Selected Podcast
LSVT BIG Therapy for Parkinson's Disease
Physical therapist Margaret Rodzel discusses LSVT BIG therapy and how it can help patients dealing with Parkinson's.
Featuring:
Margaret Rodzel
Margaret Rodzel obtained her BS in Physical Therapy from Hunter College CUNY. She has more than 20 years of outpatient clinical experience treating a diverse caseload of Orthopedics and Neurological conditions. These interests have led her to LSVT BIG certification in 2016 for individuals with Parkinson’s Disease. Her other clinical interests include the MEEKS method and the McKennzie Method. Margaret is a strong advocate for her patients and she is always working towards helping each individual achieve their functional goals to get them back to living their life to the fullest potential possible. This is achieved by providing evidenced-based care to her patients. She continues to expand her knowledge through professional webinars and continuing education to bring the most up to date care to her patients. Transcription:
Melanie Cole (Host): If you know anyone with Parkinson’s Disease, as I do, you know how much trouble, even little things like rolling over in bed can be for them, but there are programs that can help with movement disorders that are really amazing. My guest today is Margaret Rodzel. She’s a physical therapist with Montefiore St. Luke’s Cornwall. Margaret, thanks for joining us today. Tell us about some of the effects that Parkinson’s has on movement and speech.
Margaret Rodzel (Guest): So the hallmarks of Parkinson’s Disease for speech is softness of speech, difficulty understanding someone and for the physical part, usually people with Parkinson’s have slowness of movement called bradykinesia, and small movements called hypokinesia, which impacts their ability to walk and move.
Host: Tell us about some exercise programs and PT and how they can help ease some of the tremors and some of the rigidity that comes with Parkinson’s, what do you do with patients?
Margaret: So at our hospital we do a treatment called LSVT BIG. It is an international treatment program. It’s used all over the world, used in 45 countries by LSVT BIG certified clinicians, both physical therapists and occupational therapists, and this program is meant – it’s a different type of treatment in that it’s a very intense amplitude based exercise program for the limb motor system. So the hallmark of it is high intensity and frequency, which in studies, this is evidence based has shown that it has the biggest effect of neuroplasticity, and that’s our brain’s ability to change and adapt. So the program is delivered four times a week for one month, one hour individual sessions with an LSVT BIG certified either physical therapy or occupational therapist.
Host: So tell us a little bit about what it is, LSVT BIG. How does it help and why is it called BIG?
Margaret: So LSVT is actually an acronym for Lee Silverman Voice Training and the whole program developed about 20 years ago with a woman named Lee Silverman, and the treatment is kind of dedicated to her. So for 10 years, LSVT BIG – LSVT LOUD was used to treat the speech component of Parkinson’s Disease, and 10 years later LSVT BIG was developed. So LSVT BIG is basically used for the motor system, which is your ability to walk, change positions, things like that. It is intensive amplitude based exercises versus years ago, or even presently, for physical therapists, we might do a very eclectic approach to treating a person with Parkinson’s, but this is a specific protocol that is delivered exactly the same way by every clinician who is certified, but there is also an individualized component of the treatment as well. So basically the patients are evaluated to see if they’re appropriate for LSVT BIG, and we can use what’s called stimulability testing. We have them come in. We do our initial assessment, and we see if our cuing actually helps them move bigger, and if in fact it does, then this program is going to be very beneficial for this. So then they would attend a session which would typically be a series of 7 exercises called maximum daily exercises. They’re delivered the same way to all patients, with some modifications depending on the severity or the progressiveness of the person’s Parkinson’s, and then besides the 7 exercises, we also do what’s called functional component tasks, and those are trying to find things that the patient individually would like to work on, or things they’re having difficulty with, and we focus on 5 things that might be difficult for them to do, and we do those each session. And then we also do what’s called BIG walking, walking big, trying to cue people for bigger arm swings, bigger steps. So the idea of the BIG, the word big is that when we say big, it effects all the systems of the body, rather than being so specific and saying stand up straight, take a big step, swing your arms – we just say, move big, and it kind of helps that person cue themselves and move better.
Host: How interesting. What a great description of it Margaret. Do you have results? Tell us what you’ve seen as far as outcomes and what are the after effects on a patient’s life? I mean how long does something like this work for them?
Margaret: So the program, once they complete the program with us, which is the one month, we really try to reinforce even during their program that they do these maximum daily exercises, the functional component tasks, and big walking everyday after they’re discharged. Kind of say – you know it’s like medicine, you take medicine every day and these exercises are going to be like your medicine for your movement. It is so important to stay active. So the research does show that there’s a long lasting effect if the patients are dedicated to doing the program. It shows that they walk faster with bigger steps. They have improved balance. They have increased trunk rotations, and improvements in activities of daily living such as things like bed mobility, transitioning from sit to stand, fine motor tasks such as writing because we work specifically on what that person has difficulty with. But it is, like I said, evidence based and has shown to foster this larger movement that is so important in daily life, being able to do things like they – people could do before. So patients will definitely will benefit from it. We have seen big changes in people’s gait speed, their ability to move, get in and out of bed, which I’ve had patients that were unable to get out of bed say at night to use the bathroom independently, so after doing the program frequently, they’ll be able to get up safely and walk to the bathroom or to do their daily activities with more independence. But the program can be used really at any stage of the disease, very early on or in the later stages of disease. It can be modified to doing in sitting or in lying down position if needed to encourage greater independence at whatever level you’re at in the disease process.
Host: What about the family? Can they get involved in an intense therapy program such as this? What do you want patients to be doing at home and for their families? How can they help with this? Should they be saying big and things like that when their loved ones are doing things?
Margaret: Correct. We love to have the family come and observe and to see how to cue correctly, to really help with some patients will require some assistance at home with their exercises depending on their level or progression of the disease. We also have a homework helper DVD, which would be very similar to the therapist sitting, that they could watch and do along with the therapist and that would be the exercise component. So we do encourage the family to get involved, because we would like them to cue them correctly so that it doesn’t overload them with too many cues, but that one cue for bigness, which is going to increase their amplitude of movement, which is what we’re focusing on.
Host: How long are they supposed to be doing this kind of therapy and wrap it up for us with some of your best advice because people have not heard of this program very much and it is such an amazing useful program for people with Parkinson’s. Just kind of tell us what you would like the take home message to be and how long patients can be doing this kind of intense therapy.
Margaret: So our programs generally last for one month, which is at 4 times a week for one hour sessions with a clinically trained physical therapist or occupational therapist. I think the take home message is that even though you are diagnosed with a neurological progressive disease, there’s definitely – there’s hope in that you can actually really help yourself and you can actually be more active by getting yourself moving, participating, and just knowing what it feels like to move big. So many people will just kind of sit because it is hard to move, but with the cuing and when you can really see how well you can do, you really want to try to stay as active as you can for as long as you can. I’ve had so many patients that really once they were told they have Parkinson’s just kind of sat back and felt overwhelmed by the fact that their life was going to change. So when they come in and we show them how much they can do with some cuing and education, it makes a huge difference in their life and hopefully give them a better quality of life.
Host: And tell people how they can get in touch with you.
Margaret: So at our facility, they can contact the hospital Montefiore St. Luke’s Cornwall, but also on the website, www.lsvtglobal.com, there is a find a clinician site there that you can tap on and put your area where you live and find someone who is certified to either do the BIG program or the LOUD program, and there’s also a lot of educational material and videos of before and after for patients and family members to view on that site, so it’s lsvtglobal.com.
Host: Thank you so much Margaret for coming on and explaining this amazing program and what you do for patients and their families that are living with Parkinson’s Disease. Thank you again. This is Doc Talk presented by Montefiore St. Luke’s Cornwall. For more information, please visit monnslc.org, that’s montefioreslc.org. I’m Melanie Cole, thanks for tuning in.
Melanie Cole (Host): If you know anyone with Parkinson’s Disease, as I do, you know how much trouble, even little things like rolling over in bed can be for them, but there are programs that can help with movement disorders that are really amazing. My guest today is Margaret Rodzel. She’s a physical therapist with Montefiore St. Luke’s Cornwall. Margaret, thanks for joining us today. Tell us about some of the effects that Parkinson’s has on movement and speech.
Margaret Rodzel (Guest): So the hallmarks of Parkinson’s Disease for speech is softness of speech, difficulty understanding someone and for the physical part, usually people with Parkinson’s have slowness of movement called bradykinesia, and small movements called hypokinesia, which impacts their ability to walk and move.
Host: Tell us about some exercise programs and PT and how they can help ease some of the tremors and some of the rigidity that comes with Parkinson’s, what do you do with patients?
Margaret: So at our hospital we do a treatment called LSVT BIG. It is an international treatment program. It’s used all over the world, used in 45 countries by LSVT BIG certified clinicians, both physical therapists and occupational therapists, and this program is meant – it’s a different type of treatment in that it’s a very intense amplitude based exercise program for the limb motor system. So the hallmark of it is high intensity and frequency, which in studies, this is evidence based has shown that it has the biggest effect of neuroplasticity, and that’s our brain’s ability to change and adapt. So the program is delivered four times a week for one month, one hour individual sessions with an LSVT BIG certified either physical therapy or occupational therapist.
Host: So tell us a little bit about what it is, LSVT BIG. How does it help and why is it called BIG?
Margaret: So LSVT is actually an acronym for Lee Silverman Voice Training and the whole program developed about 20 years ago with a woman named Lee Silverman, and the treatment is kind of dedicated to her. So for 10 years, LSVT BIG – LSVT LOUD was used to treat the speech component of Parkinson’s Disease, and 10 years later LSVT BIG was developed. So LSVT BIG is basically used for the motor system, which is your ability to walk, change positions, things like that. It is intensive amplitude based exercises versus years ago, or even presently, for physical therapists, we might do a very eclectic approach to treating a person with Parkinson’s, but this is a specific protocol that is delivered exactly the same way by every clinician who is certified, but there is also an individualized component of the treatment as well. So basically the patients are evaluated to see if they’re appropriate for LSVT BIG, and we can use what’s called stimulability testing. We have them come in. We do our initial assessment, and we see if our cuing actually helps them move bigger, and if in fact it does, then this program is going to be very beneficial for this. So then they would attend a session which would typically be a series of 7 exercises called maximum daily exercises. They’re delivered the same way to all patients, with some modifications depending on the severity or the progressiveness of the person’s Parkinson’s, and then besides the 7 exercises, we also do what’s called functional component tasks, and those are trying to find things that the patient individually would like to work on, or things they’re having difficulty with, and we focus on 5 things that might be difficult for them to do, and we do those each session. And then we also do what’s called BIG walking, walking big, trying to cue people for bigger arm swings, bigger steps. So the idea of the BIG, the word big is that when we say big, it effects all the systems of the body, rather than being so specific and saying stand up straight, take a big step, swing your arms – we just say, move big, and it kind of helps that person cue themselves and move better.
Host: How interesting. What a great description of it Margaret. Do you have results? Tell us what you’ve seen as far as outcomes and what are the after effects on a patient’s life? I mean how long does something like this work for them?
Margaret: So the program, once they complete the program with us, which is the one month, we really try to reinforce even during their program that they do these maximum daily exercises, the functional component tasks, and big walking everyday after they’re discharged. Kind of say – you know it’s like medicine, you take medicine every day and these exercises are going to be like your medicine for your movement. It is so important to stay active. So the research does show that there’s a long lasting effect if the patients are dedicated to doing the program. It shows that they walk faster with bigger steps. They have improved balance. They have increased trunk rotations, and improvements in activities of daily living such as things like bed mobility, transitioning from sit to stand, fine motor tasks such as writing because we work specifically on what that person has difficulty with. But it is, like I said, evidence based and has shown to foster this larger movement that is so important in daily life, being able to do things like they – people could do before. So patients will definitely will benefit from it. We have seen big changes in people’s gait speed, their ability to move, get in and out of bed, which I’ve had patients that were unable to get out of bed say at night to use the bathroom independently, so after doing the program frequently, they’ll be able to get up safely and walk to the bathroom or to do their daily activities with more independence. But the program can be used really at any stage of the disease, very early on or in the later stages of disease. It can be modified to doing in sitting or in lying down position if needed to encourage greater independence at whatever level you’re at in the disease process.
Host: What about the family? Can they get involved in an intense therapy program such as this? What do you want patients to be doing at home and for their families? How can they help with this? Should they be saying big and things like that when their loved ones are doing things?
Margaret: Correct. We love to have the family come and observe and to see how to cue correctly, to really help with some patients will require some assistance at home with their exercises depending on their level or progression of the disease. We also have a homework helper DVD, which would be very similar to the therapist sitting, that they could watch and do along with the therapist and that would be the exercise component. So we do encourage the family to get involved, because we would like them to cue them correctly so that it doesn’t overload them with too many cues, but that one cue for bigness, which is going to increase their amplitude of movement, which is what we’re focusing on.
Host: How long are they supposed to be doing this kind of therapy and wrap it up for us with some of your best advice because people have not heard of this program very much and it is such an amazing useful program for people with Parkinson’s. Just kind of tell us what you would like the take home message to be and how long patients can be doing this kind of intense therapy.
Margaret: So our programs generally last for one month, which is at 4 times a week for one hour sessions with a clinically trained physical therapist or occupational therapist. I think the take home message is that even though you are diagnosed with a neurological progressive disease, there’s definitely – there’s hope in that you can actually really help yourself and you can actually be more active by getting yourself moving, participating, and just knowing what it feels like to move big. So many people will just kind of sit because it is hard to move, but with the cuing and when you can really see how well you can do, you really want to try to stay as active as you can for as long as you can. I’ve had so many patients that really once they were told they have Parkinson’s just kind of sat back and felt overwhelmed by the fact that their life was going to change. So when they come in and we show them how much they can do with some cuing and education, it makes a huge difference in their life and hopefully give them a better quality of life.
Host: And tell people how they can get in touch with you.
Margaret: So at our facility, they can contact the hospital Montefiore St. Luke’s Cornwall, but also on the website, www.lsvtglobal.com, there is a find a clinician site there that you can tap on and put your area where you live and find someone who is certified to either do the BIG program or the LOUD program, and there’s also a lot of educational material and videos of before and after for patients and family members to view on that site, so it’s lsvtglobal.com.
Host: Thank you so much Margaret for coming on and explaining this amazing program and what you do for patients and their families that are living with Parkinson’s Disease. Thank you again. This is Doc Talk presented by Montefiore St. Luke’s Cornwall. For more information, please visit monnslc.org, that’s montefioreslc.org. I’m Melanie Cole, thanks for tuning in.