5 minute read
Parkinson’s Patients Think BIG
Parkinson’s Patients Think BIG
Parkinson’s Disease is a neurogenerative disorder that affects movement. It’s progressive, getting worse over time, and there is no cure. Common symptoms include tremor, rigid muscles, speech and handwriting changes, poor posture, and loss of balance. The movements of those with Parkinson’s may become slow and they may lose automatic movements, such as blinking or swinging their arms as they walk.
In other words, Parkinson’s makes normal movements small, which is why Boone Therapy provides ways to make them big again.
Occupational Therapist Leah Botkin proposed the implementation of the the Lee Silverman Voice Treatment (LSVT) BIG® in 2021. The global program requires certification to use its protocol. It uses occupational therapy and physical therapy to improve and maintain movement and decrease rigidity. There’s also a speech component, LSVT LOUD®, to assist patients with those speech and swallowing issues as well.
“The only thing that we know that helps with symptoms and helps keep symptoms at bay and maintain function over time is exercise – high amplitude, high repetition, intense exercise, which is what the LSVT BIG® intervention is,” Leah says.
High amplitude is a big part of the BIG protocol. This type of exercise involves making large, exaggerated movements.
Those help patients concentrate on overcoming small movements as the disease progresses. For example, patients may perform a series of long steps to help keep them from shuffling.
“The program really focuses on the small movements that Parkinson’s encourages and making those bigger and more functional,” Leah says. “We’re taking small, shuffling movements and getting them to be large, functional movements.”
The LSVT exercises help with a patient’s specific balance and rigidity problems and other functional tasks. But it’s not entirely a one-size-fits-all program.
“It’s a structured protocol that also has a lot of room for personalization,” Leah says. “ The idea is that they take that and continue doing it as a home exercise program.”
The program benefits people across the Parkinson’s progression spectrum, although early intervention is ideal. There are four LSVT protocols, including regular exercise, adaptive exercise, exercise done while seated, and exercise done while lying down. So, the type of exercise meets patients where they are on the spectrum of disease progression.
“Parkinson’s is a progressive disease, so the goal of the LSVT program is to take you where you are, raise that baseline up, and then ideally keep you at that new baseline,” Leah said.
Going BIG means undergoing therapy four times a week for four weeks for a total of 16 one-hour sessions. Half of the sessions are occupational therapy and the other half are physical therapy. If a patient requires intensive speech therapy, it will be scheduled either after those four weeks or prior to rather than combined. That separation helps keep therapy intensive.
The intensity of the program is what makes it effective. But that isn’t all there is to it. Depending on the severity of symptoms, patients are encouraged to return to therapy for “tune-ups” to check on maintenance of the baseline and address any new issues as they arise. Patients may be in the tune-up phase for a period of three to 12 months.
Some patients experiencing symptoms begin the program even before a neurologist has diagnosed Parkinson’s.
“Navigating Parkinson’s can be really difficult,” Leah said. “Being able to meet with us and get our input and their questions answered before they ever meet with a neurologist often better helps them prepare for their neurology appointment.”
Thee outcomes for LSVT patients are solid. Improvements in functional balance and decreased fall risks are common. Gait and the ability to traverse stairs improve. Writing improves. A patient’s ability to change clothes and other activities of daily living improve.
“The response to this program is overwhelmingly positive,” Leah said. “Everyone really enjoys it, and I honestly think a lot of them are far more confident. Many people come in distraught after the diagnosis. But by the end of it, a lot of people feel more con dent about what they can do about it.”
“I think having a progressive disease can make you feel pretty out of control at times. Being able to have tools in your toolbox you can utilize to stay functional really helps a lot of people,” Leah said. “I think we see some really good outcomes from the program. Not just physical outcomes, but psychological and emotional outcomes as well.”
The LSVT BIG® program was designed for patients living with Parkinson’s. However, the protocols are also used for other neurological conditions, such as post-stroke, normal pressure hydrocephalus (a build up of cerebrospinal fluid), and progressive supranuclear palsy (damage to nerve cells in areas of the brain.)
By Michelle Terhune
