LSVT BIG STANDARD EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔Pathological findings for motor disorder - ✔✔Loss of dopaminergic neurons in the
substantia nigra
50-60% cell death at dx
70-80% loss of DA terminals
✔✔Primary motor symptoms - ✔✔Resting tremor
Rigidity
Postural instability
Brady and hypokinesia
✔✔Neural substrates for sensory disorder in PD - ✔✔kinesthetic mismatch that
contributes to brady and hypokinesia
✔✔Model for pre-treatment - ✔✔Reduced amplitude of motor output --> small
movements --> problem in self-awareness means they don'Roct realize that -->self
cueing deficits continue in the same movement pattern
✔✔Treatment cycle - ✔✔Increase amplitude of motor output --> bigger movements --
>improve self-awareness of amplitude needed -->improve cueing to habitually increase
amplitude of movement
✔✔Exercise acts upon... - ✔✔molecular machinery
✔✔When referral to PT/OT usually happens - ✔✔When people are already in the
parkinson's phase; more severe
✔✔Exercises impact in PD - ✔✔Hypothesis: increases neurotrophic factors which may
initiate cellular events that prevent vulnerable neurons
✔✔Inactivity is... - ✔✔Pro-degenerative
, ✔✔Principles of neuroplasticity - ✔✔1. intensity matters
2. complexity matters (more complex, greater plasticity)
3. repetition matters
4. salience matters (has to be rewarding)
5. timing matters
6. specificity matters (target hypo and brady)
✔✔LSVT general protocol - ✔✔1. 7 daily exercises
2. 5 functional tasks
3. walking big
4. hierarchy tasks
✔✔Paradigm shifts in care delivery - ✔✔1. Use modeling to bring about change
2. Minimize clinical explanations
3. Push the patient
✔✔Sustained daily exercises - ✔✔Floor to ceiling and side to side (both seated)
✔✔Repetitive daily exercises - ✔✔All standing exercises. last two both have 10 reps
instead of 8
✔✔Purpose of sustained exercise - ✔✔To enhance sustained muscle activity for daily
activities
✔✔Rock and reach exercises - ✔✔Do 10 reps and goal is to work up toward 20 reps
✔✔Common reasons to adapt exercises - ✔✔-fear of falling
-increasing success
-use positive reinforcement
✔✔Late PD adaptations - ✔✔-Use supports to hold onto
-use tactile adjustment or facilitation
-Break exercises down
-use a coach
-adapt it to be done in sitting
-reduce distractions
-decrease hold time or number of repetitions
-use adaptive equipment when walking
-add additional weeks to the protocol
✔✔Floor to ceiling adaptations - ✔✔-have them reach for something that is higher than
the floor
✔✔Side to side adaptation - ✔✔Put two chairs together to create more of a bench-like
surface
QUESTIONS SET A+
✔✔Pathological findings for motor disorder - ✔✔Loss of dopaminergic neurons in the
substantia nigra
50-60% cell death at dx
70-80% loss of DA terminals
✔✔Primary motor symptoms - ✔✔Resting tremor
Rigidity
Postural instability
Brady and hypokinesia
✔✔Neural substrates for sensory disorder in PD - ✔✔kinesthetic mismatch that
contributes to brady and hypokinesia
✔✔Model for pre-treatment - ✔✔Reduced amplitude of motor output --> small
movements --> problem in self-awareness means they don'Roct realize that -->self
cueing deficits continue in the same movement pattern
✔✔Treatment cycle - ✔✔Increase amplitude of motor output --> bigger movements --
>improve self-awareness of amplitude needed -->improve cueing to habitually increase
amplitude of movement
✔✔Exercise acts upon... - ✔✔molecular machinery
✔✔When referral to PT/OT usually happens - ✔✔When people are already in the
parkinson's phase; more severe
✔✔Exercises impact in PD - ✔✔Hypothesis: increases neurotrophic factors which may
initiate cellular events that prevent vulnerable neurons
✔✔Inactivity is... - ✔✔Pro-degenerative
, ✔✔Principles of neuroplasticity - ✔✔1. intensity matters
2. complexity matters (more complex, greater plasticity)
3. repetition matters
4. salience matters (has to be rewarding)
5. timing matters
6. specificity matters (target hypo and brady)
✔✔LSVT general protocol - ✔✔1. 7 daily exercises
2. 5 functional tasks
3. walking big
4. hierarchy tasks
✔✔Paradigm shifts in care delivery - ✔✔1. Use modeling to bring about change
2. Minimize clinical explanations
3. Push the patient
✔✔Sustained daily exercises - ✔✔Floor to ceiling and side to side (both seated)
✔✔Repetitive daily exercises - ✔✔All standing exercises. last two both have 10 reps
instead of 8
✔✔Purpose of sustained exercise - ✔✔To enhance sustained muscle activity for daily
activities
✔✔Rock and reach exercises - ✔✔Do 10 reps and goal is to work up toward 20 reps
✔✔Common reasons to adapt exercises - ✔✔-fear of falling
-increasing success
-use positive reinforcement
✔✔Late PD adaptations - ✔✔-Use supports to hold onto
-use tactile adjustment or facilitation
-Break exercises down
-use a coach
-adapt it to be done in sitting
-reduce distractions
-decrease hold time or number of repetitions
-use adaptive equipment when walking
-add additional weeks to the protocol
✔✔Floor to ceiling adaptations - ✔✔-have them reach for something that is higher than
the floor
✔✔Side to side adaptation - ✔✔Put two chairs together to create more of a bench-like
surface
