LSVT-BIG with Nicole Dufresne OTR/L

To kick off the OT Specialties and Certifications series, we will be discussing the LSVT-BIG certification with Nicole Dufresne, OTR/L.

For those who do not know what LSVT-BIG, or Lee Silverman Voice Treatment, is, it is an evidence-based intervention for those with Parkinson’s disease. This treatment trains individuals to improve their physical movements and in return, increase participation in life through gross motor and fine motor tasks.

The LSVT-BIG certification can be acquired by both physical and occupational therapists, and the LSVT-LOUD certification, a treatment for vocal volume, is usually acquired by speech language pathologists.

Total Estimated Time to Acquire Certification: 2 days, or self-paced up to 90 days

Total Estimated Cost: $580

You can find more about the LSVT-BIG certification here.

Now, we will get to hear about how Nicole uses her LSVT-BIG certification in her practice as a homecare occupational therapist. Thank you again, Nicole, for contributing to this blog series!

Nicole D, OTR/L

Nicole is a home health occupational therapist who graduated from OT school in Springfield, MA in 2015. She has been practicing since September of 2015, and began her practice in a hospital setting before transitioning to home health.




Why did you choose OT?

I chose OT initially based off a career survey. (Wild I know).

My middle school had everyone complete one and mine suggested health professions, after which I researched and thought OT seemed like the best fit for me. After that it just stuck! I never really considered anything else. I did some job shadowing while in high school and fell in love with the idea of spending my career helping others. 

What setting(s) do you work in/have you worked in? Do you have a favorite? Why?

After graduation I took a job working for a 20 bed inpatient acute rehab unit inside a hospital. While working there I also provided cross coverage to the acute side of the hospital as well. I left that job after 2 years and transferred to a much larger level 1 trauma center. While at that job I took a position working for a homecare company and did both for a while. Now I’m doing homecare full time. 

I’m not sure I have a favorite as there are components of each that I really loved. Acute care brought SO many interesting cases and opportunities to learn in interdisciplinary groups, but I hated not getting to follow up with my patients as they got discharged often before receiving more than one follow up. Homecare brings me so much happiness because it’s where I truly feel the patients make the most progress, and where the content of OT visits really emulates “meaningful occupations.”  

What does a typical day in the clinic/hospital/etc. look like for you?

A day in acute care typically involves assigning myself, or being assigned patients, from the list of referrals, and then working my way through them around the patient’s other hospital testing or disciplines. Often patients are unavailable and it’s a lot of running around trying to prioritize and get appropriate discharge recommendations to physicians and get documentation completed ASAP. Point of care documentation doesn’t usually work as we document on desktops and can’t have them in patient rooms.

In homecare the day usually starts the night before, calling patients with their appointment times and planning out a schedule for the day. In my agency we have a “point system” which represents the total patients needed in a week with different weights for evals, re-visits etc. Homecare days usually have a decent chunk of time each day that is made up with driving time, calling doctors offices and confirming orders, with point of care documentation encouraged as much as possible.  

Why (and when) did you decide to pursue the LSVT-BIG certification?

I decided to pursue my LSVT-BIG certification after a friend of mine who is a speech language pathologist introduced me to the LSVT-LOUD program. It was just prior to the start of my homecare job and I was excited about the opportunity to utilize it in its entirety in the homecare setting. (The treatment requires it be administered on 4 consecutive days for 4 weeks, which isn’t achievable in acute care.)

I had noticed that the number of patients with Parkinson’s disease as a secondary diagnosis was staggering and often they had very little education on the management of their symptoms. 

How often do you find yourself using the skills you learned from obtaining this certification? How do you believe the certification has impacted your practice?

I use the skills I learned in the training with every patient who has a Parkinson’s diagnosis, and for those who I suspect have the disease but may not have been diagnosed yet! The certification teaches practitioners a way to mold how a patient manages their symptoms by re-teaching them how normal movement should feel. The principles can be applied to all activities all the time, therefore even if I can’t complete the entire program, I can apply the skills I learned in this certification.

It has absolutely impacted my practice in a good way!  

Does your employer require you to have this certification? And do you get paid more because of it?

My employer does not require it, but I do think having the certification helped me get the job in the first place! I do not get paid more for having it personally, but my company does reimburse me for the renewal as continuing education credit. 

What are the steps to acquiring the credentials? (hours of experience, course(s), cost, exams, applications…etc.)

  1. The certification can be completed either at an in-person workshop (2 days), or via online certification where you learn through a series of computer-based modules (self paced, you have 90 days to finish)
  2. All OTs, COTAs, PTs, PTAs and students enrolled in those programs can take the course. The certification mandates that COTAs/PTAs cannot administer the program unless they have a supervisor who is also certified. 
  3. It costs $580 for clinicians and $300 for students (if you complete it as a student, you have to contact them with proof of licensure after which you will be changed to “professional status”.)
  4. Both the in-person and online versions have a 40-question exam to pass upon completion 
  5. You earn 12 continuing education hours (1.5 CEUs)

Is there a renewal process?

The certification needs to be renewed every 2 years.

You complete a 2.5-hour course online and the cost is $50. There is a 10-question exam to pass.

For Q’s 8 & 9: Did you pay for this yourself or did an outside source, such as your employer, pay?

I paid for my initial certification; my employer paid for the renewal

Do you believe having the credentials is worth it?

I absolutely think its worth it if you work with the Parkinson’s population. As I mentioned earlier, I find that I have a ton of patients who are not necessarily referred for services due to their Parkinson’s, but no one has ever addressed it with them before, and the progressive symptoms often lead to other issues (difficulty feeding, dressing, balance problems, falls etc.). 

Do you have any words of advice for someone wanting to pursue this certification?

I recommend going for it if you’re on the fence about it, as the skills I learned helped me tremendously in my approach to the neuro population as a whole and undoubtedly with Parkinson’s disease. The biggest drawback is that its hard to apply if you work outside of homecare/a clinic because of the need for consecutive days/weeks to administer it.

My other recommendation is to wait for the printed materials to arrive before starting the live course (if you choose to do it that way). The LSVT site also offers great additional material including webinars and an “ask the expert” section where you can chat with seasoned LSVT clinicians and a copy of all the handouts/exercises and forms for reference.


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