezing is commonly experienced in people with PD
o Correctly identify how treatment of freezing can be incorporated into the LSVT BIG protocol

Module 28: Calibration Education (18:15)

• Resources: Slides, Video Recording Form, Relative Movement Amplitude Model
• Knowledge Review Questions: 4
• Learning Objectives:
o Define when calibration activities begin in treatment
o Explain the rationale for education as an area of calibration
o Explain implementation of education during treatment sessions
o Describe how using video feedback can help convince patients that the new bigger
movements are within normal limits

Module 29: Calibration in the Treatment Setting (8:45)

• Resources: Slides
• Knowledge Review Questions: 3
• Learning Objectives:
o Understand how calibration is embedded into the treatment session
o Correctly identify statements that would facilitate calibration during a treatment session

Module 30: Calibration through Carryover Assignments (19:01)

• Resources: Slides, Carryover Assignments, Carryover Sample Dialogue
• Knowledge Review Questions: 2
• Learning Objectives:
o Explain the rationale for carryover exercises in LSVT BIG
o Define carryover exercises as they are used in LSVT BIG
o Explain how carryover exercises are implemented in LSVT BIG

Module 31: Calibration Homework (12:38)

• Resources: Slides, LSVT BIG Homework Form
• Knowledge Review Questions: 3
• Learning Objectives:
o Explain the rationale for homework in LSVT BIG
o Describe how homework is assigned (what tasks and how often) in LSVT BIG
o Explain the goal of homework exercises during the one month of treatment and after treatment
has ended
o Explain the role of spouse/family in LSVT BIG

Module 32: Calibration Criteria (18:13)

• Resources: Slides, Calibration Chart, Calibration Education Tips, LSVT BIG Skills Checklist
• Knowledge Review Questions: 4
• Learning Objectives:
 o Explain how to evaluate successful calibration during LSVT BIG
o Describe the clinician’s role in ensuring calibration is successful
o Explain what is meant by “don’t let small movements slip by” and the role it plays in
calibration

Module 33: Follow-up Recommendations (13:25)

• Resources: Slides
• Knowledge Review Questions: 3
• Learning Objectives:
o Understand the expectations to be met prior to discharge o List post discharge
expectations
o Explain rational for a “tune-ups” in LSVT BIG

Module 34: LSVT BIG Quantification (29:34)

• Resources: Slides, LSVT BIG Assessment Packet, UPRDS Rating Form, UPDRS Rating Scale
• Knowledge Review Questions: 3
• Learning Objectives:
o Describe the key elements of the initial assessment o Understand the importance of timing
when performing initial and discharge evaluations
o Define “stimulability testing”
o Describe role of stimulability testing in LSVT BIG o Identify ways in which a LSVT BIG
examination differs from a traditional therapy examination

Module 35: Reimbursement and Documentation (11:20)

• Resources: Slides, LSVT BIG Therapy Session Form, LSVT BIG Homework Form, LSVT BIG
Documentation Examples
• Knowledge Review Questions: 3
• Learning Objectives:
o Recognize potential quantification variables that could be used in documenting progress
made with LSVT BIG
o Describe some of the key elements of documentation that are needed for reimbursement of
LSVT BIG

Module 36: Real World Application of LSVT BIG (6:22)

• Resources: Slides
• Knowledge Review Questions: 5
• Learning Objectives:
o Explain the protocol for deciding if LSVT BIG is appropriate for adults with other
neurological disorders
o Identify selection criteria for the best responders to LSVT BIG
o Identify considerations in using LSVT BIG with patients who have advanced PD and/or
other challenging co-morbidities
Module 37: Interdisciplinary Care in PD (9:49)
• Resources: Slides, Home Care Delivery of LSVT BIG form
• Knowledge Review Questions: 3
• Learning Objectives:
o Discuss strategies for successful interdisciplinary care in people with PD using LSVT BIG
and LSVT LOUD
o Recognize how both PT and OT can collaborate to provide holistic care for the patient
using LSVT BIG
o Identify benefits of interdisciplinary care in people with PD using LSVT LOUD and LSVT
BIG

Module 38: Review of Paradigm Shifts (18:37)

• Resources: Slides, LSVT BIG Essential Concepts
• Knowledge Review Questions: 3
• Learning Objectives:
o Revisit the three paradigm shifts that are unique to LSVT BIG
o Explain additional data and support of these paradigms

Module 39: Marketing LSVT BIG (18:11)

• Resources: Slides, LSVT Fact Sheets
• Knowledge Review Questions: 3
• Learning Objectives:
o Identify ways LSVT BIG can be successfully marketed
o Describe how the LSVT Clinician search works and how to update your personal profile
o Recognize resources for getting help or asking questions about LSVT BIG (email,
webinars, forums)

Module 40: Future Directions and Conclusions (18:44)

• Resources: Slides
• Knowledge Review Questions: 2
• Learning Objectives:
o Review the “next steps” in LSVT BIG certification

LSVT BIG Certification Exam

LSVT BIG Workshop Survey

Total Run Time for Modules 01-40: 12 hours, 40 minutes

Instructor Bios:
Cynthia Fox, Ph.D., CCC-SLP
Dr. Fox received her doctorate degree in Speech and Hearing Sciences from the University of
Arizona, Tucson. Dr. Fox is a Research Associate at the National Center for Voice and Speech, an
affiliate of the University of Colorado-Boulder and Co-Founder of LSVT Global, Inc. Dr. Fox is among
the world’s experts in speech treatment for people with Parkinson disease. She has multiple
publications in this area of focus, as well as numerous national and international research and clinical
presentations. Dr. Fox has worked closely with Dr. Ramig for the past 15 years on studies examining
the efficacy of LSVT LOUD™, the underlying mechanisms of speech disorders in Parkinson disease,
and the application of LSVT LOUD to other disorders (children and adults) and other motor systems
(e.g., limb). She is an expert on rehabilitation and neuroplasticity and the role of exercise in the
improvement of function consequent to neural injury and disease.

Jenny Tuccitto, BS, MPT, GCS

Ms. Tuccitto received her Master’s degree in Physical Therapy from the College of St Catherine in
Minneapolis, MN in 2001. As a physical therapist she treats a wide variety of clients with neurological
and/or orthopedic diagnoses at Courage Kenny Rehabilitation Institute, part of Allina health in
Minnesota. She serves as the facility lead for treatment of clients with Parkinson disease. Ms.
Tuccitto is an LSVT BIG Faculty member & Expert Clinician, and has assisted with development of
many LSVT BIG treatment tools including the LSVT BIG Homework Helper DVD. She has presented
for the National Parkinson Foundation, the Minnesota Physical Therapy Association and at the
American Speech and Hearing Association on LSVT BIG as well as being actively involved with local
Parkinson support groups.

Laura Gusé, MPT

Ms. Guse´ received her Master’s Degree in Physical Therapy from the University of North Dakota.
Ms. Guse´ has worked extensively in the area of neurogenic disorders since then, both in outpatient
and inpatient settings. She has specialized in treatment of Parkinson disease and Multiple Sclerosis.
She has been certified in LSVT BIG® since 2009. She is an LSVT BIG faculty member and Expert
Clinician, and has helped to develop many of the current LSVT BIG treatment tools, webinars and
curriculum. She now serves as the Chief Clinical Officer of LSVT BIG for LSVT Global.
 Online LSVT BIG Training and Certification Workshop
Self-Practice Guidelines
General Instructions:
1. Wear comfortable clothes and shoes you can exercise freely in. Avoid shoes like flip flops and
heels.
2. Adequate space around you is very important so you can move BIG! You will need a space large
enough so that you can take a BIG step forward, backward and sideways without any
obstructions. This space should be within viewing distance of the computer monitor or screen so
that you can practice the movements along with the videos.
3. You will need a firm chair without arms rests for optimal practice of the two seated and sustained
exercises.
4. If you cannot practice the exercises near your computer monitor, we suggest you print off the
Maximal Daily Exercise attachment, watch the video demonstrating the exercise, and then
practice it in an open area using the handout as a reference.
5. Practicing of ALL physical aspects of the LSVT BIG treatment protocol (Maximal Daily Exercises,
BIG walking, Functional Component Tasks, and Hierarchy Tasks) is vital to your success as a
clinician! There is built in practice time for the Maximal Daily Exercises, Hierarchy Tasks and
Teaching Techniques, and there are videos clearly demonstrating Functional Component Tasks
and BIG walking. Although there is no built in practice time for the Functional Component Tasks
and BIG walking, please take time to practice them after you have learned the LSVT BIG
Teaching Techniques. We urge you to take this practice time seriously so that you are confident
and well prepared when you begin treating patients.
6. Practicing on others is a great way to learn, especially the Teaching Techniques. We encourage
you to “practice” on friends, family, colleagues or whoever you can find before you start treating
patients with LSVT BIG! Again, our mission is to help YOU become successful as you provide
LSVT BIG to your future patients, and practice will be a key factor in your success.

Location of Self-Practice Slides:

Floor to Ceiling Exercise: Module 12, Slide 8
Side to Side Exercise: Module 12, Slide 13
Step Forward and Reach Exercise: Module 13, Slide 9
Step Sideways and Reach Exercise: Module 13, Slide 14
Step Backwards and Reach Exercise: Module 13, Slide 19
Forward/Backward Rock and Reach: Module 14, Slide 7
Sideways Rock and Reach: Module 14, Slide 12
Teaching Methods Practice-Putting it All Together: Module 20, Slide 25
Hierarchy Task Practice: Module 25, Slide 23