Exploring the Potential of Lee Silverman Voice Treatment BIG for Improving Balance and Gait in Patients with Multiple Sclerosis: A Pilot Study
Source abstract
Abstract
Background: Lee Silverman Voice Treatment (LSVT) BIG is a well-established exercise program in Parkinson’s Disease (PD), but its effectiveness in other neurological disorders is not well studied. This pilot study examined whether LSVT-BIG similarly improves balance and gait in MS patients compared to PD. Methods: A pilot clinical trial was conducted with two participant groups: MS and PD. Assessments were performed before, during, and after the 4-week LSVT BIG intervention, which followed the established PD protocol of one-hour sessions, four consecutive days per week. Balance and gait were evaluated using the mini-Balance Evaluation Systems Test (mini-BESTest), Timed Up and Go (TUG), and Functional Gait Assessment (FGA). Single-leg stance time on firm, foam, and inclined surfaces was also measured. Data analysis was carried out using mixed ANOVA in SPSS v24. Results: Twelve participants completed the study (6 PD, 6 MS). Both groups significantly improved in mini-BESTest, FGA scores, and timed tasks (p < 0.001). Comparable between-group results revealed, with no significant differences between MS and PD groups (p > 0.5). Conclusions: Similar improvements across groups suggest that LSVT BIG may also benefit patients with MS. Larger randomized trials are needed to confirm its suitability for this population.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Balance, Gait, and Falls Prevention · Voice and Speech Disorders · Amyotrophic Lateral Sclerosis Research
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Rio, 26504 Patras, Greece
References (77)
Show source-provided references
1. Comparing exercise in Parkinson’s disease-the Berlin BIG Study10.1002/mds.23212 ↗
2. The Impact of Lee Silverman Voice Treatment (LSVT LOUD®) on Voice, Communication, and Participation: Findings from a Prospective, Longitudinal Study10.1016/j.jcomdis.2020.106031 ↗
3. Lee Silverman Voice Treatment to improve speech in Parkinson’s disease: A systemic review and meta-analysis
4. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease
5. Intensive Amplitude-specific Therapeutic Approaches for Parkinson’s Disease10.1097/01.TGR.0000318898.87690.0d ↗
6. Peterka, M., Odorfer, T., Schwab, M., Volkmann, J., and Zeller, D. (2020). LSVT-BIG therapy in Parkinson’s disease: Physiological evidence for proprioceptive recalibration. BMC Neurol., 20.10.1186/s12883-020-01858-2 ↗
7. The perception of passive motion in Parkinson’s disease10.1007/s00415-006-0426-2 ↗
8. Pathophysiology of somatosensory abnormalities in Parkinson disease10.1038/nrneurol.2013.224 ↗
9. Quantitative assessment of the gait improvement effect of LSVT BIG® using a wearable sensor in patients with Parkinson’s disease10.1016/j.heliyon.2023.e16952 ↗
10. Application of LSVT BIG Intervention to Address Gait, Balance, Bed Mobility, and Dexterity in People with Parkinson Disease: A Case Series10.2522/ptj.20130232 ↗
11. Clarkin, C. (2020). LSVT®BIG Exercise-Induced Neuroplasticity in People with Parkinson’s Disease: An Assessment of Physiological and Behavioral Outcomes. [Bachelor’s Thesis, University of Rhode Island]. ProQuest Number: 27741888.
12. Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy10.1186/s12984-020-00729-8 ↗
13. Doucet, B.M., Blanchard, M., and Franc, I. (2025). Effects of LSVT BIG® on Bradykinesia During Activities of Daily Living. OTJR Occup. Ther. J. Res., 15394492251367275.10.1177/15394492251367275 ↗
14. Evaluating the Impact of Adding Lee Silverman Voice Treatment BIG into Routine Physiotherapy on Both Motor and Nonmotor Functions in Individuals with Parkinson’s Disease10.18502/dmj.v8i1.18308 ↗
15. Lee Silverman Voice Treatment (LSVT)-BIG to improve motor function in people with Parkinson’s disease: A systematic review and meta-analysis10.1177/0269215517734385 ↗
16. KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson’s Disease10.12786/bn.2020.13.e17 ↗
17. Epidemiology and natural history of multiple sclerosis: New insights10.1097/01.wco.0000227033.47458.82 ↗
18. Rehabilitation for people with multiple sclerosis: An overview of Cochrane Reviews
19. The characterisation of gait patterns of people with multiple sclerosis10.3109/09638280903464497 ↗
20. Rehabilitation interventions in multiple sclerosis: An overview10.1007/s00415-012-6577-4 ↗
21. The disease burden of Multiple Sclerosis from the individual and population perspective: Which symptoms matter most?10.1016/j.msard.2018.07.013 ↗
22. Walking and talking: An investigation of cognitive—Motor dual tasking in multiple sclerosis10.1177/1352458509106712 ↗
23. Relationship between sensation and balance and gait in multiple sclerosis patients with mild disability10.1016/j.msard.2024.105690 ↗
24. Fling, B.W., Dutta, G.G., Schlueter, H., Cameron, M.H., and Horak, F.B. (2014). Associations between Proprioceptive Neural Pathway Structural Connectivity and Balance in People with Multiple Sclerosis. Front. Hum. Neurosci., 8.10.3389/fnhum.2014.00814 ↗
25. Sensory integration balance training in patients with multiple sclerosis: A randomized, controlled trial10.1177/1352458514562438 ↗
26. Resistance training improves strength and functional capacity in persons with multiple sclerosis10.1191/1352458504ms1088oa ↗
27. Exercise in Multiple Sclerosis10.1016/j.pmr.2013.06.010 ↗
28. Cardiovascular adaptation in people with multiple sclerosis following a twelve week exercise programme suggest deconditioning rather than autonomic dysfunction caused by the disease. Results from a randomized controlled trial
29. Halabchi, F., Alizadeh, Z., Sahraian, M.A., and Abolhasani, M. (2017). Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol., 17.10.1186/s12883-017-0960-9 ↗
30. Impact of Pilates Exercise in Multiple Sclerosis10.7224/1537-2073.2017-066 ↗
31. Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: A randomized controlled trial10.1177/0269215516637202 ↗
32. Effects of Pilates exercises on sensory interaction, postural control and fatigue in patients with multiple sclerosis10.1016/j.msard.2016.03.008 ↗
33. The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis10.1016/j.ctim.2019.02.010 ↗
34. The effects of Tai Chi on physical and psychosocial function among persons with multiple sclerosis: A systematic review10.1016/j.ctim.2017.03.001 ↗
35. Duan, H., Jing, Y., Li, Y., Lian, Y., Li, J., and Li, Z. (2023). Rehabilitation treatment of multiple sclerosis. Front. Immunol., 14.10.3389/fimmu.2023.1168821 ↗
36. Effects of Intensive Voice Treatment (The Lee Silverman Voice Treatment [LSVT LOUD]) in Subjects With Multiple Sclerosis: A Pilot Study10.1016/j.jvoice.2020.07.025 ↗
37. LSVT BIG in late stroke rehabilitation: A single-case experimental design study10.1177/0008417419832951 ↗
38. Lee Silverman Voice Treatment BIG® for a Person With Stroke10.5014/ajot.2018.028217 ↗
39. Feasibility of the Lee Silverman voice treatment-BIG intervention in stroke10.1177/1539449220932908 ↗
40. Eldridge, S.M., Lancaster, G.A., Campbell, M.J., Thabane, L., Hopewell, S., Coleman, C.L., and Bond, C.M. (2016). Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework. PLoS ONE, 11.10.1371/journal.pone.0150205 ↗
41. Pilot and feasibility studies in exercise, physical activity, or rehabilitation research10.1186/s40814-018-0326-0 ↗
42. Movement Disorder Society Task Force on Rating Scales for Parkinson’s Disease. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations10.1002/mds.20213 ↗
43. Motl, R., Neal, W., Backus, D., Hebert, J., McCully, K., Bethoux, F., Plummer, P., Ng, A., Lowman, J., and Schmidt, H. (2024). Middle-range scores from the patient determined disease steps scale reflect varying levels of walking dysfunction in multiple sclerosis. BMC Neurol., 24.10.1186/s12883-024-03871-1 ↗
44. The Mini-BESTest is an independent predictor of falls in Parkinson Disease10.1016/j.bjpt.2019.07.006 ↗
45. Test-Retest Reliability of the Mini-BESTest in People with Mild to Moderate Multiple Sclerosis10.1093/ptj/pzab045 ↗
46. Optimal MMSE and MoCA cutoffs for cognitive diagnoses in Parkinson’s disease: A data-driven decision tree model10.1016/j.jns.2024.123283 ↗
47. Using psychometric techniques to improve the Balance Evaluation Systems Test: The mini-BESTest10.2340/16501977-0537 ↗
48. Reliability, validity and minimal detectable change of the Mini-BESTest in Greek participants with chronic stroke10.1080/09593985.2018.1441931 ↗
49. Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease10.1136/jnnp.2005.068742 ↗
50. Reliability, internal consistency, and validity of data obtained with the functional gait assessment10.1093/ptj/84.10.906 ↗
51. Lampropoulou, S., Kellari, A., Gedikoglou, I.A., Kozonaki, D.G., Nika, P., and Sakellari, V. (2024). Cross-Cultural Adaptation and Psychometric Characteristics of the Greek Functional Gait Assessment Scale in Healthy Community-Dwelling Older Adults. Appl. Sci., 14.10.3390/app14020520 ↗
52. Timed Up and Go test and risk of falls in older adults: A systematic review10.1007/s12603-011-0062-0 ↗
53. Barry, E., Galvin, R., Keogh, C., Horgan, F., and Fahey, T. (2014). Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: A systematic review and meta-analysis. BMC Geriatr., 14.10.1186/1471-2318-14-14 ↗
54. Brain activity during dual task gait and balance in aging and age-related neurodegenerative conditions: A systematic review10.1016/j.exger.2019.110756 ↗
55. How to Understand the 95% Confidence Interval Around the Relative Risk, Odds Ratio, and Hazard Ratio: As Simple as It Gets10.4088/JCP.23f14933 ↗
56. Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Front. Psychol., 4.10.3389/fpsyg.2013.00863 ↗
57. The JFK BIG study: The impact of LSVT BIG® on dual task walking and mobility in persons with Parkinson’s disease10.1589/jpts.30.636 ↗
58. The impact of LSVT BIG therapy on postural control for individuals with Parkinson disease: A case series10.1080/09593985.2018.1508260 ↗
59. Effectiveness of Lee Silverman Voice Treatment (LSVT®BIG) for improving motor function in patients with Parkinson’s disease: A systematic review and meta-analysis of randomised clinical trials10.1097/PHM.0000000000002751 ↗
60. Boissoneault, C., Datta, S., Rose, D.K., Waters, M.J., Khanna, A., and Daly, J.J. (2020). Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series. Brain Sci., 10.10.3390/brainsci10080555 ↗
61. Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis10.1016/j.msard.2022.104424 ↗
62. The Effect of Task-Oriented Sensorimotor Exercise on Visual Feedback Control of Body Position and Body Balance
63. Comparative effects of sensory motor and virtual reality interventions to improve gait, balance and quality of life MS patients10.1038/s41598-025-05048-3 ↗
64. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease10.1016/S1474-4422(13)70123-6 ↗
65. Brain activity changes following neuroproprioceptive “facilitation, inhibition” physiotherapy in multiple sclerosis: A parallel group randomized comparison of two approaches
66. Tavazzi, E., Cazzoli, M., Pirastru, A., Blasi, V., Rovaris, M., Bergsland, N., and Baglio, F. (2021). Neuroplasticity and Motor Rehabilitation in Multiple Sclerosis: A Systematic Review on MRI Markers of Functional and Structural Changes. Front. Neurosci., 15.10.3389/fnins.2021.707675 ↗
67. Straudi, S., Martinuzzi, C., Pavarelli, C., Sabbagh Charabati, A., Benedetti, M.G., Foti, C., Bonato, M., Zancato, E., and Basaglia, N. (2014). A task-oriented circuit training in multiple sclerosis: A feasibility study. BMC Neurol., 14.10.1186/1471-2377-14-124 ↗
68. Effect of Task Oriented Approach on Balance in Ataxic Multiple Sclerosis Patients
69. Salmani, S., Mousavi, S.H., Navardi, S., Hosseinzadeh, F., and Pashaeypoor, S. (2022). The barriers and facilitators to health-promoting lifestyle behaviors among people with multiple sclerosis during the coronavirus disease 2019 pandemic: A content analysis study. BMC Neurol., 22.10.1186/s12883-022-03019-z ↗
70. Engaging patients to improve quality of care: A systematic review10.1186/s13012-018-0784-z ↗
71. Maddocks, M., Fettes, L., Takemura, N., Bayly, J., Talbot-Rice, H., Turner, K., Tiberini, R., Harding, R., Murtagh, E.M.F., and Siegert, R.J. (2025). Functional goals and outcomes of rehabilitation within palliative care: A multicentre prospective cohort study. BMC Palliat. Care, 24.10.1186/s12904-025-01816-0 ↗
72. Physical Activity, Exercise, and Physiotherapy in Parkinson’s Disease: Defining the Concepts
73. Li, P., He, Y., and He, M. (2025). The comprehensive impact of exercise interventions on cognitive function and quality of life in Alzheimer’s disease patients: A systematic review and meta-analysis. BMC Geriatr., 25.10.1186/s12877-025-06454-y ↗
74. Effects of physiotherapy interventions on balance in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials10.2340/16501977-1047 ↗
75. Effect of Exercise Training on Walking Mobility in Multiple Sclerosis: A Meta-Analysis10.1177/1545968308320641 ↗
76. Cognitive and motor dual task gait training improve dual task gait performance after stroke—A randomized controlled pilot trial10.1038/s41598-017-04165-y ↗
77. Development of the Better Balance Program for People with Multiple Sclerosis: A Complex Fall-Prevention Intervention