Bartlett Regional | HouseCalls | Winter 2018

12 HouseCalls Winter 2018 Some of Bartlett Regional Hospital’s therapists are trained to help patients with Parkinson’s disease (PD) and other neurological conditions, with international certification therapies known as LSVT BIG and LOUD. LSVT stands for the Lee Silverman Voice Treatment. The programs have been developed over the past two decades with funding from the National Institutes of Health. LSVT LOUD helps patients with verbal communication, and LSVT BIG helps strengthen patient movement. Marisha Bourgeois, Bartlett speech- language pathologist, highly endorses both programs because when patients participate in these programs, she sees big results. People diagnosed with PD will have problems with speech, such as a soft or hoarse voice or mumbled or monotone speech. These symptoms often begin early on and can worsen as the disease progresses. Succeeding with BIG and LOUD The key to success with the BIG and LOUD programs is to start the therapy in the early or middle stages of the condition. “Research suggests that you should not wait until you begin to experience disability, impaired function or loss of balance to start one of these programs,” notes Bourgeois. “These programs can give you guidance on how to manage symptoms as the condition progresses.” However, Bourgeois recommends focusing on one therapy at a time. “Typically, people do one program and then the other because doing them both can be exhausting,” she says. “It just depends on what the patient desires most to work on. For some people it’s movement—for others it’s voice.” “There is a strict protocol that we follow and that’s why we have the science behind it,” notes Bourgeois. “You will change for the better in this program.” But she also emphasizes that success requires strong patient commitment. “The regimen for both of these programs is intense—16 one-hour sessions four times a week, for four weeks. In addition to the evaluation, there’s homework and daily carryover exercises.” Want to join BIG and LOUD? Patients are usually referred to one of the BIG and LOUD programs for speech, occupational and physical therapies through their primary care physician. If you are interested, check with your insurance provider to make sure it is covered. The LOUD program The LSVT LOUD approach can be summed up as “think loud.” “Parkinson’s is a perceptual disability,” says Bourgeois. “You can say, ‘Oh, you’re not talking loud enough,’ but people with the condition think that they are talking at a normal volume.” “Part of the protocol involves exercises with biofeedback and visual feedback,” Bourgeois says. LSVT global voicing technology is set up in a rehabilitation services office, where Bourgeois has patients speak into a special microphone connected to a computer. On the screen is a graphic that shows patients a visual of their voice- volume level. These exercises improve vocal loudness by stimulating the muscles of the voice box (larynx) and speech mechanism. LOUD treatment focuses on improving respiratory, laryngeal and articulatory function to help patients speak more clearly. It does not train people to shout or yell, but instead uses loudness training to help the patient regain healthy vocal loudness with no strain. The BIG program The LSVT BIG program addresses unique movement impairments of people with Parkinson’s disease (PD). This program involves using the repetition of coremovements in daily life. The goal of BIG is to get patients to exaggerate their gross motor skills. “Before starting the BIG program, when patients with PDwrite their name, it is small, and all their drawings are small. But after they complete the BIG program, their writing and drawings will be at normal sizes. It’s pretty fascinating,” says Marisha Bourgeois, speech-language pathologist. Big and Loud for Parkinson’s TAILORED THERAPY