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Treating Parkinson's with MossRehab's Big and Loud Program
By: Peter Schnellenberger
Feb 17 2021

Three individuals sitting in a circle playing drums.

As part of its Parkinson's Disease Therapies, MossRehab physical, occupational, and speech therapists throughout the network are trained and certified in the Lee Silverman Voice Treatment (LSVT) BIG and LOUD programs that address motor and speech deficits caused by Parkinson’s Disease.

Parkinson’s Disease is a progressive, neurodegenerative disorder.  The condition gradually manifests itself in tremors, stiffness, slow and small movements, poor balance as well as difficulties with walking, daily activities, speech and swallowing. The second most common age-related neurodegenerative disorder after Alzheimer’s Disease, Parkinson’s affects about one million Americans. While there is no cure for the disease, medication and exercise can effectively manage the symptoms.

Expanding its Parkinson’s rehabilitation treatments, MossRehab added the LSVT-BIG and LSVT-LOUD programs in 2013. These evidence-based, intensive training programs are delivered by certified therapists to help improve or slow some of the side effects related to speech and motor functions.  LSVT-LOUD is a speech therapy program focused on improving voice volume and quality, while LSVT-BIG is an intensive whole-body exercise program that works on larger body movements and repetitive functional training.

Patients Start in Programs After Initial Diagnosis

Programs are conducted at select MossRehab outpatient facilities, with patients attending four times per week for a minimum of four consecutive weeks. Sessions are one hour, with one-to-one treatment. “It is best to start patients on BIG and LOUD therapy as soon as they’re clinically diagnosed with Parkinson’s Disease,” explains Michele Aguado, Physical Therapist, who was certified in LSVT-BIG therapy in 2013. “Working with a therapist, a dedicated patient can make noticeable progress in walking, balance, mobility, speech, and basic daily activities.”

For example, a speech therapist trained in LSVT-LOUD will work with individuals to improve voice volume and quality. Individuals with Parkinson’s Disease frequently suffer from hypophonia characterized by soft speech that makes it difficult for others to hear them. Occupational and physical therapists certified in LSVT-BIG work with patients with Parkinson’s Disease having movement problems. Full-body exercises of the upper and lower extremities and trunk, as well as walking training and functional activity instruction, help improve balance, mobility and daily activities.

“We try to increase the level of difficulty of meaningful activities to challenge the patients,” notes Aguado. “For example, I had a patient who liked to cook but had difficulty whisking as she couldn’t move her arm well.  So, we repetitively practiced whisking during BIG therapy. First, she started with just whisking, then stood on a balance pad while whisking. Finally, she whisked while on a balance pad and reciting a favorite recipe. At the end of the program, she could whisk with greater intensity with less focused effort while holding a conversation.”

As Parkinson’s is a progressive neurological disease with different stages, many patients return for a reassessment. While symptoms during stage one may be mild, symptoms during stages four or five become more pronounced and result in the individual experiencing difficulty walking or talking. “Someone in the early stages who is still very functional may return in six months to a year while someone in the more advanced stages may come back in three to six months,” explains Aguado. “The reassessment also allows us to ensure they are doing home exercises correctly.”

PWR! and Speak Out Training Offer Additional Support

In addition to the BIG AND LOUD programs, Moss Rehab offers the PWR! (Parkinson's Wellness Recovery) exercise-based program that addresses different stages of the Parkinson’s Disease. Our certified PWR! therapists decide on the frequency and duration of patient-specific exercise programs depending on individual needs as well as the disease severity. The training program, offered at three MossRehab locations, is designed to target symptoms in maintaining or restoring skills. Patients with Parkinsons’ Disease can integrate exercises learned during PWR! Into daily life, work and community activities.

The Speak Out! therapy approach that combines education, individual speech therapy and ongoing group sessions is offered at MossRehab King of Prussia to patients with Parkinson’s to improve speech and voice. The treatment combines both therapy sessions and home practice that emphasizes speaking with intent.

MossRehab Hosts Maintenance Exercise Programs

To encourage those with Parkinson’s’ Disease to stay with exercises after leaving either the LSVT-BIG or PWR! programs, clinics at MossRehab Elkins Park and MossRehab Tabor Road through a grant from The Parkinson Council host maintenance exercise groups for the community.  In-person groups are on hold due to the pandemic. However, the exercise group resumed virtually in 2021. “Even though we encourage patients to continue daily exercises, sometimes they need encouragement and guidance to continue with the program and to stay active,” notes Aguado.

Michele leads a Parkinson’s Special Interest Group with MossRehab physical therapists, occupational therapists, and speech therapists, as well as individuals from the Klein Family Parkinson’s Rehabilitation Center at MossRehab. Besides sharing experiences about patients with Parkinson’s’ Disease and insights on the disorder, the multidisciplinary group attends presentations on different topics related to the disease to further their knowledge and enhance the treatment of individuals with Parkinson’s Disease.

Visit Parkinson’s Disease Therapies for more information about the MossRehab LSVT-BIG and LSVT-LOUD Program and outpatient sites offering these programs.

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