Public Webinar Series - LSVT...
Transcript of Public Webinar Series - LSVT...
Public Webinar Series
Title: Improving communication and movement through evidence-based speech, physical, and occupational therapies in Parkinson disease
Presenters: Laura Guse, MPT, MSCS
Cynthia Fox, PhD, CCC-SLP
Date Presented: March 16, 2016
Disclaimer:
The information provided in this webinar and handout is not a substitute for medical or professional care, and you should not use this information in place of a visit, call consultation or the advice of your physician, speech, physical or occupational therapist, or other healthcare provider.
Copyright:
The content of this presentation is the property of LSVT Global and is for information purposes only. This content should not be reproduced without LSVT Global’s permission.
Contact Us:
Web: www.lsvtglobal.com Email: [email protected]
Phone: 1-888-438-5788 (toll free), 1-520-867-8838 (direct)
Copyright© LSVT Global, Inc. 2017 1
Improving Communication and Movement through Evidence-based Speech, Physical, and Occupational
Therapies in Parkinson Disease
Supported, in part by research grants: R01 DC01150, R21 RFA-NS-02-006, R21 DC006078, R21 NS043711
Presented byCynthia Fox, PhD, CCC-SLP
LSVT BIG/LSVT LOUD Faculty
Co-Founder, VP of Operations
LSVT Global, Inc.
Laura Gusé, MPT, MSCSLSVT BIG Faculty
Chief Clinical Officer – LSVT BIG
LSVT Global, Inc.
Plan for WebinarLogistics (questions, handouts)
Present Webinar
Question/Answer Session
Survey will automatically launch at the conclusion of the webinar (less than 5 minutes to complete)
Disclosures
All of the LSVT Global faculty have both financial and non-financial relationships with LSVT Global. Non-financial relationships include a preference for the LSVT LOUD as a treatment technique and equipment which will be discussed as a part of this workshop.
Dr. Fox and Ms. Guse are employees of and receive lecture honorarium and travel reimbursement from LSVT Global, Inc. Dr. Fox has ownership interest in LSVT Global, Inc.
STATEMENT ON DISCLOSURE AND CONFLICT: All members of this research teamhave fully disclosed any conflict of interest. The conflict of interest management plan has been approved by the Office of Conflict of Interest and Commitment at the University of Colorado, Boulder (Ramig, Fox and Halpern).
Objectives of Presentation
• Discuss development and data on an efficacious speech treatment LSVT LOUD®
• Highlight LSVT LOUD treatment concepts and increased treatment accessibility through technology-supported delivery
• Describe development and key aspects of limb motor treatment LSVT BIG®
• Provide a list of additional resources to learn more about LSVT LOUD and LSVT BIG
Polling Question 1
• Is this your first LSVT Global webinar?– Yes
– No
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Poll Question 2
• Who are you?– Professional SLP, PT, or OT
– Graduate Student in Speech, PT, or OT
– Person with Parkinsons
– Caregiver or loved one of someone with PD
– Other
Rehabilitation (ST, PT, OT) is becoming a routine part of management in PD
To provide symptomatic relief; improve function
Pharmacological(L-dopa)
Speech, PhysicalOccupational Tx
(Empower)
Neurosurgical(DBS-STN)
Kleim & Jones, 2008; Kleim et al., 2003; Zigmond et al, 2009
Our work – LSVT Protocols:based on 25 years of NIH funded research and clinical experience
• LSVT LOUD is a speech therapy – Delivered by LSVT LOUD Certified
Speech-Language Pathologists
• LSVT BIG is a physical/occupational therapy– Delivered by LSVT BIG Certified Physical
or Occupational Therapists
Video Example:
• 59 year old female• 2.5 years post-diagnosis• On-meds pre and post video
Pre/post LSVT (Lee Silverman Voice Treatment)Intensive physical exercise of speech mechanism
LSVT LOUD Pre and Post Treatment Video
http://www.lsvtglobal.com/news/video
Patient case: Bernie
• 71 year-old, diagnosed with Parkinson’s disease in 1994
• Reason for referral: slowness and difficulty walking, history of falls, freezing
• Optimized on PD medications
• Hoehn & Yahr 3
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LSVT BIG Pre and Post Treatmenthttp://www.lsvtglobal.com/news/video
Bernie’s Outcomes:
Falls 1-2/month 0/month
Assistive device Cane None
Confidence 37.5% 56.8%
Gait Velocity 0.35 m/s 1.17 m/s
% of age matched norm 29.6 % 100%
Endurance 730 ft 1200 ft
Bernie’s Goals: To improve his walking
To go to the movies
To play with his grandchildren
To go out to dinner with friends and family
PRE POST
Where did we begin…
“If only we can hear and understand her”Family of Mrs. Lee Silverman 1987
Over 89% of the nearly 6 million individuals with Parkinson disease
worldwide suffer from voice and speech disorders.
• Reduced vocal loudness
• Hoarseness
• Monotone voice
• Imprecise articulation (e.g., Logemann et al., 1978; Sapir et al., 2001)
These voice and speech disorders contribute to lifelong frustration, embarrassment and social isolation
(e.g., Miller et al, 2006).
“If I have no voice, I have no life.”-Natalie, individual with PD
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Classic Medical Treatments Alone do not Consistently or Significantly Improve Speech in PD
Pharmacological Treatment:“…no evidence of systematic improvement in dysarthria owing to dopamine replacement therapy.” (e.g., Pinto et al, 2004)
Surgical Treatment:
Neurosurgical interventions do not consistently or effectively improve speech in PD (e.g., Freed et al., 1992; Goberman, 2005; Pinto et al., 2004; Rousseaux et al., 2000; Tripoliti et al., 2008; Astromet et al., 2010)
1987 no effective voice and speech treatments for PD
LSVT LOUD Treatment Concepts
Evidence-based Practice
SOFT
LOUD
HEALTHY LOUDNESS
Loud is more than a laryngeal event – spread of effects
TARGET
• Treatment delivered 4 days a week for 4 weeks
• Individual 1 hour sessions ( repetitions)
• Daily homework practice (all 30 days of the month)
• Daily carryover exercises (all 30 days of the month)
LIFE LONG HABIT OF PRACTICE!
Consistent with practice principles that drive activity-dependent neuroplasticity.
MODE: Intensive and High Effort
Kleim & Jones, 2008; Kleim et al, 2003; Zigmond et al, 2009
LSVT LOUD ExercisesDaily Exercises
Sustained “ah” (15+ repetitions)High/Low “ah” (15+ repetitions)Functional phrases (50+ repetitions)
Hierarchical speech Exercises
Week 1 – words, phrasesWeek 2 – sentencesWeek 3 – readingWeek 4 - conversation
Shorter, simple
Longer, complex
If you don’t feel like you are talking “too loud” you
are not talking loud enough!!
CALIBRATION
Fox et al, 2002; Sapir et al, 2011
Retrain sensory perception of the amount of effort and loudness needed to speak with a normal loudness level.
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LSVT LOUD DATA
Ramig et al., 2001; J Neurol, Neurosurgery, PsychiatryLevel 1 Evidence Goetz,2003
60
65
70
75
-2 0 2 4 6 8 10 12 14 16 18 20 22 24
Months
SP
L R
ain
bo
w (
50
cm
)
LSVT R
LSVT® LOUD
RESP
N=45
Blinded, no med changeSame time med
Advances in Clinical Efficacy(Ramig et al, 1995; 1996; 2001a; 2001b; Goetz, 2003)
Cross-system effects, Neural changes
Spielman, Borod (2003)
(facial expression)
El-Sharkawi, Logemann(2002)
(swallowing)
Smith, M. (1995)
(adduction)
Ramig & Dromey(1996)
(aerodynamics)
Baker (1998),
Luschei (1999) (EMG)
P. Fox, Liotti(2003)
Narayana (2010)
(PET) Dromey, (1995) (articulation)
Sapir (2007; 2010)
(articulatory acoustics)
Smith,A. (2001)(STI)
Taskoff (2001)
(perceptual)
Huber, Stathopoulos, (2003)
(respiratory kinematics)
LSVT eLOUD LSVT Companion
Funded by: NIH-NIDCD &Michael J. Fox Foundation
www.LSVTGlobal.com
Telemedicine
LSVT BIG
LSVT LOUD LSVT BIG
(Ebersbach et al, 2010; Farley & Koshland, 2005; Fox et al, 2012)
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BIG (Large amplitude whole body movement)Single Target - Triggers Activation across motor systems
SMALLBIG
NORMAL “BIGNESS“
TARGET
Delivery– Certified LSVT BIG™ Physical/Occupational
Therapist• 1:1 intervention
Time of Practice– 4 consecutive days per week for 4 weeks
– 16 sessions in one month
– 60 minute sessions
– Daily carryover assignments (30 days/entire month)
– Daily homework (30 days/entire month)
MODE
MISMATCH betweenon-line perception ofoutput and how others perceive it
“I had no idea how small my world had become”
“I can’t move like this, people will think I am crazy!!”
CALIBRATION
LSVT BIG DATA
Comparing Exercise in Parkinson’s Disease —The Berlin BIG Study (2010, Movement Disorders)
Georg Ebersbach,1* Almut Ebersbach,1 Daniela Edler,1 Olaf Kaufhold,1 Matthias Kusch,1
Andreas Kupsch,2 and Jo¨rg Wissel3
Comparing Exercise in Parkinson’s Disease —The Berlin LSVT BIG Study (2010, Movement Disorders)
Georg Ebersbach,1* Almut Ebersbach,1 Daniela Edler,1 Olaf Kaufhold,1 Matthias Kusch,1
Andreas Kupsch,2 and Jo¨rg Wissel3
FIG. 2. UPDRS motor score (blinded rating), mean change from baseline (vertical bars 5 standard deviations). Change between baseline and follow up at week 16 was superior in BIG (interrupted line) compared to WALK (dotted line) and HOME (solid line), P <0.001. ANCOVA did not disclose significant differences between in intermediate and final assessments.
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LSVT BIGExercises
Treatment SessionDaily Exercises1.Floor to Ceiling 2.Side to Side 3.Forward step 4.Sideways step 5.Backward step 6.Forward Rock and Reach 7.Sideways Rock and Reach
Functional Component Tasks
5 EVERYDAY TASKS– 5 reps each For Example:
-Sit-to-Stand
-Pulling keys out of pocket
-Opening refrigerator door
Walking BIG distance/time may vary
Hierarchy TasksPatient identified tasks:
Getting out of bed
Playing golf
In and out of a car
Build complexity across 4 weeks of treatment towards long term goals
Maximum Sustained Movements
Floor to Ceiling Side to Side
Multidirectional Repetitive MovementsStep and Reach
Forward Step Sideways Step Backward Step
Multidirectional Repetitive MovementsRock and Reach
Sideways Rock and Reach Forward/Backward Rock and Reach
-Stepping stones for use of good big
movements in daily life-
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-Tools to facilitate improved movements, not the end goal of therapy-
Examples:
• Rolling in bed
• Sit to stand
• Reach for something
• Stir
• Pull pants up
Functional Component TASKS
Simple Movements– Patient DRIVEN!
Sit to stand BIG
5 tasks; 10 repetitions per day each x 30 days = 300 BIG repetitions of each task in one month!
Daily Hierarchical Tasks
“Real-World” Complex BIG Tasks – Patient DRIVEN!
• Bed to Bathroom• In/Out of Car• Walk and Talk• Tennis• Chores• Golf• Hiking• Gardening
BIG Walking- Big arm swings, Big steps
Goal: Normalize amplitude, stride length, posture, arm swing so
walking is more normal and safer in a variety of real world situations and
settings.
Carryover Exercises
Daily assignments to useBig movements
in real life situations outside of the treatment room
LSVT BIG TREATMENT GOAL
People with Parkinson disease will use their bigger movements
“automatically” in everyday living –
and there will belong-term carryover
of increased amplitude use!
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“My voice is alive again!” - Lucy R.
“LSVT BIG has changed my life. I can free walk, arise from any armless chair, in or out of a car in a flash, the impact on my life is beyond a miracle.” - Charles H.
Our patients…living proof
Resources for You
For Therapy Professionals: How to get started with
LSVT BIG and LSVT LOUD Training
• For ONLINE LSVT BIG or ONLINE LSVT LOUD, go to www.lsvtglobal.com and click on LSVT BIG or LSVT LOUD and then “Online Courses” . Same content, certification, and CEUs as live course!
• For IN-PERSON LSVT BIG or IN-PERSON LSVT LOUD go to www.lsvtglobal.com and click on LSVT BIG or LSVT LOUD to find course locations.
For People with Parkinson’s:How to get started with
LSVT BIG and LSVT LOUD• Ask your doctor for a referral and a prescription for a speech
or physical/occupational therapy evaluation and treatment
• Visit www.lsvtglobal.com and click on “find a clinician” to find an LSVT LOUD or LSVT BIG Certified Clinician in your area
• DVDs available to introduce you to movement exercises used in LSVT BIG and voice exercises used in LSVT LOUD: www.lsvtglobal.com/products or www.amazon.com/shops/LSVTGlobal SOON available for Download or Streaming!!
Other Resources
1. LSVT Training: Live workshops and patient symposiums
2. Professional Meetings
3. Parkinson Events
4. Webinars
5. LSVT LOUD App for clinicians and patients
6. BIG for LIFETM and LOUD for LIFETM
7. New Video resources and streaming
How to ask questions1. Type in the question box on your control panel
2. Raise your hand! (click on the hand icon in your control panel)
• Your name will be called out• Your mic will be unmuted, then you can ask your
question out loud
3. Email [email protected] if you think of questions later!
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Thank you!
Questions???
Please complete the survey that will automatically launch at close of webinar.
Additional Resources More details
LSVT LOUD Live Trainings 2016Full schedule at www.lsvtglobal.com
Updates as year progresses
April 1 - 2, 2016 Minneapolis, MNApril 9 - 10, 2016 São Paulo, BRApril 21 - 22, 2016 Dallas, TXMay 13 - 14, 2016 Cherry Hill, NJJune 17-18, 2016 Berlin, GermanyJune 24 - 25, 2016 London, UKJuly 16-17, 2016 Tokyo, JapanAugust 4-5, 2016 New York, NYAugust 26-27, 2016 Mainz, GermanyDecember 1 - 2, 2016 New York, NY
Every live workshop (LSVT BIG and LSVT LOUD) offers free patient symposiums on day 2! To register please go to www.lsvtglobal.com → Patient Resources → Patient Symposium
LSVT BIG Live Trainings 2016Full schedule at www.lsvtglobal.com
Updates as year progressesMarch 17 - 18, 2016 East Midlands, UKApril 9 - 10, 2016 St Louis (Creve Coeur), MOApril 16 - 17, 2016 Columbus, OHApril 30 – May 1, 2016 Minneapolis, MNApril 30 – May 1, 2016 Beelitz, GermanyMay 14- 15, 2016 Orlando, FLMay 21-22, 2016 Crown Point, INJune 10 - 11, 2016 Cherry Hill, NJJune 17-18, 2016 Berlin, GermanyJuly 9-10, 2016 Tokyo, JapanAugust 6-7, 2016 New York City, NYAugust 20 - 21, 2016 Traverse City, MIAugust 27– 28, 2016 Austin, TXOctober 1 - 2, 2016 Cherry Hill, NJOctober 29-30, 2016 Beelitz, GermanyNovember 19-20, 2016 Nuremburg, GermanyDecember 2-3, 2016 New York City, NY
Parkinson Events 2016• National Participating Partner in Partners in Parkinson’s:
Michael J Fox Foundation www.partnersinparkinsons.orgMarch 19: Birmingham, AlabamaMay 14: Oakland, CaliforniaJune 4: Cincinnati, OhioOctober 1: New York, New York
• Corporate Sponsor for the Victory Summit Symposia Series: Davis Phinney Foundation
• www.davisphinneyfoundation.org/victory-summit/April 30: Vancouver, BC, CanadaOctober 8: Sacramento, CA
Parkinson Events 2016
• Sponsor for the Parkinson’s Unity Walk www.unitywalk.orgSaturday, April 23, 2016
• World Parkinson Congress http://www.wpc2016.org/Portland, OR from September 20 – 23, 2016
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Webinars 2016Use of LSVT LOUD® and LSVT BIG® in Advanced ParkinsonDate/Time: 2/10/16, 2:00 p.m. EST
LSVT BIG® and LSVT LOUD®: Evidence-Based Physical and Occupational Therapy for Parkinson’s DiseaseDate/Time: 3/16/16, 2:00 p.m. EST
Addressing Difficulties with Voice and Activities of Daily Living in Parkinson DiseaseDate/Time: 4/13/16, 2:00 p.m. EST
Turn up the Gain: Are you getting what you should be getting out of LSVT LOUD® and LSVT BIG®? Date/Time: 5/11/16, 2:00 p.m. EST
Atypical Parkinsonian Disorders: Can LSVT LOUD® and LSVT BIG® be effective? Date/Time: 6/8/16, 2:00 p.m. EST
www.lsvtglobal.com → Patient Resources → FREE Live or FREE On Demand Webinars
LSVT LOUD App (Free)
• Patient App • What happens when you get loud?• Homework reminder
• Clinician App• Clinical tools• Treatment guide
COMING SOON!
BIG for LIFE™ and LOUD for LIFETM
• Post discharge maintenance groups for people that received LSVT BIG and/or LSVT LOUD
• Pilot Launch of Test Group: July 2015-ongoing• Phase 1: Live training for LSVT BIG and LSVT
LOUD Clinicians in Spring of 2016• Phase 2: Assess results and expand access to
all LSVT BIG and LSVT LOUD Clinicians either live or online TBD
• Will be able to search the clinician directory to find a group near you – late 2016
LSVT BIG Homework Helper DVD Volume 2: Seated and Supine Adaptations
• Includes special chapter for caregivers!• New Exercise pictures• Coming 3rd Quarter 2016!