David Wroughton, an occupational therapist at the hospital, attended a continuing education event in Chicago. The course involved his recertification in LSVT BIG, an exercise protocol that is designed specifically for the treatment of movement disorders common in Parkinson's disease.
Parkinson’s is a neurodegenerative disorder that affects a large number of Americans, and an increasing number of new cases are diagnosed each year, according to the Parkinson's Disease Foundation.
Parkinson’s is a progressive disease affecting everyday activities such as dressing or getting into a car. Some patients may notice unusual tiredness and difficulty with balance and walking, and may fall at times. Often such symptoms are ignored or attributed to aging until they have been diagnosed by a physician.
“There have been great advances in pharmacological treatments to decrease the symptoms that patients experience,” Wroughton said, “and there are also surgical interventions that show great promise.”
Wroughton said advances also have been made in therapeutic exercise programs for these patients that represent a significant improvement over past exercise routines.
The name LSVT is an abbreviation of “Lee Silverman Voice Treatment.” The protocol was developed in the 1980s as a method to train Parkinson's patients to increase the amplitude of speech. This led to louder and more intelligible speech.
LSVT LOUD became the subject of a number of medical studies. The National Institutes of Health has spent more than $8 million researching the protocol, which has shown it to be effective in improving Parkinson's symptoms.
Wroughton said Brodstone offers LSVT LOUD for Parkinson's patients who are having difficulty talking or being heard.
Finding success with LSVT LOUD, therapists applied the same treatment principles in targeting Parkinson’s related movement disorders and created LSVT BIG, which has documented improved ratings of motor function. Patients have realized faster walking with bigger steps, improved balance and increased trunk rotation.
Wroughton said LSVT BIG treatment is intensive, requiring high-effort practice that lasts through four weeks of treatment in the clinic four days per week, with hourlong sessions.
Home exercise sessions are mandatory and are done once a day on treatment days and twice a day on non-treatment days. The patient keeps a record to present to the therapist each week.
Patients also are asked to work at home on daily carryover tasks. A home coach, who has learned the exercises, can be beneficial in helping the patient at home.
“The bottom line is that LSVT BIG requires a significant commitment from the patient and caregivers,” Wroughton said. “The earlier the patient comes for treatment, the better the outcome will be.”
The therapist will do an initial evaluation whenever a patient comes in, to help identify whether LSVT BIG is an appropriate treatment for him or her. Most exercises may be modified to make them easier, Wroughton said.
Initially, a patient is asked to list 10 activities he or she is having trouble with and would like to do better. That list is used to tailor the treatments to the needs of each particular patient.
One of the biggest differences in LSVT BIG compared to traditional therapy programs, according to Wroughton, is that LSVT BIG trains a single target of bigger movements by training patients to exaggerate the bigness of their movements so that they actually move more normally. The patients then are encouraged to “move bigger” in all their daily tasks. Another difference is that this program has been extensively studied and found to be effective, Wroughton said.
Finally, the treatment consists of a standardized protocol so that the certified therapist provides the same program no matter where they are.
Interested individuals who live in the Superior area can obtain more information by contacting Wroughton at Brodstone Hospital at 402-879-3281 or by asking their caregiver for a referral. Those outside the Superior area may go to www.lsvtglobal.com to find a list of licensed physical or occupational therapists who are LSVT BIG-certified and provide services in other areas.
In early April, Superior resident Larry Havens was nearing graduation from the Parkinson’s therapy program. He participated in hourlong sessions with Wroughton.
The exercises include movements forward and back; side to side; complete turns; walking; and some finer movements used in daily activities. The patient faces the therapist and copies his movements.
The program is based on amplitude, Wroughton said, which means amplifying the movements to cause the patient to think he or she is taking longer steps than usual, so his or her steps will actually be fairly normal in length.
“The patient may be told he is shuffling when he thinks he is taking a regular length of step,” Wroughton said. In the three-plus weeks Havens had been in the program, he said, he could see much progress in his mobility. He is better able to compensate when he steps on an irregular part of a sidewalk, for instance, and maintain his balance rather than experiencing a fall, and he is also better at climbing stairs than before the therapy.
“I used to depend on my cane a lot,” Havens said, “but now I rarely even think about it.” Gloria, Havens’ wife, notices his improvements quite often faster than he does.