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LSVT Global® Public Webinar Series
Title: Research and Clinical Advances in LSVT LOUD® and LSVT BIG®
Presenters: Cynthia Fox, PhD, CCC-SLP
Heather Cianci, PT, MS, GCS
Date Presented: December 12, 2018
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. 2018 1
Research and Clinical Advances in LSVT LOUD® and LSVT BIG®
Cynthia Fox, Ph.D., CCC‐SLP
VP Operations and Co‐Founder
LSVT Global, Inc.
Heather Cianci, PT, MS, GCS
LSVT BIG Faculty
Dan Aaron Parkinson’s Center, Philadelphia, PA
Innovation in Science. Integrity in Practice.
Supported by• National Institutes of Health ‐ National Institute Deafness and Communication
Disorders (NIH‐NIDCD)• Office of Education‐National Institute for Disability and Rehabilitation Research (OE‐
NIDRR)• Coleman Institute • Hearst Foundation• Axe‐Houghton Foundation• Family of Lee Silverman• Davis Phinney Foundation • Parkinson Alliance• Supported by NIH grants: R01DC01150, R21 RFA‐NS‐02‐006 R21DC006078, R21NS04371
R43DC010956, R43DC010498, R43DC00741
DisclosuresDr. Fox and Ms. Cianci have both financial and non‐financial relationships with LSVT Global. Non‐financial relationships include a preference for LSVT BIG as treatment techniques. Dr. Fox is an employee of LSVT Global and receives lecture honorarium. Additionally, Dr. Fox has ownership interest in the company. Ms. Cianci is a consultant for LSVT Global and receives lecture honorarium, consulting fees and travel reimbursement.
Plan for Webinar
• Logistics
• Presentation of Content
• Address your questions
• Survey
Information to Self‐Report CE Activity
• This LSVT Global webinar is NOT ASHA or state registered for CEUs, but it may be used for self‐reported CEU credit as a non‐registered 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 licensing board to determine if your state accepts non‐ASHA registered CEU activities.
• Attendance for the full hour is required to earn a certificate.
Instructor BiographiesCynthia Fox, PhD, CCC‐SLPDr. Fox received her doctorate degree in Speech and Hearing Sciences from the University of Arizona, Tucson. Dr. Fox is a research associate at the National Center for Voice and Speech and Co‐Founder of LSVT Global. She is an expert on rehabilitation and neuroplasticity and the role of exercise in the improvement of function consequent to neural injury and disease. Dr. Fox is among the world’s experts in speech treatment for people with Parkinson disease. She has multiple publications in this area of focus, as well as numerous national and international research and clinical presentations. Dr. Fox has worked on studies examining the efficacy of LSVT LOUD, the underlying mechanisms of speech disorders in PD, and the application of LSVT LOUD to other disorders (children and adults) and other motor systems (e.g., limb).
Heather Cianci, PT, MS, GCSMs. Cianci is the founding therapist of the Dan Aaron Parkinson's Rehab Center at Pennsylvania Hospital in Philadelphia, PA. She received her bachelor's in PT from the University of Scranton in Scranton, PA and her master's in gerontology from Saint Joseph's University in Philadelphia. Heather received her GCS in 1999. She was certified in LSVT BIG in 2007 and is the PT Faculty for the Parkinson Foundation’s (PF) Allied Team Training for PD. She has authored book chapters on rehabilitative strategies for PD, and Frontotemporal Degeneration and is the author of an educational manual on fitness for the PF. Heather has lectured for various state Physical Therapy Associations, the PF, national continuing education companies, and Philadelphia‐area conferences and support groups about PD. Her research includes movement strategies for bed mobility, falls, freezing of gait, and functional movement disorders.
Polling Question Who are you?
• Speech Therapist• Physical or Occupational Therapist
• Person with PD• Family/friend of person with PD
• Other
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Objectives of Presentation
Provide a framework for importance of
research and evaluating research
evidence
Briefly review foundational LSVT LOUD and LSVT BIG
research
Update on new LSVT LOUD and LSVT BIG research in 2017‐
2018
Summarize future research and
clinical innovations
Highlight clinical advances for
improving LSVT LOUD and LSVT BIG
in practice
Prevalence of PD is expected to DOUBLE by 2040
The need for effective
treatments is great!
Up to 8 million people worldwide are living with PD.
Dorsey ER, Bloem BR (2018) The Parkinson Pandemic—A Call to Action. JAMA Neurol. 2018;75(1):9-10. doi:10.1001/jamaneurol.2017.3299
Our MissionTo empower people with Parkinson’s to
restore and maintain their highest levels
of functional communication, mobility
and independence with ADL’s through
scientifically supported rehabilitative
treatment programs:
• LSVT LOUD®
• LSVT BIG®
Research is essential to provide the strong foundation we need as
therapists!
What is Evidence‐ Based Practice (EBP)?
• Definition ‐ EBP includes the integration of best available research, clinical expertise, and patient values and circumstances related to patient and client
management, practice management, and health policy decision‐making
• Therapist perspective? Do the treatments you are using have quality
evidence? Do your choose interventions that have been researched, and if
you do, do you deliver the intervention as it was delivered in the study
(method, dosage, intensity, etc.)?
• Consumer/patient perspective? Are the treatments being offered to you
ones with quality evidence? When receiving evidence‐based treatments, is
the therapist and/or facility maintaining the method, dosage, intensity as
delivered in research studies?
Research → Clinical Implementa on
How do I choose which evidence-based treatments to use or receive?
Amount of research?
Quality of research?
Feasibility for my patient and me?
Reimbursement of the treatment?
Am I skilled at this treatment?
Will my patient like it?
What about interventions that are notevidence-based?
Are there ethical or safety issues?
How can research and clinical advances best guide
decision‐making for therapists and patients?
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Model for Clinical Outcome Research(Robey & Schultz, 1998; Robey, 2004)
Phase I : DiscoveryDetect presence of therapeutic effect; population, protocol, dosage
Phase IIDefine and refine protocol, outcomes, valid and reliable measurement
Phase III Test efficacy of treatment (RCT randomized, controlled trial; GOLD STANDARD of EVIDENCE)
Phase IVTreatment real‐world practice, expand populations, service delivery models
Phase V: Implementation in Standard practiceTreatment generalized to standard scope of practiceCost effectiveness & customer satisfaction research
Provide a framework for evaluating research evidence Classes of Evidence
(e.g., Scottish Intercollegiate Guidelines)
1A Meta‐analysis of multiple well‐designed controlled studies
1 Well‐designed randomized controlled trials (RCT)
2 Well‐designed non‐randomized controlled trials (quasi‐experimental)
3 Observational studies with controls (retrospective studies, interrupted time‐series studies, case‐control studies, cohort studies with controls)
4 Observational studies without controls (cohort studies without controls and case series)
Studies may be rated on qualities, such as, Random allocation; Concealed allocation; Baseline comparability; Blind subjects; Blind therapists; Blind assessors; Adequate follow‐up; Intention‐to‐treat analysis; Between‐group comparisons
https://www.asha.org/evidence‐maps/
ASHA Evidence MapsMotor Speech Language Cognition Swallowing
Independent (non‐biased) reviewsPT/OT Evidence Maps
http://www.otseeker.com/“OTseeker is a database that contains abstracts of systematic reviews, randomized controlled trials and other resources relevant to occupational therapy interventions.”
https://www.pedro.org.au/“PEDro is the Physiotherapy Evidence Database, a free database of over 42,000 randomized trials, systematic reviews and clinical practice guidelines in physiotherapy.”
Comparing exercise in Parkinson's disease ‐‐ the Berlin LSVT BIG studyEbersbach G, Ebersbach A, Edler D, Kaufhold O, Kusch M, Kupsch A, Wissel J; Movement Disorders 2010 Sep 15;25(12):1902‐1908 clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow‐up: Yes; Intention‐to‐treat analysis: No; Between‐group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*
Independent (non‐biased) reviews
25+ year LSVT LOUD journey from invention to scale‐up
1987‐89: Initial invention; Pilot data Lee Silverman Center
1989‐91: Treatment development OE‐NIDRR
1991‐94: Treatment follow‐up OE‐NIDRR
1990‐95: Treatment Efficacy NIH R01, RCT
1995‐00: Underlying Mechanism NIH R01 RCT
2002‐07: Distributed effects NIH R01
2007‐12: Target/mode NIH R01 RCT
2001‐02: LSVT Companion Coleman Institute
2002‐04: LSVTC NIH & MJ FOX Foundation NIH R21
2002‐04: LSVTVT Coleman Institute
2004‐06: LSVTVT NIH R21
2004: LSVT Down Syndrome Coleman Institute
2006: Technology Enhanced Clinician Training NIH SBIR
2009: Telehealth Delivery of Software Enhanced LSVT NIH SBIR
2010: Independent Delivery of Software Enhanced LSVT NIH SBIR
Phase I, II
Phase III
Phase IV, V
On average, it takes 17 years for 14% of original research to be implemented into a physician’s practice (Brownson, 2006)
Implementation in ‘real world’ clinical practice
LSVT BIG development began
LSVT BIG RCT published
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Briefly review Foundational LSVT LOUD research
1st RCT
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2nd RCT 1st RCT
Change in UPDRS motor score (blinded ratings)
Resources to review all foundational LSVT LOUD and LSVT BIG research
https://academy.pubs.asha.org/2018/08/special‐collection‐lee‐silverman‐voice‐treatment/
https://blog.lsvtglobal.com/research/
Update on new LSVT LOUD research in 2017‐2018
Movement Disorders, 2018
Speech treatment in Parkinson's disease: Randomized controlled trial (RCT). Ramig L, Halpern A, Spielman J, Fox C, Freeman K. Mov Disord. 2018 Nov;33(11):1777‐1791. doi: 10.1002/mds.27460. Epub 2018 Sep 28.
3rd RCT
Objective. To evaluate two speech treatments for PD matched in intensive dosage and high‐effort mode of delivery, differing in subsystem target: voice (respiratory‐laryngeal) versus articulation (orofacial‐articulatory).
Methods. Sound pressure level (SLP) was measured across a range of speaking tasks and a self‐reported communicative effectiveness scale was administered in 20 healthy controls (HCs) and 64 patients with idiopathic PD.
Participants with PD were randomized to either LSVT LOUD, LSVT ARTIC or NO Treatment and studied at baseline, 1 and 7 months.
Study Flow Consistent with CONSORT Guidelines
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Comparison Treatment Chart
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LSVT LOUD is the only speech treatment with 3 RCTs documenting short and long‐term efficacy
Objective. To specify cerebral pathophysiology of hypokinetic dysarthria and treatment‐induced changes using functional magnetic resonance imaging (fMRI).
Methods. fMRI in 11 healthy controls (HCs) and 11 patients with idiopathic PD before and after treatment with LSVT LOUD.
Measured fMRI during covert reading with normal or high intensity.
Tested LSVT effects on intelligibility and different speech features (intensity, pitch,articulation).
Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease. Baumann A, Nebel A, Granert O, Giehl K, Wolff S, Schmidt W, Baasch C, Schmidt G, Witt K, Deuschl G, Hartwigsen G, Zeuner KE, van Eimeren T.Neurorehabil Neural Repair. 2018 Nov 16:1545968318812726. doi: 10.1177/1545968318812726. [Epub ahead of print]
Changes in Vowel Triangle pre/post LSVT LOUD Changes in fMRI measures (B) post LSVT LOUD
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Conclusions
• Hypokinetic dysarthria in people with PD may be due to a dysfunction of mesial fronto‐striatal neuronal networks
• Increased intensity of covert reading appeared to rely on right temporoparietal networks which are engaged in prosodic elements of speech
• Effective LSVT LOUD may be explained by an increased recruitment of these right temporoparietal networks for high intensity speech during normal speech levels (i.e., regular conversation)
• Post‐LSVT LOUD findings are consistent with previous PET studies (Liotti et al., 2003; Narayana et al., 2010)
(from Baumann 2018 study)
Other LSVT LOUD Publications in 2017‐18
Neuroimaging pre/post LSVT LOUD in children with cerebral palsy and dysarthria
Changes in White Matter Integrity following Intensive Voice Treatment (LSVT LOUD®) in Children with Cerebral Palsy and Motor Speech Disorders. Reed A, Cummine J, Bakhtiari R, Fox CM, Boliek CA. Dev Neurosci. 2017;39(6):460‐471. doi: 10.1159/000478724. Epub 2017 Jul 28.
Changes in brain activity following intensive voice treatment in children with cerebral palsy.
Bakhtiari R, Cummine J, Reed A, Fox CM, Chouinard B, Cribben I, Boliek CA. Hum Brain Mapp. 2017 Sep;38(9):4413‐4429. doi: 10.1002/hbm.23669. Epub 2017 Jun 5.
LSVT LOUD in Spanish speakersThe Effects of Intensive Speech Treatment on Conversational Intelligibility in Spanish Speakers With Parkinson's Disease. Moya‐Galé G1,2, Goaders A3, Bayes À2, McAuliffe M4, Bullet B5, Levy ES1. Am J Speech Lang Pathol. 2018 Feb 6;27(1):154‐165. doi: 10.1044/2017_AJSLP‐17‐0032.
Impact of LSVT LOUD on swallowingEffect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson's disease: A pilot study. Miles A, Jardine M, Johnston F, de Lisle M, Friary P, Allen J. J Neurol Sci. 2017 Dec 15;383:180‐187. doi: 10.1016/j.jns.2017.11.015. Epub 2017 Nov 15.
Technology‐enhanced delivery of LSVT LOUD
Technology‐enabled management of communication and
swallowing disorders in Parkinson's disease: a systematic scoping
review. Theodoros D, Aldridge D, Hill AJ, Russell T. Int J Lang
Commun Disord. 2018 Jun 19. doi: 10.1111/1460‐6984.12400.
[Epub ahead of print] Review.
Delivering group speech maintenance therapy via
telerehabilitation to people with Parkinson's disease: A pilot study.
Quinn R, Park S, Theodoros D, Hill AJ. Int J Speech Lang Pathol.
2018 Jun 7:1‐10. doi: 10.1080/17549507.2018.1476918. [Epub
ahead of print]
Long‐term effects of Lee Silverman Voice Treatment on daily voice
use in Parkinson's disease as measured with a portable voice
accumulator. Körner Gustafsson J, Södersten M, Ternström S,
Schalling E. Logoped Phoniatr Vocol. 2018 Feb 15:1‐10. doi:
10.1080/14015439.2018.1435718. [Epub ahead of print]
The effectiveness of Lee Silverman Voice Treatment therapy issued
interactively through an iPad device: A non‐inferiority study.
Griffin M, Bentley J, Shanks J, Wood C. J Telemed Telecare. 2018
Apr;24(3):209‐215. doi: 10.1177/1357633X17691865. Epub 2017
Feb 1.
Update on new LSVT BIG research in 2017‐2018
Isaacson S, O'Brien A, Lazaro JD, Ray A, Fluet G. J Phys Ther Sci. 2018 Apr;30(4):636‐641. doi: 10.1589/jpts.30.636. Epub 2018 Apr 20.
Objective: To test the hypothesis that Lee Silverman Voice Treatment‐BIGdecreases the negative impact of hypokinesia on dual task performance in persons with Parkinson’s disease.
Methods: Retrospective chart review of patient records who completed 14 of 16 sessions of LSVT BIG. 93 records of 114 reviewed were included.
Records of pre and post‐test Timed Up and Go, Timed Up and Go Motor, and Timed Up and Go Cognitive scores were examined.
Data on TUG tests pre/post LSVT BIG
Dual task cost (DTC)
Dual task cost (DTC) was calculated by dividing the difference between TUG MOTOR or TUG COG times and the TUGme collected the same day and then dividing by the TUG score (TUG Cog − TUG) / TUG33).
Isaacson et al., 2018
Measures impact of performing a second task on the performance of a reference task.DTC>10% associated with decreased mobility and functional ability
Conclusions
These findings suggest that cueing strategies associated with LSVT BIG become internalized and decrease the negative impact of hypokinesia on mobility and cognitive performance while performing two tasks simultaneously in persons with Parkinson’s.
Limitations: uncontrolled, treating therapist collected data, need longer follow‐up, no standardized measure of disease severity collected
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Objective: To describe the impact of LSVT BIG therapy on postural control and gait in three individuals with moderate PD.
Methods: Three case studies of individuals with moderate(H&Y 3) Parkinson disease (PD) received LSVT BIG .
Measured balance, gait, dual‐task performance, quality of life and balance confidence at pre, immediately post (retrospective chart analysis) and prospective follow up at 1‐ and 4 months later.
Fishel SC, Hotchkiss ME, Brown SA. Physiother Theory Pract. 2018 Aug 17:1‐9. doi: 10.1080/09593985.2018.1508260. [Epub ahead of print]
LSVT BIG Functional Component and Hierarchy Tasks
Changes in measures Pre, Post, FU1 and FU 2 LSVT BIG
Outcomes: Clinically meaningful improvements in balance and gait, including performance under dual‐task conditions, were achieved by all patients and many of these improvements were maintained up to 4 months later. Changes in quality of life were not observed during the length of the intervention.
Fishel et al., 2018 Conclusions_____________
LSVT BIG therapy may improve postural control, gait, and dual‐task performance, and therefore reduce fall risk for individuals with moderate PD.
Limitations: case series, uncontrolled, therapist collected data
Purpose: “The purpose of this study was to examine the feasibility of using the LSVT BIG protocol with a person with chronic stroke.”
Method: In‐clinic 4x/week and HEP using “Mystic Isle platform, which uses the Microsoft Kinect sensor (Microsoft Corp., Redmond, WA) as the input device.”
Conclusion: “The intensity of the LSVT BIG intervention coupled with the integrated neuroplasticity principles and the game‐based delivery of the home program led to the participant making gains beyond what was expected. Moreover, she was able maintain most of those gains after 6 wk of no intervention.”
“The improvements Brenda made in her performance of occupations and engagement in new occupations reflect the saliency of the LSVT BIG intervention.”
Other Publications in 2017‐18
Use of a Telehealth System to Enhance a Home Exercise Program for a
Person With Parkinson Disease: A Case Report. Chatto CA, York PT,
Slade CP, Hasson SM. J Neurol Phys Ther. 2018 Jan;42(1):22‐29. doi:
10.1097/NPT.0000000000000209.
Lee Silverman Voice Treatment (LSVT)‐BIG to improve motor function
in people with Parkinson's disease: a systematic review and meta‐
analysis.
McDonnell MN, Rischbieth B, Schammer TT, Seaforth C, Shaw AJ,
Phillips AC. Clin Rehabil. 2018 May;32(5):607‐618. doi:
10.1177/0269215517734385. Epub 2017 Oct 5.
Effect on Gait Speed, Balance, Motor Symptom Rating, and Quality of
Life in Those with Stage I Parkinson's Disease Utilizing LSVT BIG®.
Millage B, Vesey E, Finkelstein M, Anheluk M. Rehabil Res Pract.
2017;2017:9871070. doi: 10.1155/2017/9871070. Epub 2017 Feb 26.
LSVT‐BIG Improves UPDRS III Scores at 4 Weeks in Parkinson's Disease
Patients with Wearing Off: A Prospective, Open‐Label Study.
Ueno T, Sasaki M, Nishijima H, Funamizu Y, Kon T, Haga R, Arai A, Suzuki
C, Nunomura JI, Baba M, Tomiyama M. Parkinsons Dis.
2017;2017:8130140. doi: 10.1155/2017/8130140. Epub 2017 Feb 1.
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Highlight Clinical Advances for Improving LSVT LOUD and LSVT
BIG in practice
Clinical advances entail research (both specific to LSVT and general research on Parkinson’s motor learning, neuroplasticity) and our clinical experience! These advances help us highlight key treatment components that we need to emphasize even more during therapy.
• Personalized Care: Focus on function and personalize materials and goals
• Maintenance: Build a plan for life‐long practice• Non‐motor Symptoms: Consider role on non‐motor symptoms and how LSVT LOUD and LSVT BIG can help
PLUS Functional Application
Can you achieve “person-centered care” in standardized, evidence-based treatments? Yes you can!
Salient and engaging tasks
• Incorporate tasks that are meaningful and salient to person –enhances motivation
• Link program to functional goals that are personalized to each patient
• Hobbies and passions should be incorporated and used to achieve self‐realization and improved communication, function and engagement in daily activities
Family
Work
Hobby
After treatment, your clients must take their daily dose of LSVT LOUD and LSVT
BIG homework exercises!
+ =
The best combination for success!
+
Lifelong Support After LSVT
• Daily exercise practice life‐long• LSVT Homework Helper Videos • LSVT Companion Client Edition
• New Group Exercise Options• LOUD® for LIFE or BIG for LIFE®
• Regular LSVT “Tune‐ups” every 3‐12 months
• “Other” enjoyable activities
LOUD for LIFE® & BIG for LIFE®
Group exercise maintenance class specifically for patients who have completed the entire LSVT LOUD or LSVT BIG Protocol!
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Cash Based
Led by LSVT LOUD or 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 BIG
•A replacement for LSVT LOUD or LSVT BIG treatment
Motivation and EngagementNonmotor Symptom Complex
Collective strategies overlap to address these issues in treatment!
FatigueSleep
DisordersDepression
Apathy Anxiety
Positive Reinforcement
• Positive reinforcement/Positive spin:
Client: “These exercises are a lot of work.”
Clinician: “Yes, they are! This is what will help you improve your communication/movement and give you more confidence when talking/walking. You have important things to say/do and we want to keep you active!”
• Encourage energetic participation
• There is an important role of arousal in motor learning
Therapist Testimonial
https://blog.lsvtglobal.com/this‐was‐one‐of‐the‐most‐functional‐and‐fulfilling‐courses‐we‐both‐have‐ever‐taken/
“…what makes us the happiest to see how much his demeanor has changed. When we started, he wore a baseball hat pulled down low over his eyes and did not joke or smile. He stopped wearing the hat, jokes and laughs all the time, and walks with his head held high.”
Amy and Scott B
“I do believe that as patients begin to see positive results from therapy and hear positive comments from others their confidence increases which impacts their ability to cope with anxiety, depression, apathy, etc. better.”‐LSVT LOUD Clinician
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Regain self‐efficacyHelp person to feel “in control”
Pre‐treatment
Small, slow movements
Less Success and Confidence
Withdraw
Bigger more normal
movements
Salient Intense Exercise
More Success
Less Withdrawal
Post‐treatment
Zemankova et al., 2016
Confident Engaged
Participant in Life
“LSVT BIG is my miracle!I was diagnosed around my forty first birthday, but on my birthday this year, the big 45, I gained my balance and a lot of mobility back. I am excited to want to share my hope with others!”
Christopher B. ‐ LSVT BIG Graduate
Client Testimonial
SummaryIt is essential in our field that we develop research‐based treatments that are based on solid evidence and theory. However…
You can have the best model/theory in the world, but the crucial question is: can therapists implement it and can patients participate in it?
• What is unique about LSVT LOUD and LSVT BIG is the answer is YES!
• LSVT can help people with early through late stage disease• LSVT research outcomes and clinical knowledge are feeding successful implementation and as a result, people with PD benefit.
• This webinar provided an update on latest findings and positions for both research and clinical advances that assist with implementation issues.
Future Research
• Publication of RCT data comparing LSVT LOUD, LSVT ARTIC, Untreated and healthy control:• Speech intelligibility in noise (Levy & Forrest, 2016; Schulz, 2016)• Facial expression (Borod, 2016)• Swallowing (Martin‐Harris & McFarland, 2016)• Language (Ramage)• PET imaging (Narayana, 2016)
• RCT of LSVT BIG compared to another evidence‐based approach
• Impact of LSVT BIG on fall prevention
• Prospective studies looking at nonmotor scales pre/post LSVT LOUD and LSVT BIG (e.g., anxiety, apathy)
• Continued technology‐enhanced LSVT LOUD and LSVT BIG studies
• Impact of LOUD for LIFE and BIG for LIFE maintenance groups on long‐term outcomes
• Clinical implementation studies
How to ask questions LIVE:
1. Type in the QUESTION BOX on your control panel
2. Raise your hand! (Click on the hand icon.)• Your name will be called out• Your mic will be unmuted (make sure your mic is unmuted as well)
• Then ask your question out loud
3. Email [email protected] if you think of questions later
QUESTIONS??
Next Public Webinar:LSVT LOUD and LSVT BIG Myth busters: What you need to know!Date: Wednesday, January 16, 2019Time: 2:00 PM - 3:00 PM Eastern Standard Time
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