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Helping Parkinson's Patients Get Big & Loud · Bryan Health Podcasts

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  Intro: At Bryan Health, we care for patients, educate tomorrow's
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  healthcare providers, motivate our community with fitness and health
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  programs and collaborate to continually improve how we serve others.
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  That's why we are proud to present another Bryan Health podcast.
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  Caitlin Whyte: Welcome to the Bryan Health podcast.
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  I'm Caitlin Whyte.
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  And today, we are discussing the LSVT BIG and LOUD treatment
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  for Parkinson's disease.
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  Joining us are Dan Kasparek, a speech language pathologist; and Cathryn
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  Breutzmann, an occupational therapist.
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  So Cathryn, we'll start with you.
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  What are the LSVT BIG and LOUD programs?
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  Cathryn Breutzmann, OTR/L: So up to 18 million people worldwide are living
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  with Parkinson's disease and that's a disease that really causes people to be
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  smaller and quieter, make smaller steps, quieter voice, smaller hand movements.
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  It just really slows down their mobility and their speech.
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  And so LSVT BIG and LSVT LOUD are both programs that are meant to help someone
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  with Parkinson's be bigger or be louder to the point where they sound and move
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  more naturally like they would have before they were diagnosed with Parkinson's.
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  So both LSVT BIG and LSVT LOUD are programs put on by therapists.
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  So LSVT BIG focuses on movement, so that's put on by either
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  occupational or physical therapist.
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  And then LSVT loud has to do with voice and speaking and that's put
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  on by a speech therapist like Dan.
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  Each of the programs is very intensive and they focus on amplitude.
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  So for LSVT BIG and LSVT LOUD at 16 sessions at least, four consecutive days
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  a week for four weeks, one-hour sessions.
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  And the patients have homework that they're supposed to do each day at home.
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  So it's very intensive to just kind of retrain the brain to act big and act loud.
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  Caitlin Whyte: So, Dan, can you tell us a bit more about how
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  communication and movement are improved through these programs?
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  Dan Kasparek, SLP: Sure.
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  Yeah.
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  Most of the research shows that from a loudness standpoint, not
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  only do people get louder, but there's better variation in pitch.
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  There's even change in articulation and swallowing and facial expression,
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  basically anything that has to do with communication can be
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  improved through this program.
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  Most of the gains are maintained for at least two years.
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  We do have a follow-up once a year that we come in and just sort of recalibrate
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  and make sure that everything is staying where it's supposed to stay.
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  In the past, most treatment for voicing anyway was we would do
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  it almost sort of passively.
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  So we'd work on articulation for a little bit and some loudness.
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  But now with this LSVT, it's intensive, it's high effort.
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  And so basically, it's a one-on-one session that
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  improves overall communication.
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  Caitlin Whyte: And Cathryn, can someone receive both the BIG and
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  LOUD treatments at the same time?
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  How does that work?
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  Cathryn Breutzmann, OTR/L: Yeah.
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  So it's really a patient preference.
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  Because it's an hour long and it's pretty intensive, some people, depending on,
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  you know, their age or their strength level or that type of thing, we'll
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  do four weeks of one program and then switch to four weeks of another program.
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  But Dan and I definitely have people that will do both at once.
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  And when we do have them both at once, we try and get them back to back on
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  the same days, so they can come in and see Dan to work on loud speech and
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  then come right over to work with me on big movements right back to back,
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  so they don't have to wait or come back later in the day or that type of thing.
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  So we really try and work with people's schedules to make sure
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  that they get the best treatment possible that works for them.
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  Caitlin Whyte: Now, Dan, when should someone start treatment and how
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  can they get started with you guys?
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  Dan Kasparek, SLP: Sure.
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  It's best to start whenever you get a chance.
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  The research mostly shows that you want to start as early as you possibly can.
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  As soon as you start showing symptoms of decreased loudness or
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  the smaller movements, you want to get in and get the program started.
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  And each one, you know, both LOUD and BIG, they're individualized treatments.
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  So, you know, it's a personal goal of where you want to get
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  to and, you know, we've been trained to get you to that point.
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  Caitlin Whyte: Well, Cathryn, is there anything else you'd
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  like to share before we wrap up?
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  Cathryn Breutzmann, OTR/L: Yeah.
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  So maybe just a taste of what a session might look like.
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  So a patient would come and visit with us.
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  For LSVT BIG, for my program I can speak to, they would come in for an evaluation
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  and we could look at how quickly they could walk, how big their handwriting
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  may be, how coordinated they are doing buttons or snaps, how they do sitting
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  into a chair and standing back up again, a bunch of different tasks like that,
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  putting a jacket on, taking a jacket off.
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  And a lot of people will have troubles with some of those activities where
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  they'll either freeze or they'll get stuck or their movements will be
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  really small or they won't have enough momentum to stand up from a chair.
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  So after we evaluate them, we would talk to the patient about their specific goals.
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  So what is hard for you?
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  What do you feel like you struggle with on a day-to-day basis?
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  What do your kids tell you that you're doing very small?
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  Or what do people tell you that you look like you're having a hard time with?
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  So then we would make goals together.
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  So then each of our sessions, there's a standard set of
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  exercises that we do each day.
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  So the patient gets really familiar with stepping big, reaching big with
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  their arms, standing up from the chair, using big energy, walking big.
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  And then we also focus on their goals.
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  So maybe they wanted to put their seatbelt on better, they really
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  have a hard time reaching across and fastening their seatbelt.
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  So then, during our sessions, we would work on reaching big for
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  the seatbelt and buckling big.
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  And it's a lot of big, exciting, active motion.
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  And it's really a fun time to work on their goals in each of the sessions
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  and see what they want to do better and really get better at those tasks.
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  Caitlin Whyte: Great.
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  And Dan, is there anything else on your end?
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  What do your sessions look like?
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  Dan Kasparek, SLP: Sure.
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  Sure.
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  So, yeah, we do what we call sustained phonation and then rising
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  and falling pitch, which are just exercises to help calibrate the voice
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  and then we do functional phrases.
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  So if you imagine that you lost your voice tomorrow, what are the 10 phrases
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  that would be most important to you?
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  And so we practice those every single session.
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  So all 16 sessions start with the exact same setup.
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  And then what we do is we stair step up in complexity.
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  So the first week is more of a word base and we're keeping it
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  small, then we go to phrases and sentences and finally conversational
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  speech during the fourth week.
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  And I tend to see the biggest gains.
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  The first week, you don't see a lot of change, but usually by the
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  middle of the second week, we get a report of almost everybody that
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  we work with seeing some change.
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  And this is something that's sort of Cathryn mentioned, but usually
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  it's not the person themself that noticed the initial change.
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  It's somebody else in your family that says, "Wow, you sound so much
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  better" or "You sound louder."
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  And that's really encouraging because you can see results as you're going.
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  Caitlin Whyte: Well, we so appreciate both of you taking
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  the time to speak with us today.
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  And that wraps up this episode of the Bryan Health Podcast.
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  We'd like to thank our Bryan Foundation partner, Mapes industries.
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  You can head on over to our website at bryanhealth.org
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  for more information and to get connected with one of our providers.
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  Please remember to subscribe, rate and review this podcast and all of
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  the other Bryan Health podcasts.
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  I'm Caitlin Whyte.
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  Stay well.