Christian Health Care Center’s (CHCC) short-term rehab program recently announced BIG news for individuals living with Parkinson’s disease. LSVT BIG, research-based physical and occupational therapy addressing symptoms of Parkinson’s disease, has joined the roster of outpatient rehab therapies.
Parkinson’s is a brain-based movement disorder that affects the ability to perform common, daily activities. The disease is chronic and progressive, with symptoms worsening over time. Common symptoms include tremors, stiffness or rigidity of muscles, slowness of movement, low speech volume, sleep problems, anxiety, depression, fatigue, numbness, burning, and pain.
“People with Parkinson’s often move differently. Their gestures and actions become smaller and slower because that’s what feels normal to them,” says Erica Lotz, DPT. Ms. Lotz and Physical Therapy Assistant Kate Abbis are CHCC’s LSVT BIG Certified Clinicians. “LSVT BIG is intensive one-on-one treatment which trains individuals to use their body more normally. It focuses on walking, balance, and activities of daily living. By learning how and when to use extra effort to produce bigger motions, their movements become more like those of everyone else around them.”
LSVT BIG was named for Lee Silverman, a woman living with Parkinson’s. More than 25 years ago, Lorraine Ramig, PhD, CCC-SLP, began research after meeting Mrs. Silverman and her family, who wanted to hear and understand her better. The result was LSVT LOUD (Lee Silverman Voice Treatment) to increase speech volume and amplitude. It later expanded to LSVT BIG.
“LSVT BIG increases amplitude of motion. Not only does motion get big, but it gets faster and smoother and larger,” Ms. Lotz says. “Essentially, we’re training individuals with Parkinson’s to use what others would consider exaggerated movements. If I tell you that I want you to move your arm from your side to over your head with the maximum amount of effort and speed that you can, you would fling your arm. If I ask a person with Parkinson’s to do that, the motion is slow because the reduced amount of dopamine in the brain doesn’t allow him or her to do something as fast or as large. Through LSVT, that individual learns how to create normal movements by using exaggerating movements.”
Prior to commencing the four-week program of four one-hour sessions per week, LSVT BIG candidates are evaluated, and their goals are discussed. Although LSVT BIG can help at any stage or severity of Parkinson’s, studies have shown that it is most effective for individuals in the early to middle stages.
“The treatment plan comes directly from the patient: What are you having trouble doing? What do you want to make sure that you don’t have trouble doing? From that, we pick five simple daily movements and create a hierarchy – one-step movements that combine to make a whole activity. One person’s hierarchy might be the ability to make breakfast. Someone else’s may be to walk down the front steps to the car,” Ms. Lotz says.
The outpatient program takes place in CHCC’s 14,000-square-foot Bolger Rehab Gym & Wellness Center.
“It takes time to build up tolerance and endurance, learn appropriate technique and position, and understand what it feels like to make that big a movement,” Ms. Lotz says. “Exercise is modeled, meaning that I’m across from the patient doing the exercise that I want him or her to do, such as reaching out, down, and up, and holding it.”
Exercises lead up to the individualized hierarchy with its one-step movements.
“If the hierarchy is to make breakfast, we look at all the steps involved: Go to the refrigerator. Open the door. Take out the juice. Put it on the counter. Reach for a glass. Pour the juice. Bring it to the table, and so on. We then determine the portions that are the most difficult. Maybe the person lost balance when opening the refrigerator door. For the remainder of the session, we’ll focus on that movement. In subsequent sessions, we’ll make the hierarchy more difficult by adding a cognitive task, such as talking to someone while making breakfast,” Ms. Lotz says.
“LSVT BIG is phenomenal. Erica is enthusiastic and encouraging. I could tell a difference shortly after I started the program. I have greater mobility, and my sense of well-being has improved,” says outpatient Doris Minck, who was diagnosed with moderate Parkinson’s disease in 2012. “I’m very happy with CHCC overall. There’s a caring spirit. And being picked up and dropped off by a CHCC van is a tremendous help. The drivers are so courteous.”
Daily practice at home is key to successful LSVT BIG, both during the program and following discharge. A follow-up appointment is scheduled three to six months post-discharge, depending on the individual’s stage of Parkinson’s. If warranted, “tune-up” sessions may be scheduled.
“LSVT BIG has tremendous benefits, not only for an individual’s physical well-being, but for mental well-being, as well,” Ms. Lotz says. “It can help a person be more confident and more empowered to re-engage in life. Just remember to think BIG!”