Patients with neurological impairments are using exaggerated movements to regain balance and muscle dexterity.
Modeled after Lee Silverman Voice Treatment LOUD, a program designed to improve enunciation and speech volume in Parkinson’s patients, the “BIG” version is helping people like Nina Fatchett regain independence.
The 70-year-old Parker woman was diagnosed with multiple sclerosis two years ago and visits the Center for Rehabilitation and Sports Medicine at Parker Adventist Hospital four times a week for exercise sessions with June Hartmann, the lead occupational therapist for outpatient rehabilitation. The hospital became certified in LSVT BIG in December, and the few patients who have gone through the specialized treatment have shown vast improvements in mobility.
Fatchett’s normal walking pace had become a shuffle, her balance was shaky, and she lost range of motion in her arms. But four visits to Hartmann per week for the last month, plus daily half-hour-long sessions at home, have helped her accomplish everyday tasks that had become difficult.
“It’s easier to get towels out of the washer because those are heavy, and I can reach up and put the dishes away,” Fatchett said. “Things like that make a big difference.”
And “big” is a key word in the therapy. Hartmann said changes in the brain’s ability to communicate with the rest of the body cause the slower movements to go unrecognized by the patients. The deliberate movements involved in the exercises feel big to them, but they are actually moving normally, Hartmann says. Therapists record before and after videos to monitor progress, and patients are often stunned by their improvement.
“She gets it all back because she’s doing these every day,” Hartmann says of Fatchett’s prescribed exercises.
The exaggerated movements used in BIG borrow from the LSVT LOUD therapy, which gained popularity after being developed in the 1990s by a group of Colorado researchers. Parkinson’s patients often begin to mumble because of neurological damage, and medical experts discovered that facial muscles and speech memory can be retrained. In the LOUD therapy, patients are given tasks to build their vocal strength.
They are instructed, for instance, to practice specific frequently used phrases and then repeat those sentences in everyday settings, like the grocery store or at home. Muscle memory eventually takes over and speech clarity and volume improve, said Susie Peterson, who oversees the LOUD program at Parker Adventist.
LSVT BIG was quickly found to have a tremendous impact on other patients with neurological impairments.
“It was designed for the Parkinson’s patients, but right now I’m doing it with two stroke patients, because they have the motion, but they haven’t figured out, ‘how do I loosen my trunk? How do I get better balance?’” Hartmann said.
Fatchett can’t drive — she credits her husband for “faithfully” driving her to every therapy appointment — but she no longer uses a walker and can take larger steps when walking and navigate stairs more easily. The home exercises have become routine, but it helps having Hartmann coaching her on the correct movements.
Fatchett, a Parker resident for 37 years, said she does not expect MS to take away her ability to speak, precluding the need for LOUD therapy.
“I talk a lot,” she says, with a laugh.