UPMC Washington Makes Progress with Parkinson’s Disease

By Kevin Brown

Therapists at UPMC Washington are making progress in helping people with Parkinson’s disease. By offering the LSVT Big and LSVT Loud therapy programs at the Wilfred R. Cameron Wellness Center in Washington, PA, therapists are significantly improving movement and communication deficiencies common to people with Parkinson’s disease. The therapy programs have been offered there since 2019.

Parkinson’s disease affects the production of dopamine in the brain, which causes neurological movement and speech difficulties, among other symptoms. It is commonly considered a disease of aging, although younger people are diagnosed with early-onset Parkinson’s as was the actor and author Michael J. Fox in 1991 at age 29.

Individuals with Parkinson’s can exhibit a variety of movement disorders such as tremors, slowness, stiffness, and shuffling, as well as speech issues including soft talking, mumbling, and hoarseness, among others.

According to Scott Gilbert, M.A., CCC/SLP, speech-language pathologist at UPMC Washington, the disease is progressive, so symptoms are expected to get worse. “The LSVT program, from its inception, has been designed to bring people back from that deterioration, to stop and/or slow the progression of symptoms and reverse some of the communications deficits. It is not a cure for Parkinson's, however,” he says.

LSVT stands for Lee Silverman Voice Training and is named after Mrs. Lee Silverman, a person with Parkinson’s who was the first to receive the Loud therapy from Dr. Lorraine Ramig 40 years ago at the University of Colorado-Boulder. LSVT Big is modeled after the same principles as LSVT Loud but involves physical and occupational therapy to improve movement issues. The word Big describes the emphasis on large, definitive movements patients are encouraged to make. Similarly, Loud represents the use of a louder voice to improve the soft and mumbling speech patterns.

April Eddy, PT, DPT, physical therapist at UPMC Washington, describes LSVT Big as dealing with the physical aspects of Parkinson’s. “We focus on addressing the motor symptoms of Parkinson's disease, as well as the non-motor symptoms such as the slow, shuffling walk, small movements, and not being able to do two things at the same time. I have a lot of gentlemen who say ‘I can't keep up with my wife. I used to be able to walk right next to her, and now she's leaving me in the dust.’”

Scott says that people with Parkinson's disease can have a low speaking voice and a vocal quality that is hoarse, even monotone. “Not having a lot of change in the loudness creates a very rigid voice without a lot of character and the ability to express oneself,” he explains. “The way it deteriorates over time can affect the person to the extent that they're just not understood anymore.”

When individuals with Parkinson’s are referred to the programs, the first step is an evaluation. Scott and April interview the patients to find out what made them seek help in the first place. What symptoms do they notice? Have there been any changes to their Parkinson's medication? When were they diagnosed with Parkinson's? “After the interview, we’ll do an examination with walking tests, balance tests, and strength tests,” April says. Scott conducts similar tests related to speech and communication.

Following the evaluations and testing, Scott and April develop an individual treatment plan for each patient that comprises 16, one-hour sessions, four days a week for four weeks. “We only work with one person in a one-hour session,” April says. “We are wholly one-on-one with each patient because, with the intensity and the amplitude of LSVT, it needs our full attention.”

The therapists see patients in all different phases of their progression through Parkinson's from early stages to very late stages. Research has shown that this protocol can benefit people with Parkinson's at any stage. It can be very adaptable to what that patient needs at that time.

“By the end of the 16 sessions, we hope to see progress with their movement — they're standing straighter and taller, their postures are better,” April says. “Also, their walking speed is improved, and they are taking larger steps. They're able to keep up with their wives again.”

Scott says the LSVT Loud therapy focuses on a louder voice and improved pronunciation with the ultimate goal of increasing that until it becomes a learned behavior. “In addition to the therapy, the patients learn techniques so that when they finish the program, they'll have improvement in their speech as well as tools they can use after that,” he explains.

The LSVT Big and LSVT Loud therapy programs require a physician referral and are covered by most insurances, including Medicare. For more information about the programs, call UPMC Washington Outpatient Rehabilitation at 724-250-6280, or visit www.whs.org and click on Care & Treatment and Rehabilitation. The Wilfred R. Cameron Wellness Center also offers exercise classes and a support group for patients with Parkinson’s.

Additional information about the LSVT therapy programs is available at www.lsvtglobal.com.