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LSVT Global® Public Webinar Series
Title: Maintain the gains! Life after LSVT LOUD® and LSVT BIG®
Presenters: Elizabeth Peterson, MA, CCC-SLP
Heather Cianci, PT, MS, GCS
Date Presented: February 19, 2020
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 the permission of LSVT Global.
Contact Us:
Web: www.lsvtglobal.com Email: [email protected]
Phone: 1-888-438-5788 (toll free), 1-520-867-8838 (direct)
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Copyright LSVT Global, Inc. 2020 1
Maintain the gains! Life after LSVT LOUD and LSVT BIG
Elizabeth Peterson, MA, CCC‐SLP
LSVT LOUD Training and Certification Faculty
LSVT Global, Inc.
Heather Cianci, PT, MS, GCS
LSVT BIG Training and Certification Faculty
Dan Aaron Parkinson’s Center, Philadelphia, PA
Innovation in Science. Integrity in Practice.
Plan for Webinar
• Logistics
• Presentation of Content
• Address your questions
• Survey
Instructor BiographiesElizabeth Peterson, MA, CCC‐SLP
Ms. Peterson received her master’s degree in Speech, Language and Hearing Sciences from the University of Colorado‐Boulder. She began working with Dr. Lorraine Ramig’s research team while completing her master’s thesis. She has worked as a research associate at the National Center for Voice and Speech‐Denver and the University of Texas Health Science Center, San Antonio and primarily delivers LSVT LOUD in a research setting. Ms. Peterson is currently involved in Dr. Ramig’s research investigating the short and long‐term impact of LSVT LOUD on neural underpinnings of speech in Parkinson disease.
Heather Cianci, PT, MS, GCS
Ms. Cianci is the Neurological Team Leader and founding therapist of the Dan Aaron Parkinson’s Rehab Center at Pennsylvania Hospital in Philadelphia, PA. She received her Bachelor of Science in Physical Therapy from the University of Scranton, and her MS in gerontology from Saint Joseph’s University, both in Pennsylvania. Heather received her Geriatric Clinical Specialist Certification in 1999 and was certified in LSVT BIG in 2007. She is a 2004 graduate of the Parkinson’s Foundation’s Allied Team Training for PD (ATTP), and now serves as co‐coordinator and PT faculty for the program. Ms. Cianci has written and lectured for several national PD organizations, on‐line CEU providers, and PT programs at Philadelphia area universities. Her research is on falls and bed mobility in PD, and she is also a former board member for CurePSP.
Disclosures
• All LSVT faculty have both financial and non‐financial relationships with LSVT Global.
• Non‐financial relationships include a preference for LSVT BIG and LSVT LOUD as treatment techniques.
• Financial Relationships include: Ms. Peterson is an employee of LSVTGlobal and receives lecture honorarium and travel reimbursement. Ms. Cianci is a consultant for LSVT Global and receives lecture honorarium, consulting fees and travel reimbursement.
Information to Report CE Activity
• This LSVT Global webinar is NOT ASHA or state registered for CEUs for speech, physical and occupational therapy professionals, but it may be used for self‐reported CEU credit as a non‐registered/non‐preapproved CEU activity.
• If you are a speech, physical or occupational therapy professional and would like to self‐report your activity,e‐mail [email protected] to request a certificate after completion of the webinar which will include your name, date and duration of the webinar.
• Licensing requirements for CEUs differ by state. Check with your state PT, OT or Speech licensing board to determine if your state accepts non‐ASHA registered or non pre‐approved CEU activities.
• Attendance for the full hour is required to earn a certificate.
Learning Objectives
Upon conclusion of this webinar, participants will be able to:
• Discuss the importance of establishing good home practice habits during the one month of therapy and elements of a homework session
• Explain the importance of continued at home practice and potential tools to assist in client maintenance post‐discharge
• Describe post‐treatment practicerecommendations and “tune‐up” sessions
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Poll #1. Who is joining
us?
• Person with Parkinson’s
• Family member, friend or caregiver
• Physical or Occupational Therapist (including students)
• Speech Language Pathologist (including students)
• Other
Poll #2. If you are a person
with PD, have you ever had:
• LSVT LOUD• LSVT BIG
• Both
Exercise is VITAL in PD!Needs to be sufficiently intensive, specific,
challenging, consistent, ongoing and meaningful
www.womeninneuroscience.orgBeall, et al. 2013, Petzinger et al, 2010
Speech Therapy
Physical Therapy
Occupational
Therapy
-Evaluation‐Treatment‐Life‐long follow‐up
Kleim & Jones, 2008; Kleim et al., 2003; Zigmond et al, 2009
Exercise‐based rehabilitation (ST, PT, OT) is becoming a routine part of management in PDTo provide symptomatic relief; improve function
Our work –LSVT Protocols:based on 30 years of federally funded research and clinical experience
LSVT LOUD is speech therapy
• Delivered by LSVT LOUDCertified Speech‐Language Pathologists
LSVT BIG is physical/occupational therapy• Delivered by LSVT BIG
Certified Physical orOccupational Therapists
LSVT Protocols
• Structured, evidence‐based, rehabilitativetreatment protocols developed specificallyfor PD
• Adhere to principles of motor learning andactivity dependent neuroplasticity
• Intensive and challenging EXERCISE, specific tothe unique features of PD
• Personalized and specific functional training ofvoice, mobility and activities of daily living
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Each treatment is delivered 4 consecutive days aweek for 4 weeks
Individual 1 hour sessions by LSVT Certified Therapists found in all practice settings
Daily homework practice(all 30 days of the month)
Daily carryover exercises (all 30 days of the month)
LIFE‐LONG HABIT OF PRACTICE IS ESTABLISHED!
LSVT LOUD and LSVT BIG Treatment are SEPARATE protocols
Goals for People with PD
People with PD will use their bigger movements
and louder voice “automatically” in everyday living –
and there islong‐term carryover
of increased amplitude use!
LSVT BIG and LSVT LOUD
LSVT LOUD Treatment Session Summary
Daily Exercises
1. Maximum Duration of Sustained Vowel Phonation(Long Ahs) – 15+ reps
2. Maximum Fundamental Frequency Range (High/LowAhs) – 15 reps each
3. Maximum Functional Speech Loudness (Functional Phrases) – 5 reps of 10 phrases
Hierarchy Exercises
Structured reading – multiple reps, 20+ min.
Off the cuff – bridge the gap to conversation
Build complexity across 4 weeks of treatment towards your long‐term communication goal
Homework
Includes all daily exercises and hierarchy exercises
Assigned all 30 days
Carryover Exercises
Use loud voice in real life situations outside of the treatment room
Assigned all 30 days
LSVT BIG Treatment Session SummaryMaximal Daily Exercises
1.Floor to Ceiling – 8 reps
2.Side to Side – 8 each side
3.Forward step – 8 each side
4.Sideways step – 8 each side
5.Backward step – 8 each side
6.Forward Rock and Reach – 10 each side(working up to 20)
7.Sideways Rock and Reach – 10 each side (working up to 20)
Functional Component Tasks
5 EVERYDAY TASKS– 5 reps each
For example:
‐Sit‐to‐Stand
‐Pulling keys out of pocket
‐Using cell phone
Walking BIG
Distance/time may vary
Hierarchy Exercises
Patient identified tasks: Getting out of bed, Playing golf, Getting in and out of a car
Build complexity across 4 weeks of treatment towards long‐term goal
Homework
Includes all daily exercises and hierarchy exercises
Assigned all 30 days
Carryover Exercises
Use loud voice in real life situations outside of the treatment room
Assigned all 30 days
If you received treatment that was any thing other than the
dosage, exercises, homework and carryover described – you did NOT receive LSVT. There are no
modified versions.
Treatment fidelity is KEY!
If a clinician offers any modified version, don’t do it! You will not receive the benefits of treatment we have established in our 30
years of research.
After treatment, continue daily dose of LSVT homework exercises!
+ =
The best combination for success!
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Home Routine is Critical
• By the end of treatment, clients should have a well‐established homework routine they can and willcontinue on their own
• Importance of homework should be discussed duringassessment
• If homework routine is not followed, grounds for dismissal
Homework during
Treatment
• 15‐20 minutes oneother time ontreatment days
• 15‐20 minutes twice aday on non‐treatmentdays
Components of Homework
LSVT LOUD• Daily exercises• Long ahs• High/low ahs• Functional phrases
• Speech hierarchyexercises• Carryover Assignments
LSVT BIG• Daily exercises• Sustained Exercises• Repetitive Stepping and Rocking Exercises• Functional Component Tasks
• BIG walking• Carryover Assignments
Homework is NOT optional! Homework is a KEY to long‐term success!
Homework makes you feel better and speak/move better!
Discharge..Now What?
You have completed the full course of LSVT LOUD or LSVT BIG
4x per week for 4 weeks
16 total treatment sessions
What are your discharge recommendations?
How do you continue to be successful with the gains you have made in therapy?
When should you see your clinician again for a tune up?
What do data say about maintenance?
• Research data have documented maintenance of outcomes in LSVT LOUDat 6 month, 12 months and 24 months post‐treatment (Ramig et al., 1995; 1996, 2001a, 2001b)
• BUT…
…Clinically one of the challengesmany people with PD face following therapy is how to maintain treatment effects over time and keep exercising.
• No longer regularly attending therapy• Disease progression• Other medical complications
• The feeling of “I’m doing well, I don�t need to do this anymore.”
• Lack of motivation
• Sensory impairment impacting quality of practice
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AFTER LSVT LOUD and
LSVT BIG Treatment
• Practice at home daily –Homework 1 time perday FOREVER!!
• Participate incommunity‐based classes
• Schedule Tune Ups every3‐6 months
While Regular Intensive Exercise is very important, it does NOT replacea “daily dose” of
LSVT BIG or LSVT LOUD.
Both are needed!
WHY?
• Not all exercise focuses onAMPLITUDE• Amplitude focused exercise needed EVERY day due to hypokinesiaand bradykinesia
• Not all exercise focuses onsensory awareness challenges in people with PD. Recognizing you need to feel louder and biggerthan you think just to be within normal limits!!
WHY?
• Not all intensive exercise is intensive across the “spectrum”. Consider intensity of training in terms of amplitude, balance, endurance, strength, complexity, etc.
• Not all exercises are salient/individualized.Functional phrases/ functional movements as part of LSVT LOUD and LSVT BIG important for long‐term carryover.
Tools to assist in maintenance of LSVT LOUD and LSVT BIG improvements
Poll #3. Have you
heard of any of these LSVT Maintenance
tools?
• LSVT LOUD HomeworkHelper Video• LSVT BIG HomeworkHelper Video• LSVT Companion HomeEdition• LOUD for LIFE groupexercise maintenanceclasses• BIG for LIFE groupexercise maintenanceclasses
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LSVT LOUD and LSVT BIG Homework Helper Videos
Video Clip LSVT LOUD Homework Helper
Video Clip LSVT BIG Homework Helper Four ways to order:
1. Phone: 1‐888‐438‐5788
1. Online: www.lsvtglobal.com(Click on “Store”, then select desired video from dropdownmenu under “Exercise Videos”)
3. Amazon: www.amazon.com(Search LSVT LOUD or LSVT BIG Homework Helper)
4. Vimeo: www.vimeo.com(Search LSVT LOUD or LSVT BIG Homework Helper DVD)Rent or purchase downloadable versions
LSVT Companion® Home Edition
Funded by: NIH‐NIDCD & Michael J. Fox Foundation
LSVT Companion Key Features
FDA‐cleared medical device
Must be under care of an LSVT LOUD Certified Clinician (prescription)
Provides audio and visual feedback based on goals set by the clinician
Automatically obtains calibrated Sound pressure level (SPL), frequency and duration for treatment and/or homework practice
Clients can easily e‐mail results files (Excel format) for clinician review
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Video Example of LSVT Companion Home Edition
60.0
65.0
70.0
75.0
80.0
85.0
90.0
SustainedPhonation
Monologue RainbowPassage
CognitiveTask
dB
Pre
Post
FU
Changes consistent with those reported in previously published data (Halpern et al, 2012, AJSLP)
LSVT Companion Research
Post‐Graduate Groups:LOUD for LIFE® and BIG for LIFE®
Group exercise maintenanceclass specifically for patients who have completed the
FULL LSVT Protocol!
Cash Based
Led by LSVT LOUD and LSVT BIG Certified Clinicians “acting as” fitness professionals
Community Based
LOUD for LIFE and BIG for LIFE are NOT:
Skilled therapy
Billed as group therapy
For people who have not yet received LSVT LOUD or LSVT BIG
A replacement for LSVT LOUD or LSVT BIG treatment
“LOUD for LIFE not only reinforces all we learn in LOUD but carries those concepts into the real world, forcing us to practice LOUD in a truly social, real world situation.”
Halpern, et al., 2016, ASHA
100% (7/7) of participants reported decreased
practice when not attending LOUD for LIFE over a holiday
break.
Client Feedback
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What about tune‐up sessions?
Optimal Wellness Models
DENTAL MODEL
• See the Dentist• Restore and improve oral health
• Preventative care
• Get regularly scheduled cleanings every 3‐12 months
• Brush and Floss Daily!
LSVT MODEL
• See your LSVT BIG/LOUDCertified PT, OT or SLP
• Restore and improve physical function andcommunication
• Prevent functionaldecline
• Get regularly scheduled tune‐ups every 3‐12 months
• Do your LSVT BIG or LOUDExercises Daily!
Six‐monthsPost‐treatment
LSVT Clinician should check up with you at 6 months
Some patients may need a check up earlier
You may need:
1. Nothing at all2. Enhanced motivation3. Calibration rescaling4. Tune‐up sessions
Tune‐up Snapshot
Reassess performance on outcome measures, and compare to most recent discharge scores.
Reassess
Reassess current level of calibration and need for “re‐scaling” of vocal loudness or bigness of movement (amplitude).
Reassess
Reassess performance and amplitude with daily exercises, functional tasks and communication and/or mobility in real life.
Reassess
Tune‐Up Recommendations
• Establish frequency and number of visits based on assessment findings
• Range: 0 ‐16 visits! Average 2‐6 visits
• Continue to follow patients every 3‐12 months• More Frequent (every 3‐4 months): Atypical PD, Cognitive Impairments, with changes to DBS
• Less frequent: IPD, Young, healthy, very motivated and adherent to HEP, good support, active
• Remember….PD is forever! You are an important partner on their journey!
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Tune‐ups are legitimate reimbursable “care” for people with degenerative diseases.
Refer to Jimmo v. Sebelius
Does it take effort? YES!
Is it worth the effort? YES!
Will there be days when clients don’t succeed? YES!
Do your best and know your clinician is there to help!
Summary• LSVT LOUD and LSVT BIG are evidence‐based treatments that can have a very positive impact on communication, mobility andactivities of daily living
• Homework practice during treatment is a key to success
• Continued practice post‐treatment is required for maintenanceof skills
• Tools exist to assist in maintenance
• Videos• LSVT Companion
• Group exercise maintenance classes: LOUD for LIFE and BIGfor LIFE
• Tune‐up sessions are realistic and helpful
• You deserve the care and are worth the effort!!!
How to get started with LSVT LOUD and LSVT BIG
• Ask your doctor for a referral and a prescription for a speech or physical & occupational therapy evaluation and treatment
• Visit www.lsvtglobal.com to find an LSVT LOUD or LSVT BIG Certified Clinician in your area
• Helpful Tip! If a clinician lists “Type of Organization”, look for types that apply to you (e.g. if not homebound, you will not want to select a home health provider)
Finding a
LOUD for LIFE or
BIG for LIFE Class• www.lsvtglobal.com• Click on link for “FindLSVT Clinicians”• Select desired providertype (LSVT LOUD or LSVT BIG)• Type in your locationinformation in the search bar• Choose the distance you would like to search• Look for the designationof “LOUD for LIFE Provider” under title
How can you become
certified in
LSVT LOUD or LSVT BIG?
Two great ways to become LSVT Certified:
Parallel curriculum, same certification, equal confidence
Live Course
• Hands‐on learning and practice working with other trainees and people with PD
• Complete your training in two days in a peer community with real‐time feedback from expertinstructors
Online Course
• Convenience and cost savings: no travel, no time off work or away from family
• Self‐paced format lets you focus and power through or take your time as fits your learning style and circumstances
Both options offer discounts for groups, students and previously certified clinicians
To learn more and see upcoming courses, visit:
https://www.lsvtglobal.com/LSVT_Training_Certification_Courses
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Opportunities to Learn More
• Monthly Webinars on Hot Topics!
• On Demand Webinar Library
• Patients & Family Section
• Featured Blog Articles, Testimonials, and Videos
• Live Seminars
• LSVT Global Facebook Page
• Ask our experts!
FIND IT ALL AT
www.lsvtglobal.com
Be your own best advocate: Key actions for people with Parkinson’s and families to ensure success with LSVT treatmentDate:Wednesday, March 18, 2020Time: 8:00 PM ‐ 9:00 PM Eastern Daylight Time (EDT) (EDT is UTC ‐ 4 hours)
• Questions to ask your neurologist about speech, occupational, andphysical therapy options
• Information on how to interpret treatment related research
• How to use the Clinician Directory to find the best match
• Questions to ask potential LSVT Certified therapists
https://blog.lsvtglobal.com/public‐webinars/
How to ask questions1. Type in the question box on your control panel
2. Raise your hand! (click on the hand iconin your control panel)
• Your name will be called out
• Your mic will be unmuted, then you canask your question out loud.
3. Email [email protected] if you think ofquestions later!
Thank you!
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