Exercise-based behavioral treatments may improve function and slow progression of motor symptoms
Parkinson’s disease (PD) is a neurodegenerative disorder that predominantly affects movement.1 The three primary symptoms are tremors, muscle stiffness, and slowness of movement. Other symptoms include dysphasia, dysphagia, depression, and dementia. Because it is a progressive disease, these symptoms may increase in frequency and severity over time.1 The signs and symptoms of PD result in a difficult reality one must face for the rest of life. This new lifestyle may result in a significant loss of independence and functional dependency (need for assistance with ADLs). Research has shown that regular exercise benefits people with PD. Recent advances in neuroscience suggest that exercise-based behavioral treatments may improve function and possibly slow progression of motor symptoms in individuals with Parkinson’s.2
As a result, one alternative treatment approach is Lee Silverman Voice Treatment (LSVT-BIG) home health occupational therapy. It is a therapeutic modality that has significant implications on occupational performance and quality of life. LSVT-BIG is an intensive, evidence-based exercise treatment program for people with PD based on neuroplasticity (the brain’s ability to change and reorganize itself by forming new neural connections). The unique aspects of LSVT-BIG include the combination of 1) an exclusive target on increasing amplitude (bigger movements in the limb motor system), 2) a focus on sensory recalibration to help clients recognize that movements with increased amplitude are within normal limits, even if they feel “too big,” and 3) training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes.2 LSVT-BIG is administered by a specially-trained physical or occupational therapist in a variety of clinical settings.
Within multidisciplinary care for Parkinson patients, the primary role of occupational therapy (OT) is to optimize activity performance and engagement in valued activities in the home or community. Occupational therapists identify personally meaningful activities that are negatively impacted due to their Parkinson’s symptoms and subsequently develop a home care treatment plan with specific goals to improve function and independence with daily roles and routines. Despite medical interventions for PD, the disease is progressive and can cause significant disability in individuals. As a result, individuals may become increasingly home-bound and less likely to access their community. Clients and their caregivers may gradually discover the process of safely entering the community becomes a taxing and considerable effort. The sequence of stair climbing, car transfers, functional mobility, and toileting for some results in a stressful and emotionally-distressing experience as it becomes physically more difficult to safely complete functional tasks. The fear of falling and personal injury may also accompany the process of community mobility.
Home health occupational therapy is one transitional strategy to provide LSVT-BIG sessions in one’s home and to establish and implement a daily LSVT-BIG home exercise program with the client and caregiver. Clear communication with the client and caregiver is key for LSVT-BIG long-term benefits. Client education and caregiver involvement is a critical element in successful home health outcomes. As a result, the client and caregiver are uniquely positioned to learn the foundational principles to apply LSVT-BIG in their everyday living. Perhaps, most importantly, the client and caregiver may reintegrate into valued, meaningful community tasks and become less-homebound. It is the goal that functional improvements in the home setting enable a gradual transition back to community life. With the effective use of LSVT-BIG exercises, the ultimate goal is the client and caregiver’s renewed and changed perspective about regaining their ability to experience a productive life outside one’s home. A client’s primary care physician or neurologist can refer to home health physical and occupational therapy to provide in-home LSVT-BIG treatment sessions. At discharge, a focal goal is continuing the LSVT-BIG in an outpatient physical therapy clinic. The intrinsic benefit of continuing outpatient LSVT-BIG therapy can provide a seamless transition from home care to community level activities. Home LSVT-BIG OT can empower and motivate our clients to once again re-experience the psychological, social, and physical benefits of community life. Planting the seed that one can continue a self-fulfilling and gratifying life outside their home despite the physical challenges borne from PD is cornerstone of home health OT LSVT-BIG.
- Qualicare Family Homecare. Parkinson’s and Homecare. www.qualicare.com. Published 2001. Accessed April 21, 2018
- Cynthia Fox, Georg Ebersbach, Lorraine Ramig, and Shimon Sapir, “LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson’s Disease, vol. 2012, Article ID 391946, 12 pages, 2012. doi: 10.1155/2012/391946