Big Benefits for Parkinson’s Disease

Four years ago, Robert Brown began having difficulty walking. When the problem persisted, the retired physics teacher was diagnosed with Parkinson’s disease.
“You have to walk to do almost anything, and I was having trouble just taking steps,” relates the Cape Cod, Massachusetts native. “That prevented me from doing most of my activities. No more dancing!”

Photo by Nerissa Johnson.

Robert is back to taking Ranger on leisurely walks.

“He could barely walk,” agrees Robert’s wife, Jean. “He didn’t have much confidence when he did walk, and he couldn’t walk very far.”
The issue put a halt to Robert’s regular exercise of taking the dog on long, leisurely walks. He never fell, but his balance was uneasy. Robert and Jean decided Robert needed help regaining the strength to walk with confidence again. They went to long-time trusted provider Barr & Associates Physical Therapy, where Robert was paired with physical therapist Nannine Dahlen, PT.
“Nannine was very good and helped me a lot,” states Robert. “She worked on the basics, walking at the parallel bars and going up and down steps. We also worked on the treadmill. We did a lot of exercises.”

Bigger Is Better

Years ago, a group of speech therapists helped a woman named Lee Silverman, who had a very quiet voice, strengthen her voice by speaking really loudly. The therapy worked, so the therapists developed a very successful, credentialed program called Lee Silverman Voice Training LOUD, or LSVT LOUD.
“Quiet voice is a hallmark of Parkinson’s disease,” notes Nannine. “Physical therapists who were working with those speech therapists noticed LSVT LOUD worked for the voice and wondered if something similar would work with other symptoms of Parkinson’s disease.”
The physical therapists noted that people with Parkinson’s disease tended to make very small movements. This made it difficult for them to walk and perform their activities of daily living. Maybe big movements would help them.
“They began researching and planning and eventually developed a very definitive exercise program based on big movements of all parts of the body,” recounts Nannine. “They called it LSVT BIG.
“The LSVT BIG program at Barr & Associates consists of 16 sessions. Patients have sessions at the office four days a week for four weeks. At each session, patients perform a specific series of exercises formatted for the program. Patients are also asked to do the exercises twice a day at home on days they don’t have a session.
“We have the patients repeat the exercises to help them really learn, memorize and feel confident doing the movements on their own once they’ve completed the program,” explains Nannine.
The big movements in the exercises incorporated into the LSVT BIG program have been shown to increase limb and body movement in people with Parkinson’s disease. They’ve also been documented to produce improvement in speed, balance and quality of life.
“There are two other components of LSVT BIG in addition to the exercises,” educates Nannine. “One is functional movement, which concentrates on something the patient does every day but is currently having difficulty doing. This is patient specific. The other component is hierarchy, a series of three activities that build on each other.”
Functional movement generally starts with sit-to-stand because most people with Parkinson’s disease have difficulty standing up because their legs get weak. The rest of the movements are tailored to address the problems the patient is experiencing.
“These movements could include walking, as in Robert’s case, or it could be an activity with their hands, such as writing or feeding themselves,” informs Nannine. “In their initial interviews, we talk to the patients and their caregivers to find out what those functional trouble areas are.”
Hierarchy is also patient specific. The patients report an activity they are struggling with, and the therapists build them up to it by working on three separate movements of the activity. In the end, the patients have mastered the entire activity.
“An example would be a patient who is struggling to get up and walk away from the table,” describes Nannine. “The first movement for them to learn is pushing the chair away from the table. The second is making a quarter turn to get out of the chair. The third may be maintaining balance once they get to a standing position.”
Nannine notes that Robert’s biggest problem was walking. His Parkinson’s disease caused him to take very small steps, and with small steps, he tended to lose his balance. In addition, because he couldn’t walk, he didn’t move as often. As a result, the strength in his legs decreased.
“We primarily worked on taking bigger steps, both forward and backward,” she remembers. “Many people with Parkinson’s cannot multi-task, so I increased the complexity level for Robert by adding other movements. I asked him to look up and down and side to side while he was taking bigger steps. He progressed very well on the program.
“Robert told me he got more out of the LSVT BIG program than any of the other physical therapy sessions he had that didn’t incorporate big movements.”

Happy Dog

After completing LSVT BIG, Robert is much steadier on his feet and more comfortable taking larger steps when he walks. He’s not dancing, but he can walk the dog again, and he gets around the house without assistance.
“It was probably three or four weeks when I began noticing a difference,” he reports. “I’ve gotten much better, and my walking has improved. I can walk a lot farther than before. I walk the dog whenever I can now.”

“It was probably three or four weeks when I began noticing a difference. I’ve gotten much better, and my walking has improved.” – Robert

“He has a lot more confidence when he walks now,” adds Jean. “His balance wasn’t that bad. He was a little unsteady, but all that has improved.
“At the movies or at restaurants, I used to have to park at the door and let him out. Now, I can park in the parking lot, and he can walk. We can go to the university basketball games, and he can walk and go up in the stands. He couldn’t do that before the therapy.”
Both Robert and Jean are big fans of the staff and facilities at Barr & Associates Physical Therapy, and they’ll tell anyone about it. Robert is particularly happy about his experience with LSVT BIG.
“We’ve been going to Barr and Associates for years for different things,” shares Jean. “We’ve tried other physical therapists in the area, and they don’t even compare to Barr. They’re wonderful over there.”
“I recommend this program for anybody with Parkinson’s disease, and I recommend Barr and Associates,” says Robert. “Of all the places I’ve been, Barr and Associates is far superior!”

Print This Article