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Brodstone goes BIG with Parkinson’s Therapy

Brodstone goes BIG with Parkinson’s Therapy

David WroughtonParkinson's disease is a neurodegenerative disorder which, according to the Parkinson's Disease Foundation, afflicts as many as 1 million Americans, with about 60,000 new cases diagnosed each year. Parkinson's is a progressive disease that, among other symptoms, produces bradykinesia and hypokinesia (slow movements and small movements) in the trunk and limbs. Most often occurring in those over 50, and more frequently in males than in females, the onset is often gradual and not immediately recognized by those affected.
According to occupational therapist David Wroughton, "Some patients will realize that they are feeling more fatigued, or having difficulties with everyday activities such as dressing or getting into a car. Others may notice that they are not walking as well as previously, losing their balance, or even falling. Since some of these symptoms may be written off as a part of getting older, patients often do not recognize that they are having symptoms of Parkinson's until their doctor makes the diagnosis."
In terms of treatment, Wroughton states, "There have been great advances in pharmacological treatments to decrease the symptoms that patients experience. There are also surgical interventions that show great promise." He adds that, "Advances have also been made in therapeutic exercise programs for Parkinson's patients that represent a significant improvement over past exercise routines."
Wroughton recently attended continuing education in Chicago to obtain certification in LSVT BIG, which is an exercise protocol that is designed specifically for the treatment of movement disorders common in Parkinson's disease. He says that, "People always want to know what the significance of the name is. LSVT is an abbreviation of 'Lee Silverman Voice Treatment', and began in the 1980's as a method to train Parkinson's patients to increase the amplitude of speech. This led to louder and more intelligible speech. LSVT LOUD has been the subject of a number of medical studies. The National Institute of Health has spent over 8 million dollars researching the protocol, which has shown it to be effective in improving symptoms of Parkinson's.
Recognizing the success that they had with LSVT LOUD, the therapists who developed the program applied the same treatment principles of targeting amplitude to Parkinson's related movement disorders and created LSVT BIG. Research on LSVT BIG has documented improved ratings on tests of motor function, including faster walking with bigger steps, improved balance, and increased trunk rotation. Wroughton states, "I was amazed with how quickly we begin seeing results, especially with walking."
Wroughton indicates that LSVT BIG treatment is intensive and requires high effort practice. He continues, "The treatment protocol requires four weeks of treatment in the clinic four days a week. The sessions are an hour long. 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 of their home exercises to bring back to the therapist each week. Besides the exercises, there are also daily carryover tasks that we ask patients to work on at home. It is very beneficial if the patient has a home coach who can come to some sessions to learn the exercises so they can help the patient with the home program. The bottom line is that LSVT BIG requires a significant commitment from the patient and caregivers."
Who can benefit from LSVT BIG? Wroughton states, "The earlier the patient can come in for treatment, the better the outcome will be. That does not mean that patients further along in the disease progression should not contact us. We will do an initial evaluation that will help us identify whether LSVT BIG is an appropriate treatment for them. Most of the exercises that we do may be modified to make them easier. During the evaluation, we will also ask patients to list ten activities that they are having difficulty with that they would like to improve the ability to perform. We use that list to tailor the treatments to the needs of each particular treatment."
When asked what are the differences between LSVT BIG and traditional therapy programs, Wroughton says, "One of the biggest differences is that LSVT BIG trains a single target of amplitude, or bigger movements. We train patients to exaggerate the bigness of their movements so that they actually move more normally. We then ask them to strive to move bigger in every task they perform during the day. In a sense, we are trying to recalibrate them to move bigger in everything, without having to think about it. Another difference is that this program has been extensively studied and found to be effective. Finally, the treatment consists of a standardized protocol. This means that any LSVT certified therapist provides the same program no matter where they are.
Asked if LSVT BIG is only effective for Parkinson's patients, Wroughton responds, "All of the scientific studies were limited to basic Parkinson's which represents about 85 percent of the Parkinsonian disorders. There is anecdotal evidence that atypical Parkinson's patients may benefit from LSVT BIG. These would include diseases such as multiple systems atrophy or progressive supranuclear palsy. There is little evidence that I have seen indicating that cases of secondary Parkinsonism that are the result of injuries to the brain are responsive to LSVT BIG treatment."
Asked if insurance covers LSVT BIG treatment, Wroughton responds, "We don't see any problems with Medicare patients that have Part B coverage, or for Medicaid patients. For patients with private insurance or coverage under one of the Healthcare.gov exchanges, patients should call their insurers to verify coverage." He adds that, "We do believe that since this is an evidence based treatment, and since it is a standardized protocol and dosage, insurers should ultimately reimburse it."
Asked how interested individuals can get more information, Wroughton says, "If they live in the Superior area they may contact me at Brodstone Hospital (402) 879-3281. They may also ask their primary care physicians for a referral. If you live outside of our local area, you 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 your area."
When asked if he would like to add anything Wroughton said, "Yes. We hope to offer LSVT LOUD here soon for Parkinson's patients who are having difficulty talking or being heard."