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Hospital takes team approach to Parkinson’s disease

Nancy Taggert

Community Memorial Hospital

There is a new type of treatment for patients with Parkinson’s disease at Community Memorial Hospital in Cloquet that is proving successful in enhancing the quality of life for patients with the disease. The program is called Big and Loud or LSVT (Lee Silverman Voice Treatment) and it basically involves exaggeration of both voice and physical movements.

The departments of Speech Therapy, Occupational Therapy and Physical Therapy are all involved in the delivery of this treatment.

Speech Therapy focuses on the fact that Parkinson’s disease causes the voice to become softer and more difficult to hear due to a decrease in the strength of muscles that support breathing and speaking. However, Parkinson’s patients often do not perceive that they are speaking softer and often claim that they have stopped speaking because no one listens to them. Speech Therapy involves teaching patients to accept they are not speaking at their normal level and showing them how to reset their voice to an increased level.

“We have to recalibrate what is normal and have them do it over and over,” said Katie Bradley, Speech Therapist and Director of Speech Therapy at CMH. In essence, they must be taught to project louder and louder, even though it may seem uncomfortable at first. This is the “Loud” aspect of Big and Loud treatment.

The therapy includes 16 sessions, one hour a day, four times a week for one month and lots of practice at home. The result of Big and Loud therapy is measurable with up to 80 percent showing improvement in their speaking.

Big and Loud is not just for a patient’s voice: Physical Therapy and Occupational Therapy are also a vital part of the treatment. What these therapists do involves the “Big” portion of the program.

Just as Parkinson’s patients don’t realize that their voice isn’t projecting like it once did, they also don’t always realize that their movements have become reduced in size, making every day activities a challenge.

“Their perception of reality has changed,” explained Jennifer Draxton, physical therapist at CMH. “They feel their movement patterns are normal. We are trying to change their perception by exaggerating the movements.”

The goal of the Big and Loud treatment is to have the patients greatly exaggerate their movements and produce bigger motions with their arms and legs. Essentially, the brain must be retrained to accept that the larger motions are normal. This is done by re-creating neurological pathways. Through repetition of these exaggerated actions, therapists say the progression of the disease can be slowed.

The physical therapist’s role in Big and Loud addresses the larger motions and movements, while the occupational therapist focuses on the smaller motions of daily living skills, like bathing or cooking, according to Jess Ochis, CMH occupational therapist. Ochis said a patient can go through the program with either a physical or occupational therapist, but the combined approach of occupational therapy and physical therapy is even more beneficial because it offers more a tailored treatment for each person’s individual needs.

“Big and Loud therapy does not reverse changes of the disease,” explained Ochis, “but it helps improve daily function and sustain improvements gained throughout the treatment.”

After going through the program, patients often need to return for a refresher course months later, but the therapists agree that the tools the patient learns, in helping them to achieve small or large goals, can help prevent further decline.

All therapists using the Big and Loud program must be certified after an extensive training program. These therapists at Community Memorial Hospital are among the 6,000 certified practitioners of Big and Loud worldwide.

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