Parkinson’s Disease and Physical Therapy

Posted on 1/12/2018 by Laila Hasham, P.T., DPT

Parkinson’s disease is a chronic, progressive movement disorder that affects one in 100 people over the age of 60. While the average age at onset is 60, people have been diagnosed as young as 18. It is the second most common degenerative brain disorder affecting adults (Alzheimer’s disease is the most common). Recent research indicates that at least one million people in the United States and more than five million worldwide have Parkinson’s, and there are around 50,000 new cases diagnosed each year.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Some of these dying neurons produce dopamine, a chemical that sends signals to the brain to control movement and coordination. As Parkinson’s progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. People with Parkinson’s disease are at risk of falling and sustaining injuries due to their movement and balance impairment.

Treatment includes a combination of medication and physical therapy, and in some cases surgery. A physical therapist who has experience treating Parkinson’s can help a person improve mobility, strength and balance.

The universal benefits of exercise in helping everyone feel better and improving overall health are well documented. There is evidence that exercise has specific benefits for people with Parkinson's in staying active and improving balance and coordination. Exercise approaches have long played a role in the management of Parkinson’s disease, to maximize function and minimize secondary complications and inactivity.

For decades, the Lee Silverman Voice Technique (LSVT) has been an effective way to treat the symptoms of impaired voice and swallowing from Parkinson’s called LSVT LOUD®. In 2005, a new approach to therapy called LSVT BIG® was developed. LSVT BIG is a research-based exercise program specifically designed for people with Parkinson’s. It has been shown to improve function with significant improvements noted in trunk rotation, balance and faster walking with larger steps1. LSVT BIG is provided by physical and occupational therapists who have received specific training in this technique.

LSVT programs include the combination of:

An exclusive target on increasing amplitude, or loudness in the speech motor system, and bigger movements in the limb motor system.
A focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel ‘too loud’ or ‘too big.’
Training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning2.
The LSVT BIG program includes 16 sessions of therapy over four weeks, at a frequency of four days each week. These sessions are provided in a one-to-one manner and include high intensity, whole body movements. Depending on the nature and severity of the condition, treatment sessions may focus on activities that are important to the patient and education to help transfers, bed mobility and hand movement. While other exercise interventions may focus on external cues and breaking down task components, LSVT BIG focuses on movement amplitude to achieve bigger and faster movements in the attempt to restore normal movement patterns and improve gait speed.

The program is both intensive and fun, and the hard work and dedication of the patient is integral to the success of the program. Find a local NovaCare center to see if the LSVT BIG program is offered near you.

For more information on Parkinson’s disease and the LSVT BIG program, please visit the LSVT Global website at www.LSVTGlobal.com.

References:

Farley et al (2008) Intensity amplitude-specific therapy for Parkinson’s disease. Topics in Geriatric Rehabilitation 24(2) 99-114.
Cynthia Fox, Georg Ebersbach, Lorraine Ramig, Shimn Sapir. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinson’s disease. 2012;2012.
By: Laila Hasham, P.T., DPT. Laila is a physical therapist with NovaCare in Austin, TX. Her primary expertise is in orthopaedics, but she is passionate about treating people with Parkinson’s and similar movement disorders in order to improve quality of life and overall function. Laila is pictured above treating a patient.