New ‘Big and Loud’ program helping those with Parkinson’s
By DEB WUETHRICH
It’s rigorous. It’s vigorous. And it could result in up to two years of motor functioning for a person who has Parkinson’s Disease (PD).
A program that’s new to the Tecumseh community is being utilized at Carter Rehab. The LSVT Big and Loud Program helps individuals who have PD symptoms learn to emote and to move in ways that helps them deter or overcome characteristics that typically come with the disease.
Lynn Dennie, a physical therapist at Carter Rehab, said the LSVT stands for Lee Silverman Voice Therapy, a program founded 25 years ago by a family who’s mother, Lee had PD.
“The family said, ‘we wish we would have been able to hear mom better,’” Dennie said, since people with PD experience speech and voice disorders, including soft voice, monotone, breathiness, hoarse voice quality and imprecise articulation. “Through much research, they found that a treatment that basically encompassed talking loud did work for them,” Dennie said. The program also changed how patients interacted with others, emotionally, socially, with mood and how their families responded. “With Parkinson’s, when you can’t be heard, you’re thinking you’re talking loud but you’re not” she said.
Another researcher, Dr. Farley, at the University of Arizona, found that if it works for voice, it should work for limbs, and expanded the program about three years ago to include exercises that help people “be big” through everyday tasks. But first, they have to learn how to do them. That’s where Carter Rehab comes in.
“Locally, Dr. Rebecca Poetschke, a neurologist, saw the research and said, ‘We really need this in the Tecumseh area,’” Dennie said. Through discussion with Carter Rehab’s director, Bob Leffler, the center decided to send Dennie to California to be certified in the program. She is the only one certified in the area at this point.
“The progress these patients are making is phenomenal,” said Dennis.
Tecumseh residents Iris and Dick Gage learned of the LSVT Big and Loud program just after Dick was diagnosed with PD earlier this year. There had been noticeable tremors, especially in his right hand, and he was moving into a PD shuffle with stooped posture. Iris said he also had been exhibiting signs of the typical “Parkinson’s mask” in facial expressions.
“When Dr. Poetschke told us about the program, we had to wait for Lynn to finish the certification, so Bob Leffler put him into a program that Carter Rehab already had in effect. Lynn said that program helps “beef up” those who will then move into LSVT Big and Loud.
“The more traditional program can build endurance and boost their confidence and balance,” she said. LSVT is high amplitude with big movements — and it requires a good deal of concentration and energy, if Dick is any example. On a recent Thursday, Dick shared pages of writing with his therapist, demonstrating improvements he’d made, having progressed from an illegible scrawl before getting treatment.
“He was able to fill out his own voter absentee ballot,” said Iris. “I offered to write in the return address, but he did that himself. It’s the daily things and there’s been a phenomenal improvement since we’ve been coming here.”
The treatment dosage is four one-hour sessions a week for four weeks, for 16 treatments. Dick was about halfway through the program. Lynn also had him doing exaggerated arm movements while seated in a chair, and then some “big” stepping motions, including striking a “ta-da” theatrical pose for several repetitions. He was Lynn’s first client for the program, but it’s now grown to include about five others, each at different stages of PD, notes the therapist. She said the program includes a lot of self-monitoring, asking the patients how they feel at certain stages.
“It’s been a good workout for me, and I’ve learned a lot,” said Dick. Videos were taken at two of the sessions and then he, Iris and Lynn viewed them. “It’s much easier that way for me to see what I’m doing incorrectly and then Lynn helps me work through those things.”
“There’s not only the physical benefit, but we’re seeing mental benefit as well,” said Iris. She said her husband was in quite a bit of denial of his PD at first, but has learned so much from the program — things that are carried over to everyday life. “All I had to say one day when he was cleaning the pool was what’s on the sign (in the room): “Big and Loud.”
“Homework is essential,” said Dennie. “It takes those cues on a regular basis to help them keep making the effort, but what a difference it can make. For me, with 20 years as a therapist, it’s like I have been born again into therapy. It’s one of the most gratifying things I have done, I have to tell you.”
Dick and Iris have also become cheerleaders for the program, which may include a support group component for those who complete the 16 sessions. They also continue to encourage Carter Rehab to get more therapists certified because they believe so much in the program and its visible results.
“I can’t begin to tell you the remarkable change in Dick,” said Iris. “Lynn is very gentle in criticizing and correcting, but she doesn’t let him get away with much.”
The trio emphasizes that it is not a cure, but can deter progression and add to the quality of life. Dick will also accompany his therapist to the Parkinson’s support group soon to talk about his successful experiences.
“I have been the guinea pig for this program,” he says with a smile. “It’s kind of like show and tell.”
“He’s an inspiration to others with Parkinson’s,” said Dennie. “The sooner a patient is diagnosed, the greater impact it will be because they may not have yet developed some of the symptoms, or they haven’t taken hold. But progress can still be made, even later. We’ve already seen that.”