Wednesday, August 16, 2017  

Thinking Big Yields Big Results for Parkinson's Patients


Imagine going from an active person who takes walks on the beach, plays with their kids and enjoys dinners out with friends and family to someone for whom it now takes 10 slow, deliberate steps just to get out of the car or five minutes of fumbling to put on your jacket. And while navigating the aisles of the grocery store used to be easy, these days it feels more like you’re a snail climbing Mount Everest.
These are just a few of the scenarios patients living with Parkinson’s disease can face as the neurological illness takes its toll. For Mike Mellen the impact was clear; life was no longer moving smoothly. Walking had become tedious with each step feeling uncertain. Tremors in his hands were annoying and the incessant shaking was keeping him from being independent.
“The tremors in my right hand and my gait and my balance are all challenging,” Mellen said. “And I have a tendency to lose my balance.”
Parkinson’s, which is a cluster of motor system disorders caused by a loss of dopamine in the brain, can create a debilitating tremor, rigidity in the limbs and trunk, a slowness of movement and a loss of balance or coordination. According to the National Parkinson Foundation, there is no cure for the disease and a doctor’s primary goal is to minimize symptoms, often through prescription medications.
Traditional physical therapy can help Parkinson’s patients dealing with a loss of balance or chronic falls, but that type of orthopedic treatment isn’t geared toward addressing the neurological causes of those symptoms. But there is a new technique that’s offering relief.
The treatment, called LSVT-BIG, targets movement impairments typical of Parkinson’s patients that lead to a diminished scale of mobility and function. The solution? Think bigger.
“A lot of Parkinson’s patients don’t understand that their movements are very small and that moving small affects everything from how they walk to how they move to how they get out of the car to how they put on a jacket,” said physical therapist Ken Morris, PT, DPT, CMTPT, LSVT-BIG. “Larger movement leads to more fluid movement. Instead of it taking five to 10 steps to get out of the car, larger movements mean getting out of the car in one fluid movement of swinging your legs around.”
The treatment, referred to as LSVT (Lee Silverman Voice Treatment) BIG, is based on another Parkinson’s related treatment that helps patients who have had a decline in speech due to a loss of vocal volume. While the voice treatment encourages patients to speak louder, LSVT BIG tasks patients with moving on a bigger scale. Patients in the LSVT BIG program undergo intensive treatment with four sessions a week for four weeks with an LSVT BIG certified physical therapist as well as perform a series of specific exercises twice a day at home.
The key is that each exercise requires patients to concentrate on taking big steps, making big motions or swinging their arms with purpose.
“All the exercises are kind of dramatic or over accentuated,” said Mellen.
While the sensation of taking what feels like gigantic steps or colossal squats may feel awkward, Mellen said he never felt silly or self-conscious. If anything, he was elated when he started to get results and find new hope for the future.
“The progression of my Parkinson’s, I think has been decreased,” he said. “The degree of rigidity has been relieved in my arms and legs. It just basically delayed the symptoms from getting bad.”
The program goes beyond addressing the loss of gross motor function like walking. It can also help improve diminished fine motor skills essential for performing daily tasks such as dressing, washing the dishes or using utensils.
“Whether it’s writing or buttoning a shirt, we can craft different strategies to break up patterns of freezing or stiffness,” said physical therapist Sarah Zeisler, PT, DPT, LSVT-BIG, noting that it’s all about changing a patient’s perception of movement. “A lot of times patients feel they’re moving too big when in reality they’re probably moving at what appears to be a normal pace. If they continue with that big thinking, they’ll shift to more normalized walking and overall mobility.”
Beyond improving mobility, LSVT-BIG does something else, too. It gives patients back their independence and their confidence.
“A lot of people don’t realize that it’s taking longer to walk because the length of their steps have become very small, they just know that getting to and from a location may take longer,” said physical therapist Kristina Carter, PT, DPT, CMTPT, LSVT-BIG. “As a result they stop doing as much mobility type tasks. Because things take longer, they can’t keep up with family members or friends anymore.”
Physical Therapist Erika Clements PT, DPT, LSVT-BIG, said she’s been using the LSVT-BIG treatment on Parkinson’s patients for about three years. She’s seen patients achieve a variety of goals by tailoring the program to their needs. A patient who once feared walking in her own home without a walker, now feels confident enough to carry a laundry basket through her house unaided. Another of Clements’ patients who could only cut his grass with a riding lawn mower can now tend his yard using a push mower. Clements credits such patient successes to the technique’s focus on the connection between muscular and neurological function.
“It’s really designed to almost create new pathways, to rewire the system,” she says, noting that the treatment can help patients at a variety of different levels. “It is amazing watching them put forth the effort and watching them improve.”
When a neurologist recommended Mellen try LSVT-BIG, he read up on the treatment before finding his way to Tidewater Physical Therapy in the spring of 2015. He learned a series of eight exercises that he performed faithfully at home as well as during regular visits to the clinic.
More than a year after completing the BIG program, Mellen said he rarely goes a day without doing those same exercises. What’s more, because of his physical improvement, he’s been able to embrace a more active lifestyle that now includes a boxing class twice a week and workouts every-other-day at the YMCA.
The spry 71-year-old stressed that the key to the BIG program isn’t the exercises by themselves that made the difference. For Mellen, having the encouragement and guidance of an LSVT-BIG trained physical therapist is what he said allowed him to quickly regain his active lifestyle.
“I only did the BIG exercises for a couple of months before I started doing more things,” he said “Because I’d been through that first step, I had the confidence to go on to bigger and better things.”