Joey Wahler (Host): It can improve mobility and quality of life. So, we're discussing LSVT BIG for Parkinson's disease. Our guest is Selena Facio. She's an occupational therapist. This is WickCare Talks, the podcast from Wickenburg Community Hospitals and Clinics dedicated to helping our community lead healthier, more active lives. In each episode, we connect you with trusted health experts sharing valuable insights on a wide range of topics, from managing chronic conditions to simple tips for everyday wellness. We're here to provide practical information to support you on your health journey. So, be sure to follow us so you never miss an episode. Thanks so much for being with us this time around. I'm Joey Wahler. Hi there, Selena. Welcome.

Selena Facio, OTD, OTR/L: Hi, thank you for having me.

Host: Great to have you aboard. We appreciate the time. So first, for those unfamiliar, in a nutshell, what is LSVT BIG? Because it's become big, pun intended, and how does it relate to Parkinson's disease?

Selena Facio, OTD, OTR/L: LSVT BIG is an evidence-based program specifically for Parkinson's disease. And so, it mainly focuses on these bigger movements in which individuals that do have Parkinson's disease typically have smaller movements, and they oftentimes do not realize they're having these smaller movements due to Parkinson's and how it affects their ability to perceive movements within their bodies. And so, through LSVT BIG, it is able to recalibrate this perception, and it is able to do this through, like, repetitive tasks, high-effort exercises and functional tasks.

Host: So when we talk about these smaller movements, can you give us an example of one?

Selena Facio, OTD, OTR/L: Yes, of course. So, these smaller movements are going to be like a reduced arm swing when you're walking. It's going to be more rigidity, stiffness, kind of like a slower movement. If you were to go reach out and grab something, it's going to be shortened. Just some kind of examples like that.

Host: So basically, it sounds like we're talking about smaller movements that can affect bigger movements, right?

Selena Facio, OTD, OTR/L: Yes, exactly. So if you think smaller movements of, like, trying to push up to get out of a chair, you're not getting that full extension. And a lot of times posture is a big one. And I know, you know, a lot of times, we're kind of slouched over phones these days, but being able to improve posture can also, you know, help reduce the risk of falls and things like that, which can be addressed through LSVT BIG.

Host: Yeah. In fact, you mentioned posture there. In interviewing experts from all different kinds of medicine, it seems like they all preach good posture because people often take it for granted and don't realize what a big impact it has on so many things. So, just to backtrack for a moment, what are the early signs of Parkinson's that people should watch out for that they may very well be unaware of?

Selena Facio, OTD, OTR/L: Some of the signs are going to be, like, those slower movements. A big one is, like, a reduced arm swing. So when you're walking, you're not, like, fully extending your arm back. And a lot of times, which people don't quite know is different facial expressions. They have kind of like a masking. So, also, like, a softer voice or smaller handwriting can also be some signs of Parkinson's.

A lot of times, you're not going to notice these on yourself. They're mainly going to come from the people around you. They're going to be like, "Oh, like, you're moving a little slower" or, you know, "What's wrong with your arm? You're not moving your arm when you walk." Some things like that. And so, it's kind of still important to,listen to others to see if they're noticing something that you're not, because you're not necessarily going to notice it on yourself.

Host: Yeah. You actually just answered what was going to be my next question, which is, I presume people typically don't notice this themselves and it kind of sneaks up on them. And you just told us that is in fact the case. So, how about the way in which Parkinson's is first diagnosed, and at what stage should a treatment like LSVT BIG start? Where does it all begin?

Selena Facio, OTD, OTR/L: So, Parkinson's is diagnosed through a neurological evaluation. And so, I always say, try to get into LSVT BIG as soon as possible, because the sooner that you can learn, recalibration, be able have the program kind of in your back pocket, I always think about, you know, you always want to have a toolbox. And so, this is one of the great resources that you can have in your toolbox and pull it out when you do have more symptoms or your symptoms are progressing. You're going to know how to recalibrate and be able to kind of maintain that level of functioning.

Host: Speaking of which, how would someone know if they'll benefit from occupational therapy in the first place if they have Parkinson's? Is there anyone it won't help in that condition?

Selena Facio, OTD, OTR/L: I'm always pro-therapy. So, I think even if you're the healthiest person alive, I think anyone could always benefit from a little bit of therapy. So, I mean, it can always start out as, like, a balance. Like, my main goal as a therapist is I want to keep people and patients as independent as possible.

And so, you know, I can do that, you know, through a variety of different ways. I can do it with through surgery patients, through my Parkinson's, through aging patients, being able make sure individuals are safe at home, especially if they're at a risk of falls. Anyone and everyone, I think, can benefit from occupational therapy.

Host: Absolutely. And you touched there on independence and how important that is. And so, that's why addressing things like movement and balance in Parkinson's patients is so crucial, because they're big keys in maintaining that independence, right?

Selena Facio, OTD, OTR/L: Being able to have your independence is just confidence and being able to stay true and have your identity as a person. And so, that is one of my main passions, especially why I got into this profession, is because,even till you're not independent. But, you know, I'm going to make sure you're going to be able to still get a drink of water. You're going to, find joy in just doing, like, the simplest things. I mean, how many times I've clapped and jumped that my patient can pick up a cup. I mean, sometimes it's just like the simplest things. But, you know, if that's important to a person, then, definitely, you know, I'm going to try to achieve that goal.

Host: Great to hear because indeed simple things as you say, but not so simple sometimes to those with Parkinson's and things that we often take for granted until they're not there anymore. So, that being said, what does a typical LSVT BIG session look like? What can people expect?

Selena Facio, OTD, OTR/L: So through LSVT BIG, it is four consecutive weeks, and we do treatment four times a week for one hour. And so, through that, we usually do some exercises that are called maximal daily exercises, and we'll do a set of those. We'll do some type of functional task that, you know, is a goal to you.

It could be, you know, being able to stand up from a chair without using the arms, move around the kitchen, like, fluidly, things like that. A lot of times, we'll do these maximal daily exercises. But I obviously like to tailor them to the patients I have.

And so, I always, you know, make it harder, always try to challenge them. Even though they're the same set of exercises, I can definitely add in certain things to challenge them and challenge their balance as we progress throughout the weeks.

Host: Gotcha. And this goes on for how long?

Selena Facio, OTD, OTR/L: Four weeks. It's 16 sessions.

Host: Okay. And what happens then? Why is it that particular timeframe?

Selena Facio, OTD, OTR/L: Studies have just shown through the evidence that this is kind of the sweet spot. And then, also along with doing four times a week here in the clinic, and for an hour, you also go home and do the maximal daily exercises at home. And then you do them twice when we don't have treatment here in the clinic. So, the other three days, you're doing them twice at home.

Host: And you hit on a great point there, the take-home assignments, if you will, or exercises in this case, very important, right? Because I know myself just going for regular physical therapy from time to time due to various aches and pains over the years, you get to work with a professional like yourself in-house. But then, you get those great tips on things you can do on your own. And often, those are really the key to put you over the top, right?

Selena Facio, OTD, OTR/L: Yeah. So say, you know, you're only good as your carryover. You know, as long as you're implementing this when you go home, what I kind of mentioned earlier, is like it's a great thing, a great resource to have in your toolbox. So, you know, especially with a disease like Parkinson's, is you're going to want resources and things that you're going to be able to use not only now, but also in the future. And LSVT BIG is something that you can use now and also take with you, just as the disease progresses and how, you know, being able to maintain your level of function and just improve your quality of life.

Host: Absolutely. A couple of other questions for you. First, you talked, of course, about these simple, "small tasks" that are big in this case for many Parkinson's patients to regain, right? What would you say from your experience, Selena, is the main thing that people say, "Boy, am I thrilled to be able to get that back closer to where it was before"?

Selena Facio, OTD, OTR/L: Being able to just participate in an activity. I mean, where we live in Arizona, like hiking is big. You know, being able to go on a hike or being able to stand through a cooking class, just simple things like that. And because a lot of times, you think about, you know, being able to walk a longer distance or just more, like I said, fluidly and not having those rigid moments.

It helps us a lot socially. Yes, these tasks are meaningful, but they're meaningful because, you know, they're able to, like, interact with others. Like, this is what their passions are. And overall, just keeping them active and keeping, you know, a good mindset, as they're having this experience with Parkinson's.

Host: You've done a great job here breaking down some of these details for us. Overall, though, what would you say is generally the LSVT BIG impact on patients you work with both physically and also emotionally? Because these people are going through a tough time, to say the very, very least, and anything you can do to help improve things, bring a smile to their face, make life easier in any way, I'm sure is more than welcome, right?

Selena Facio, OTD, OTR/L: Yes, of course. And, you know, Parkinson's is going to affect everyone differently. But one thing that, you know, through evidence is that early intervention and consistent movement is going to significantly improve, like, your quality of life and your function. So, you know, LSVT BIG is not just a set of exercises you're doing once or twice a day, you know. It's going to empower and create confidence within these individuals so they can be able to continue to do what they love to do.

Host: it really becomes a way of life to improve quality of life. And so, finally, here in summary, I can hear the passion in your voice when you discuss the work you do. What's most rewarding about this for you when you are able to get through to a patient and you can really see the results?

Selena Facio, OTD, OTR/L: I think it's just the joy that it brings them getting back to doing something they love or, you know, how happy it makes them is how happy, you know, I am. They're getting back to doing something that, you know, they thoroughly enjoyed, or just the joy that I see on their face when they realize they can, you know, stand up without getting wobbly, or they can run around.

I mean, like, I've had some patients that their goal is like, "I used to, you know, run a mile every day. And now, I can barely walk a quarter of a mile." And, like, you know, being able to have them just gain the confidence to go out in the world and just, you know, be who they are.

Host: Absolutely. Well, folks, we trust you're now more familiar with LSVT BIG for Parkinson's disease. Selena, important work indeed. Keep it up, and thanks so much again.

Selena Facio, OTD, OTR/L: Thank you for having me.

Host: Absolutely. And for more information, please do visit WickHosp, that's W-I-C-K-H-O-S-P.com/WickCareTalks. We hope today's discussion has provided you with valuable insights to support your well-being.

Remember, every step you take is a step toward a healthier life. To ensure you don't miss future episodes, please follow us on your favorite podcast platform. If you found this episode helpful, please do share it on your social media. Thanks so much again for being part of WickCare Talks. Until next time, stay well.