Helping Parkinson's Patients Get Big & Loud
Cathryn Breutzmann and Dan Kasparek lead a discussion on the LSVT BIG & LOUD program.
Featured Speakers:
Cathryn Breutzmann, OTD, OTR/L has experience working with a wide variety of diagnoses including neurological, orthopedic, trauma, mental health and general medical conditions. She is an ergonomic specialist, licensed in physical agent modality use and a member of the American Occupational Therapy Association. Cathryn is certified in LSVT BIG for those with Parkinson's disease.
Dan Kasparek, SLP | Cathryn Breutzmann, OTR/L
Daniel Kasparek, MA, CCC-SLP is certified in Vital Stimulation for swallow recovery and LSVT LOUD for those with Parkinson's disease. Daniel earned his bachelor's degree at the University of Nebraska at Omaha and master's degrees in both linguistics and speech-language pathology at the University of Kansas. He has worked in both inpatient and outpatient rehabilitation settings gaining experience in swallowing disorders, voice disorders, stroke recovery, cognitive-communication disorders and degenerative diseases.Cathryn Breutzmann, OTD, OTR/L has experience working with a wide variety of diagnoses including neurological, orthopedic, trauma, mental health and general medical conditions. She is an ergonomic specialist, licensed in physical agent modality use and a member of the American Occupational Therapy Association. Cathryn is certified in LSVT BIG for those with Parkinson's disease.
Transcription:
Helping Parkinson's Patients Get Big & Loud
Intro: At Bryan Health, we care for patients, educate tomorrow's healthcare providers, motivate our community with fitness and health programs and collaborate to continually improve how we serve others. That's why we are proud to present another Bryan Health podcast.
Caitlin Whyte: Welcome to the Bryan Health podcast. I'm Caitlin Whyte. And today, we are discussing the LSVT BIG and LOUD treatment for Parkinson's disease. Joining us are Dan Kasparek, a speech language pathologist; and Cathryn Breutzmann, an occupational therapist. So Cathryn, we'll start with you. What are the LSVT BIG and LOUD programs?
Cathryn Breutzmann, OTR/L: So up to 18 million people worldwide are living with Parkinson's disease and that's a disease that really causes people to be smaller and quieter, make smaller steps, quieter voice, smaller hand movements. It just really slows down their mobility and their speech. And so LSVT BIG and LSVT LOUD are both programs that are meant to help someone with Parkinson's be bigger or be louder to the point where they sound and move more naturally like they would have before they were diagnosed with Parkinson's.
So both LSVT BIG and LSVT LOUD are programs put on by therapists. So LSVT BIG focuses on movement, so that's put on by either occupational or physical therapist. And then LSVT loud has to do with voice and speaking and that's put on by a speech therapist like Dan. Each of the programs is very intensive and they focus on amplitude. So for LSVT BIG and LSVT LOUD at 16 sessions at least, four consecutive days a week for four weeks, one-hour sessions. And the patients have homework that they're supposed to do each day at home. So it's very intensive to just kind of retrain the brain to act big and act loud.
Caitlin Whyte: So, Dan, can you tell us a bit more about how communication and movement are improved through these programs?
Dan Kasparek, SLP: Sure. Yeah. Most of the research shows that from a loudness standpoint, not only do people get louder, but there's better variation in pitch. There's even change in articulation and swallowing and facial expression, basically anything that has to do with communication can be improved through this program.
Most of the gains are maintained for at least two years. We do have a follow-up once a year that we come in and just sort of recalibrate and make sure that everything is staying where it's supposed to stay. In the past, most treatment for voicing anyway was we would do it almost sort of passively. So we'd work on articulation for a little bit and some loudness. But now with this LSVT, it's intensive, it's high effort. And so basically, it's a one-on-one session that improves overall communication.
Caitlin Whyte: And Cathryn, can someone receive both the BIG and LOUD treatments at the same time? How does that work?
Cathryn Breutzmann, OTR/L: Yeah. So it's really a patient preference. Because it's an hour long and it's pretty intensive, some people, depending on, you know, their age or their strength level or that type of thing, we'll do four weeks of one program and then switch to four weeks of another program. But Dan and I definitely have people that will do both at once. And when we do have them both at once, we try and get them back to back on the same days, so they can come in and see Dan to work on loud speech and then come right over to work with me on big movements right back to back, so they don't have to wait or come back later in the day or that type of thing. So we really try and work with people's schedules to make sure that they get the best treatment possible that works for them.
Caitlin Whyte: Now, Dan, when should someone start treatment and how can they get started with you guys?
Dan Kasparek, SLP: Sure. It's best to start whenever you get a chance. The research mostly shows that you want to start as early as you possibly can. As soon as you start showing symptoms of decreased loudness or the smaller movements, you want to get in and get the program started. And each one, you know, both LOUD and BIG, they're individualized treatments. So, you know, it's a personal goal of where you want to get to and, you know, we've been trained to get you to that point.
Caitlin Whyte: Well, Cathryn, is there anything else you'd like to share before we wrap up?
Cathryn Breutzmann, OTR/L: Yeah. So maybe just a taste of what a session might look like. So a patient would come and visit with us. For LSVT BIG, for my program I can speak to, they would come in for an evaluation and we could look at how quickly they could walk, how big their handwriting may be, how coordinated they are doing buttons or snaps, how they do sitting into a chair and standing back up again, a bunch of different tasks like that, putting a jacket on, taking a jacket off. And a lot of people will have troubles with some of those activities where they'll either freeze or they'll get stuck or their movements will be really small or they won't have enough momentum to stand up from a chair.
So after we evaluate them, we would talk to the patient about their specific goals. So what is hard for you? What do you feel like you struggle with on a day-to-day basis? What do your kids tell you that you're doing very small? Or what do people tell you that you look like you're having a hard time with? So then we would make goals together.
So then each of our sessions, there's a standard set of exercises that we do each day. So the patient gets really familiar with stepping big, reaching big with their arms, standing up from the chair, using big energy, walking big. And then we also focus on their goals. So maybe they wanted to put their seatbelt on better, they really have a hard time reaching across and fastening their seatbelt. So then, during our sessions, we would work on reaching big for the seatbelt and buckling big. And it's a lot of big, exciting, active motion. And it's really a fun time to work on their goals in each of the sessions and see what they want to do better and really get better at those tasks.
Caitlin Whyte: Great. And Dan, is there anything else on your end? What do your sessions look like?
Dan Kasparek, SLP: Sure. Sure. So, yeah, we do what we call sustained phonation and then rising and falling pitch, which are just exercises to help calibrate the voice and then we do functional phrases. So if you imagine that you lost your voice tomorrow, what are the 10 phrases that would be most important to you? And so we practice those every single session. So all 16 sessions start with the exact same setup. And then what we do is we stair step up in complexity. So the first week is more of a word base and we're keeping it small, then we go to phrases and sentences and finally conversational speech during the fourth week.
And I tend to see the biggest gains. The first week, you don't see a lot of change, but usually by the middle of the second week, we get a report of almost everybody that we work with seeing some change. And this is something that's sort of Cathryn mentioned, but usually it's not the person themself that noticed the initial change. It's somebody else in your family that says, "Wow, you sound so much better" or "You sound louder." And that's really encouraging because you can see results as you're going.
Caitlin Whyte: Well, we so appreciate both of you taking the time to speak with us today. And that wraps up this episode of the Bryan Health Podcast. We'd like to thank our Bryan Foundation partner, Mapes industries. You can head on over to our website at bryanhealth.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other Bryan Health podcasts. I'm Caitlin Whyte. Stay well.
Helping Parkinson's Patients Get Big & Loud
Intro: At Bryan Health, we care for patients, educate tomorrow's healthcare providers, motivate our community with fitness and health programs and collaborate to continually improve how we serve others. That's why we are proud to present another Bryan Health podcast.
Caitlin Whyte: Welcome to the Bryan Health podcast. I'm Caitlin Whyte. And today, we are discussing the LSVT BIG and LOUD treatment for Parkinson's disease. Joining us are Dan Kasparek, a speech language pathologist; and Cathryn Breutzmann, an occupational therapist. So Cathryn, we'll start with you. What are the LSVT BIG and LOUD programs?
Cathryn Breutzmann, OTR/L: So up to 18 million people worldwide are living with Parkinson's disease and that's a disease that really causes people to be smaller and quieter, make smaller steps, quieter voice, smaller hand movements. It just really slows down their mobility and their speech. And so LSVT BIG and LSVT LOUD are both programs that are meant to help someone with Parkinson's be bigger or be louder to the point where they sound and move more naturally like they would have before they were diagnosed with Parkinson's.
So both LSVT BIG and LSVT LOUD are programs put on by therapists. So LSVT BIG focuses on movement, so that's put on by either occupational or physical therapist. And then LSVT loud has to do with voice and speaking and that's put on by a speech therapist like Dan. Each of the programs is very intensive and they focus on amplitude. So for LSVT BIG and LSVT LOUD at 16 sessions at least, four consecutive days a week for four weeks, one-hour sessions. And the patients have homework that they're supposed to do each day at home. So it's very intensive to just kind of retrain the brain to act big and act loud.
Caitlin Whyte: So, Dan, can you tell us a bit more about how communication and movement are improved through these programs?
Dan Kasparek, SLP: Sure. Yeah. Most of the research shows that from a loudness standpoint, not only do people get louder, but there's better variation in pitch. There's even change in articulation and swallowing and facial expression, basically anything that has to do with communication can be improved through this program.
Most of the gains are maintained for at least two years. We do have a follow-up once a year that we come in and just sort of recalibrate and make sure that everything is staying where it's supposed to stay. In the past, most treatment for voicing anyway was we would do it almost sort of passively. So we'd work on articulation for a little bit and some loudness. But now with this LSVT, it's intensive, it's high effort. And so basically, it's a one-on-one session that improves overall communication.
Caitlin Whyte: And Cathryn, can someone receive both the BIG and LOUD treatments at the same time? How does that work?
Cathryn Breutzmann, OTR/L: Yeah. So it's really a patient preference. Because it's an hour long and it's pretty intensive, some people, depending on, you know, their age or their strength level or that type of thing, we'll do four weeks of one program and then switch to four weeks of another program. But Dan and I definitely have people that will do both at once. And when we do have them both at once, we try and get them back to back on the same days, so they can come in and see Dan to work on loud speech and then come right over to work with me on big movements right back to back, so they don't have to wait or come back later in the day or that type of thing. So we really try and work with people's schedules to make sure that they get the best treatment possible that works for them.
Caitlin Whyte: Now, Dan, when should someone start treatment and how can they get started with you guys?
Dan Kasparek, SLP: Sure. It's best to start whenever you get a chance. The research mostly shows that you want to start as early as you possibly can. As soon as you start showing symptoms of decreased loudness or the smaller movements, you want to get in and get the program started. And each one, you know, both LOUD and BIG, they're individualized treatments. So, you know, it's a personal goal of where you want to get to and, you know, we've been trained to get you to that point.
Caitlin Whyte: Well, Cathryn, is there anything else you'd like to share before we wrap up?
Cathryn Breutzmann, OTR/L: Yeah. So maybe just a taste of what a session might look like. So a patient would come and visit with us. For LSVT BIG, for my program I can speak to, they would come in for an evaluation and we could look at how quickly they could walk, how big their handwriting may be, how coordinated they are doing buttons or snaps, how they do sitting into a chair and standing back up again, a bunch of different tasks like that, putting a jacket on, taking a jacket off. And a lot of people will have troubles with some of those activities where they'll either freeze or they'll get stuck or their movements will be really small or they won't have enough momentum to stand up from a chair.
So after we evaluate them, we would talk to the patient about their specific goals. So what is hard for you? What do you feel like you struggle with on a day-to-day basis? What do your kids tell you that you're doing very small? Or what do people tell you that you look like you're having a hard time with? So then we would make goals together.
So then each of our sessions, there's a standard set of exercises that we do each day. So the patient gets really familiar with stepping big, reaching big with their arms, standing up from the chair, using big energy, walking big. And then we also focus on their goals. So maybe they wanted to put their seatbelt on better, they really have a hard time reaching across and fastening their seatbelt. So then, during our sessions, we would work on reaching big for the seatbelt and buckling big. And it's a lot of big, exciting, active motion. And it's really a fun time to work on their goals in each of the sessions and see what they want to do better and really get better at those tasks.
Caitlin Whyte: Great. And Dan, is there anything else on your end? What do your sessions look like?
Dan Kasparek, SLP: Sure. Sure. So, yeah, we do what we call sustained phonation and then rising and falling pitch, which are just exercises to help calibrate the voice and then we do functional phrases. So if you imagine that you lost your voice tomorrow, what are the 10 phrases that would be most important to you? And so we practice those every single session. So all 16 sessions start with the exact same setup. And then what we do is we stair step up in complexity. So the first week is more of a word base and we're keeping it small, then we go to phrases and sentences and finally conversational speech during the fourth week.
And I tend to see the biggest gains. The first week, you don't see a lot of change, but usually by the middle of the second week, we get a report of almost everybody that we work with seeing some change. And this is something that's sort of Cathryn mentioned, but usually it's not the person themself that noticed the initial change. It's somebody else in your family that says, "Wow, you sound so much better" or "You sound louder." And that's really encouraging because you can see results as you're going.
Caitlin Whyte: Well, we so appreciate both of you taking the time to speak with us today. And that wraps up this episode of the Bryan Health Podcast. We'd like to thank our Bryan Foundation partner, Mapes industries. You can head on over to our website at bryanhealth.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other Bryan Health podcasts. I'm Caitlin Whyte. Stay well.