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MRC News

Published on June 26, 2013
Susan Christensen
Health and Research News Service

At Methodist Outpatient Rehabilitation in Flowood, Parkinson's patient Barbara Jones of Smithdale works with physical therapist Lisa Indest to practice the exaggerated movements that are part of LSVT Big and Loud therapy. The program addresses many Parkinson's impairments that can get progressively worse, such as a shuffling gait, slow movements, loss of trunk rotation, postural changes and muscle rigidity.

Heather Wise, a speech therapist at Methodist Outpatient Rehabilitation in Flowood, guides Barbara Jones through vocal exercises designed to help her speak louder and more clearly. The therapy is part of LSVT Big and Loud, a program that addresses the speech/swallowing problems and movement impairments common to Parkinson's disease.

“Loss of confidence” isn’t an official symptom of Parkinson’s disease.

But for Barbara Jones of Smithdale, feeling “weak and helpless” was as much a part of Parkinson’s as her frequent and debilitating falls.

“I broke my knee cap, collar bone and busted my head open,” said the 67-year-old retiree.

The tumbles were related to muscle stiffness and unsteadiness associated with the neurological disease. And Jones had no clue how to prevent them.

Then she attended a free screening for an innovative treatment offered at Methodist Outpatient Rehabilitation in Flowood, a division of Methodist Rehabilitation Center in Jackson. Known as LSVT Big and Loud, the therapy addresses two major challenges of Parkinson’s—movement impairments and speech/swallowing problems.

LSVT stands for Lee Silverman Voice Training and is the “Loud” portion of the program. “Big” refers to an exercise regimen that helps improve mobility.

“Big doesn’t replace interventions with medications,” stresses Methodist Rehab physical therapist Lisa Indest. “But it does address a lot of the impairments people have that get progressively worse, such as a shuffling gait, slow movements, loss of trunk rotation, postural changes and muscle rigidity.”

Jones said she had considered doing LSVT Loud in the past to combat swallowing problems. But it was the recent addition of the “Big” component that sold her on the program. “When I saw I could do speech, physical and occupational therapy all at once, that’s when I called Methodist Rehab,” she said.

Indest said Methodist Rehab is the first clinic in the Jackson area to combine Big and Loud, and patients appreciate the convenience once they learn of the program’s intense time commitment.

Patients do therapy four days a week for four weeks, as well as daily homework. “The whole time you are going through therapy, you are learning to do exercises so you can do them yourself,” Jones said.

The program is custom-tailored to each patient’s goals, even down to the words practiced in speech therapy.

“I ask them for 10 functional phrases they use most often,” said Methodist Rehab speech therapist Kimberly Boyd.  Since Jones’ husband is hearing-impaired, one of her phrases was: “Get your hearing aids.”

The irony of that, said Boyd, is most mates of Parkinson’s patients don’t actually have hearing problems. Their spouses just think they do because they don’t realize their disease-weakened voices are difficult to understand.

“Their perception of their voice is not what ours is, so they can’t tell their voice is low,” Boyd said. “We do voice recordings during their initial evaluation and throughout their therapy. After a couple of weeks, I’ll have them listen and they are absolutely amazed.  They can’t believe how much they’ve improved in such a short time.”

Indest said patients also can be confused about their walking ability. “What they feel is normal movement is not,” she said. So they practice making bigger movements during therapy, such as lengthening their steps and swinging their arms wide.

“I was so glad to know what to do to get better, it really does help,” Jones said. “I hear the therapists’ voices all the time: ‘Keep a wide stance. Take big steps.’”

Jones’ therapists say they couldn’t have asked for a more cooperative patient. “She was truly one of the bright lights,” said Methodist Rehab occupational therapist Suzanne Colbert. “She came in with a smile on her face and worked hard.”

“And she was very motivated and diligent about doing her home program,” Indest said.

Jones said she was inspired by her renewed abilities. “After about two weeks, I could do some of the exercises without holding on, my voice was stronger and I was having less trouble swallowing,” she said.

Now, she can rise from most chairs by herself and even walk backwards without assistance. And she has done it all without falling.

She’s also back to driving and recently managed a long day prepping her house for a weekend ice cream social.  “When she got here that following Monday, she was worn out,” Colbert said.

But her self-esteem wasn’t suffering. “One thing Big and Loud does is give you confidence,” Jones said. “It really helps your mental attitude when you know you’re doing the right thing and you can get better.”

Methodist Outpatient Rehabilitation in Flowood, a division of Methodist Rehabilitation Center in Jackson, offers free screenings for Parkinson’s disease patients interested in Big and Loud therapy. Call 601-936-8888 to schedule an appointment.