June 11, 2021

“BIG” Therapy: Specialized physical therapy for people with Parkinson’s disease helps improve symptoms

David Dennis, of Acushnet, worked as an engineer at the Polaroid Corporation in New Bedford for many years before retiring. Over the years, he enjoyed a variety of activities with his wife and sons, including his hobby as a rally car driver on challenging routes, including Mount Washington in New Hampshire. 

Beginning in 2016, though, David started to notice physical changes that were becoming more pronounced. He was more tired than usual, and he developed a tremor. Sensing that these were more than temporary, he consulted a neurologist who, after a series of tests, diagnosed David with Parkinson’s disease.

Parkinson’s affects the nervous system, resulting in smaller and slower movements that alter balance, coordination and posture. For people like David, ordinary daily activities become more difficult. Fine motor skills, such as buttoning a shirt or writing, or gross motor skills, such as walking, getting into bed, or rising from a chair, become increasingly challenging. 

While there is currently no cure for Parkinson’s, there is therapy that can improve the symptoms. A specialized physical therapy program known as LSVT BIG® – available now at Saint Anne’s Hospital Rehabilitation Services – teaches patients over the course of four intensive weeks how to develop “bigger” movements that can enable them to use their bodies more easily and effectively for everyday activities, like walking, self-care, and other physical activities. 

David’s neurologist thought he was a good candidate for BIG therapy and referred him to Saint Anne’s. Because his disease had progressed quickly – “going from nothing to using a walker,” he said – he was willing and motivated to improve his symptoms.

Denise Strycharz, MSPT, David’s BIG-certified physical therapist at Saint Anne’s, notes that the program relies on “big movement, plus big effort.”

“Patients work very hard in their therapy sessions and their home care program,” she said. “Repetitive exercises that involve exaggerated movement, tasks, and cue words train the brain to work with the body. Patients expend a lot of energy in each session, which is very tiring, but also results in real progress.”

David’s wife Diane Tripp firmly believes in the value of BIG therapy. 

“The difference I saw after just one week was unbelievable,” she said. “By the end of his rehab, I saw David do simple things like picking up a box of tissues without thinking. Even that wasn’t possible before he began therapy. I can’t say enough about the program.”

What is BIG therapy?
Developed for a Parkinson’s patient named Lee Silverman whose family initially sought help for her symptoms, LSVT BIG® is evidence-based therapy that teaches patients to achieve more effective movement through repetition and a series of carefully designed exercises.

Four times a week for four weeks, patients meet one-on-one for one hour with a BIG-certified physical therapist to perform specially designed exercises. Each session is designed to teach how more intentional movements can help improve function and mobility. 

At the outset, patients work with the therapist to set goals for improvement. Each session then uses highly customized exercises and functional tasks designed to meet the patient’s individual symptoms and needs. By using repetitive exercises, tasks and cue words, patients relearn movements that were once automatic. In this way, BIG not only improves physical strength, balance, mobility, and function, but increases confidence and independence.

Once discharged from outpatient therapy sessions, patients are encouraged to continue a daily exercise routine at home to help them maintain or even improve their mobility and function. LSVT BIG offers "Homework Helper" videos for rent or purchase, and patients can join a weekly “BIG for Life” class offered via Zoom, too. 

Who qualifies for BIG therapy?
David Dennis is one of more than one million Americans who are living with Parkinson’s disease. BIG can help adults of all ages in the early to middle stages of Parkinson’s, but treatment also can help people with later-stage disease, unusual signs and symptoms, or movement challenges from other neurological conditions.

BIG therapy is provided in the outpatient setting. A referral from a primary care provider or neurologist is required, and services are covered by Medicare and most insurances. 

To learn more
Saint Anne’s Hospital Rehabilitation Services provides LSVT BIG therapy at its outpatient center in Fall River. For inquiries and referrals, call 508-646-9470.

Information also is available online at