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In Focus: Parkinson’s Disease Therapies
By: Larry Blumenthal
Nov 13 2015



Research shows that people with Parkinson’s can slow the progression of their disease through appropriate exercise and therapy. MossRehab’s team of specially trained physical, occupational and speech therapists focus on accomplishing just that. Physical Therapist
Stephanie Tornquist, PT, DPT, took some time recently to answer questions about the MossRehab Parkinson’s Disease Therapy program.  

Who should be considering coming to MossRehab for Parkinson's therapy?

Tornquist: Really anyone with a diagnosis of Parkinson's disease could benefit from a therapy session regardless of what stage they are in their disease process. Of course, the earlier after diagnosis the better. Even if someone has had therapy before, we recommend they come for an evaluation every year for a comparison to their baseline physical status. It is a progressive disease, so patients often benefit from therapy at various times during the disease's progression. Our patients are people who are working and retired and at various stages in the disease.

Can you briefly describe the range of services that MossRehab offers people with Parkinson’s?

Tornquist: We offer physical, occupational and speech therapy. We also have exercise maintenance programs designed specifically for individuals with Parkinson's. We have education programs that we hold onsite at MossRehab on various exercise-related topics. We also go out into the community and work with local support groups to provide education about mobility and exercise for people with Parkinson's.

What kind of experts are on staff to work in this program?

Tornquist: We have physical therapists who focus on activities such as walking, getting in and out of a chair, in and out of bed, reducing falls and freezing episodes. They provide physical therapy and run the exercise/maintenance programs. We have occupational therapists who work on activities of daily living like getting dressed or taking a shower or cooking meals. If a patient is employed, occupational therapists can focus on work specific duties that the client may have trouble with. We have speech therapists who work on improving voice quality—both the volume of the voice and issues around swallowing. All three types of therapists work together if someone needs any type of cognitive training or exercises.  Our therapists are certified in a variety of programs and stay educated about Parkinson’s and news in the Parkinson’s community.

Does MossRehab have physicians who work with patients with Parkinson's Disease?

Tornquist: Several of our patients see a doctor through MossRehab’s Physical Medicine and Rehabiliation Department, which is staffed by physiatrists - doctors that specialize in physical medicine. 

The LSVT BIG and LOUD therapies seem to be an important part of the program. Can you explain what they are and why they are important?

Tornquist: LSVT stands for Lee Silverman Voice Treatment. LSVT LOUD is delivered by a certified speech therapist. It is an intensive, high-effort, evidence-based treatment to increase voice volume and quality. The BIG program consists of evidence-based, intensive, large amplitude, whole body exercises to improve the quality of movement. People with Parkinson's have issues with small, slow movements. This treatment focuses on those specific issues. It can improve balance, strength and coordination. The whole treatment is designed around the primary movement symptoms of Parkinson's or primary voice symptoms of Parkinson's. Both BIG and LOUD are delivered four times a week for four weeks, totaling 16 sessions. There are daily homework assignments that are important for carryover in the community setting and to succeed in the program.

LSVT is helpful for people at any stage of the disease?

Tornquist: According to the research, LSVT shows the largest improvement for people who are in earlier stages of the disease, with less severe impairments, but it can be helpful at any stage. I really try to stress this when I'm talking to people with Parkinson’s. Learning these exercises and making them part of your daily routine early on in the disease can slow the progression. It's better to start doing these exercises to prevent mobility issues rather than exercising to reverse them.

Can you explain what PWR! is?

Tornquist: PWR!—they call it “power”—stands for Parkinson's Wellness Recovery. It uses similar principals as the LSVT BIG treatment. It's intensive and high amplitude. The difference is that there's no strict protocol to follow with PWR!. This can be helpful for patients who can’t come four times a week for four weeks. Most patients would probably do better getting the largest and the most intense dose of therapy, but—in the real world—people aren't able to get rides here four times a week or they have a high copay. Through PWR! they can still work on different exercises that target the primary Parkinson’s symptoms.

Let's talk about the exercise maintenance program. How does that work and who would benefit from it?

Tornquist: The exercise maintenance programs are good for people with Parkinson's who are done with their therapy or no longer need skilled therapy. The programs can help to maintain the gains that they made while in therapy. It's a safe and supervised exercise option for patients who cannot exercise unsupervised at a regular gym. We can accommodate up to about 10 people. We perform a variety of exercises that have been found to be beneficial for the symptoms of Parkinson's. We do the PWR! exercise as a group. We do a lot of cardio exercises like riding the bike at a fast speed or walking at a faster speed. We do yoga. We do tai chi or boxing. We change it up to keep it fun. There’s a group spirit that helps to motivate people to stick with their exercise plan. Right now we have maintenance programs at the Medical Office Building at Tabor next to Einstein Medical Center Philadelphia and at the MossRehab Main Campus in Elkins Park, Pa. Our programs are supported by a generous grant from the Parkinson's Council, an organization in the greater Philadelphia area that benefits people with Parkinson's.

What's the best part of this work?

Tornquist: One of the biggest things is just seeing how much of a difference exercise and physical therapy can have on my patients to improve their lives and their function and the quality of life for them and their caregivers. Also, I try hard to empower them as much as I can. I want them to understand what's happening with their body and the disease and to know how much exercise can be helpful for them. I also enjoy the opportunity to go out to the community support groups and spread as much education as I can about how much exercise can help people with Parkinson's. I like showing them that there is a little bit of a light at the end of the tunnel, that there are ways to slow the progression of the disease, and help them have the best quality of life that they can.

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