LSVT Global Virtual Occupational Therapy Conference · 2020. 3. 27. · 3. Maximum Functional Speech Loudness (Functional Phrases) – 5 reps of 10 phrases Hierarchy Exercises Structured

LSVT Global® Virtual Occupational Therapy Conference

Title: An interprofessional practice approach to improving occupational participation, communication, and mobility in Parkinson disease

Presenters: Erica Vitek, MOT, OTR, BCB-PMD, PRPC Bernadette “Bernie” Kosir OTR/L, CAPS Laura Guse, BSPT, MPT Cynthia Fox, PhD, CCC-SLP

Date Presented: March 27, 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)

http://www.lsvtglobal.com/

mailto:[email protected]

3/27/2020

Copyright LSVT Global, Inc., 2020 1

Innovation in Science. Integrity in Practice.

An interprofessional practice approach to improving occupational participation,

communication, and mobility in Parkinson disease

Your presenters

• Erica Vitek, MOT, OTR, BCB-PMD, PRPC

• Bernadette “Bernie” Kosir OTR/L, CAPS

• Laura Guse, BSPT, MPT

• Cynthia Fox, PhD, CCC-SLP

LSVT BIG® and LSVT LOUD®

Training & Certification Faculty

Instructor BiographiesErica Vitek MOT, OTR, BCB-PMD, PRPCMs. Vitek has been certified in LSVT BIG since 2009 and is an ATTP graduate. She is Board Certified in Biofeedback for Pelvic Muscle Dysfunction, a Board-Certified Pelvic Rehabilitation Practitioner, and Herman & Wallace Pelvic Rehabilitation Institute faculty authoring Neuro conditions and pelvic floor rehab. She presents and authors articles for the Wisconsin Parkinson Association. She is employed by Aurora Sinai Medical Center in Milwaukee, WI, leading LSVT programing, including LSVT BIG graduate exercise classes.

Bernadette Kosir OTR/L, CAPSMs. Kosir has over 30 years of OT experience, specializing in home health clinical leadership, quality process development, and innovative clinical education. Ms. Kosir has been LSVT BIG Certified since 2008. She is a certified trainer in Integrated Care Management for coordinated care of patients with chronic diseases including Parkinson disease, and is an NAHB Certified Aging in Place Specialist.

Cynthia Fox Ph.D., CCC-SLPDr. Fox is an expert on rehabilitation and neuroplasticity and the role of exercise in the improvement of function consequent to neural injury and disease. She is a world leader in LSVT LOUD and conducted related efficacy research in Parkinson’s and other disorders. Dr. Fox worked on the development of LSVT BIG. She is faculty for LSVT LOUD and LSVT BIG Training and Certification courses. Dr. Fox is CEO and Co-Founder of LSVT Global, Inc.

Laura Gusé, BSPT, MPTMs. Gusé has extensive experience treating people with neurodegenerative disorders in various practice settings. She was LSVT BIG certified in 2009 and now serves as Chief Clinical Officer of LSVT BIG. Ms. Guse’ oversees the training, curriculum and product development related to LSVT BIG, and has helped to create many of the current LSVT BIG treatment tools, webinars, and courses. She has spoken at many national and international conferences on topics related to LSVT BIG.

Disclosures

• All the presenters have both financial and non-financial relationships with LSVT Global. Non-financial relationships include a preference for the LSVT protocols as treatment techniques which will be discussed as a part of this course.

• Dr. Fox and Ms. Guse are employees of LSVT Global, receive lecture honorarium and travel reimbursement, and Dr. Fox has ownership interest in the company.

• Ms. Vitek and Ms. Kosir receives lecture honorarium and travel reimbursement from LSVT Global, Inc.

Plan for Webinar

• Purpose

• Logistics CEU information

• Presentation of Content

• Survey

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.

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How to Ask Questions

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, • Then you can ask your question

out loud

3. Email [email protected] if you think of questions later!

Learning ObjectivesUpon conclusion of this webinar, participants will be able to:

• Briefly define interprofessional practice.

• Background for targeting amplitude and sensory recalibration across motor systems and rehabilitation disciplines in Parkinson disease (PD).

• Describe LSVT LOUD® and LSVT BIG® protocols and how they fit within the IPP model.

• Highlight key research data on LSVT LOUD and LSVT BIG.

• Discuss the practical implementation of the team approach using LSVT LOUD and LSVT BIG and utilization of other healthcare and community-based professions.

Overview of Interprofessional Practice in Parkinson disease

Define IPP

IPP occurs when multiple service providers from different professional backgrounds provide comprehensive healthcare or educational services by working with individuals and their families, caregivers, and communities - to deliver the highest quality of care across settings.

– ASHA definition

Complex disease – it takes a village!

PD Medical Team• Neurologist

• Neurosurgeon

• General practice physician

• Nurses

• Physiatrist

• Pharmacist

• Urologist

• Gastroenterologist

• Dentist

PD Allied Team • Speech therapists

• Physical therapists

• Occupational therapists

• Clinical neuropsychologist

• Social workers

• Nutritionist

• Sex therapist

• Audiologist

Community Team

• Support groups

• Exercise classes

• Personal trainers

• Massage

• Acupuncture

• Singing groups

Person with PD and Family

What are their traditional roles?

van der Marck, Kalfa, Sturkenboom, Nijkrakea, Munneke, Bloem (2009). Multidisciplinary

care for patients with Parkinson’s disease. Parkinsonism & Related Disorders;15:S219-23.

Medical management Allied health care

Focus Disease process Impact of disease process on daily functioning

Treatment goals

Reduce symptoms Minimize disease

severity

Reduce disability due to motor and non-motor symptoms

Improve participation in roles and activities in daily living

Improve level of activities

Working mechanism

Correct nigrostriatal dysfunction

Support compensatory (movement) strategies

Scientific evidence

Moderate to strong Limited (occupational therapy) to moderate or strong (physical, speech therapy)

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One Common Goal

Improve Quality of Life for People with PD

Often times allied health care interventions are delivered in isolation of other therapies, despite partially overlapping treatment strategies and potentially

complementary goals (van der Marck et al., 2009).

Occupational Therapy

PhysicalTherapy

SpeechTherapy

Loosely connected management

Our work – LSVT Protocols:based on 25 years of NIH funded research and clinical experience

LSVT LOUD is a speech therapy

Delivered by LSVT LOUD Certified Speech-Language Pathologists

LSVT BIG is an occupational or physical therapy

Delivered by LSVT BIG Certified or Occupational or Physical Therapists

AMPLITUDE: One common rehabilitation goal

PhysicalTherapy

Evaluation → Treatment → Lifelong Follow-up

Occupational Therapy

Physical Therapy

SpeechTherapy

Tightly connected management

Pre to Post LSVT LOUD Video Pre to Post LSVT BIG Video

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Background on motor impairment in PD, underlying pathophysiology that spans speech and motor systems

Hypokinesia Manifests

• Progressive loss of loudness of speech (hypophonia)

• Progressive loss of amplitude of handwriting (micrographia) and other fine motor skills

• Progressive shortening of stride length and arm swing during walking

• Progressive loss of speed and amplitude duration repetitive movements of fingers or limbs.

• Progressive loss of speed and amplitude with limb movements used in BADLs and IADLs

Baker et al., 1998; Godaux et al., 1992; Corcos et al., 1996; Jordan et al., 1992; Farley et al., 2005; Pfann et al., 2004; Koop, Hill, and Bronte-Stewart, 2013

Primary motor symptom, present in every person with PD

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ComfortableVowel

MaximumVowel

SentenceRepetition

Happy DayMonologue

RainbowPassage

Rest Breathing

mic

roV

Absolute Thyroarytenoid Muscle Amplitude

YOUNG

AGED

IPD

Neurology, 1998N=13 (4,4,5), Stage 2-3Baker, Luschei, Smith et al., 1998

↓Duration↓Peak amplitude; ↑ # bursts

Increased coactivation

Hypokinesia/bradykinesiaProgressive loss of ability to internally modulate muscle activation

Normal biphasic muscle activation

relationship

Figure adapted from Phann et al., 2001

Late PDControls

Bicep

Early PD

Tricep

How do PD motor symptoms affect ADL and mobility engagement?

• Difficulty dual tasking affects efficiency

• Balance and stability affect safety• Fear of falling affects everyday

task involvement• Slowed movements affect

efficiency• Difficulty with initiation affects time

on task• Tremors and hypokinesia affect

ADL object manipulation and potential learned non-use

• Kinesthetic awareness impairs patient’s ability to recognize changes in posture or movement

• Depressiono 25% major / 17% minoro Precedes motor symptomso May contribute to dementia

• Loss of higher cognitive functionso Shifting cognitive seto Slow thinkingo Retrievalo Self-cueingo Sustaining attention

• Dementiao 30%o Occurs 6.6X as frequently than

in elderly non-PDo Shortens survival

• Autonomic abnormalitieso (hypotension, bowel/bladder, sexual,

blurry vision, short of breath)

• Sensory changeso Pain, tingling, burningo Generalized decreased kinesthetic

awareness Self-perception/monitoring

• Sleep Disorders

• Emotional Changeso Anxietyo Apathy

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Non-Motor Symptoms of PD

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• Slower thinking• Slower learning• Problems

sustaining attention

• Apathy, anxiety, depression

• Revert to lower effort despite capacity for more (motor motivation)

• Inaccurate perception of normal amplitude

• Sensory processing deficits

• Inadequate scaling of muscle force and effort

• Bradykinesia and hypokinesia

Motor Sensory

CognitiveEmotional

Complex PD – How can we successfully and efficiently treat?

LSVT LOUD and LSVT BIG

Protocols

LSVT Protocols

•Structured, evidence-based, rehabilitative treatment protocols developed specifically for PD

•Adhere to principles of motor learning and activity dependent neuroplasticity

o Intensive and challenging EXERCISE, specificto the unique features of PD

o Personalized and specific functional training of voice, mobility and activities of daily living

LSVT LOUD & LSVT BIG are SEPARATEprotocols

Each protocol consists of:

• Treatment delivered 4 consecutive days a week for 4 weeks (16 sessions in one month’s time)

• One-hour, individual therapy sessions

• Daily homework practice and daily carryover exercises (all 30 days of the month)

• Develop a life-long habit of continuous practice

LSVT LOUD Treatment SessionDaily Exercises

1. Maximum Duration of Sustained Vowel Phonation (Long Ahs) –15+ reps

2. Maximum Fundamental Frequency Range (High/Low Ahs) – 15 reps each

3. Maximum Functional Speech Loudness (Functional Phrases) – 5 reps of 10 phrases

Hierarchy ExercisesStructured reading – multiple reps, 20+ min.Off the cuff – bridge the gap to conversationBuild complexity across 4 weeks of treatment towards your long-term communication goal

HomeworkIncludes all daily exercises and hierarchy exercisesAssigned all 30 days

Carryover ExercisesUse loud voice in real life situations outside of the treatment roomAssigned all 30 days

LSVT LOUD Goal!

Treatment Goal: louder voice in conversationTreatment Exercise: “long ah”, “high/low ah”

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Voice Exercises

plus Functional

Communication

LSVT LOUD Hierarchy Progression

LSVT BIG Treatment SessionMaximal Daily Exercises1. 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 Tasks5 EVERYDAY TASKS– 5 reps each

For example:

-Sit-to-Stand

-Pulling keys out of pocket

-Using cell phone

Walking BIGDistance/time may vary

Hierarchy ExercisesPatient 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

HomeworkIncludes all daily exercises, Functional Component Tasks and BIG walking assigned all 30 days

Carryover ExercisesUse bigger movements in real life situations outside of the treatment room

Assigned all 30 days

Generalization to functional activities in daily life!

Treatment Goal: Improved ability to reach things from high shelves

Treatment Exercise: Rock and Reach

LSVT BIG Goal

Plus… Personalized,PurposefulPractice

LSVT BIG Hierarchy Progression

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Adapted to specific abilities, goals and needs of patients across disease severity.

• People with early PD require challenges

• People with advanced PD require adaptations

• Treatment must be salient to each individual (goals and practice materials)

Standardized YET IndividualizedThe patient uses louder

voice/larger amplitude movements -“automatically”

in everyday living and treatment effects last over time.

Calibration

Self-monitoring = Sign of success!

Do not recognize voice is soft/movements are small & slow Sensorimotor integration/

processing deficits

Produce soft voice/small movements

Reducedmotor output

Hypokinesia/bradykinesia

Continue soft voice/small, slow movementsNo self-correction

PRE‐TREATMENT

Fox et al., 2012

Retrain self-perception of vocal loudness and movement amplitudeLearn self-monitoring of effort and

loudness required for WNL

Produce louder Voice/bigger movements

INCREASEmotor output

Override hypokinesia/bradykinesia with amplitude

Continue louder voice/bigger movements

Improve internal cueing for amplitude

POST TREATMENT (Intensive, High effort mode)

Fox et al., 2012

How might parallel protocols be beneficial to patients?

• Patient understands body-wide sensory motor mismatch

• Nervous system revved up

• Potential for priming for amplitude training (easier for them to learn)

• Transference of amplitude (amplitude improves in other motor areas)

• Calibrate across motor systems (voice, posture, gait, fine motor, etc.)

How do we know LSVT LOUD and

LSVT BIG therapies work?

Evidence from LSVT LOUD

Evidence from LSVT BIG and other studies

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30+ 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: LSVT Companion NIH & MJ FOX Foundation NIH R21

2002-04: LSVT Virtual Therapist Coleman Institute

2004-06: LSVT Virtual Therapist 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

1993-present: Global LSVT LOUD Training & Certification Courses

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LSVT BIG development began

LSVT BIG RCT published

Evidence for LSVT LOUD3 Randomized Controlled Trials

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PRE POST FU

Change in dB SPL During Reading (30 cm)

LSVT RCT 3 ARTIC RCT 3 UNTX RCT 3

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PRE POST FU

Change in dB SPL During Reading (30cm)

LSVT RCT 2 UNTX RCT 2

Change in dB SPL During Reading (50cm)

1st RCT; n=45LSVT: Voice/respiratory targetRESP: Respiratory targetPre, Post, 6 mos, 12 mos, 24 mos

Ramig et al., 1995; 1996, 2001a

2nd RCT; n=30LSVT: Voice/respiratory targetUnTx: No treatmentPre, Post, 6 mos

Ramig et al., 2001b

3rd RCT; n=64LSVT: Voice/respiratory targetARTIC: Articulatory target UnTx: No Treatment

Ramig et al., 2018

Study Designs• Matched dosage• Matched intensity• Matched homework• Matched therapists’

enthusiasm• Blinded data

analysis• Uncued tasks• Data collected by

someone other than therapist

Spielman, et al., 2003Dumer et al., 2014

Facial expression

El-Sharkawi, et al, 2002: Miles et al., 2017

Swallowing

Smith, et al., 1995Adduction

Ramig & Dromey, 1996Aerodynamics

Baker, 1998; Luschei, 1999 Electromyography

(EMG)

Liotti, et al., 2003Narayana, et al., 2010Baumann et al., 2018

Neural ImagingDromey, 1995; Cannito et al., 2012

Articulation/Intelligibility

Sapir, et al., 2007; 2010Articulatory acoustics

Smith, A., 2001Speech Motor Stability

Taskoff, 2001Perceptual

Beyond Efficacy – numerous studies (over 30) examining distributed effects, neural correlates, mechanism of change

Ramig et al., 1995; 1996; 2001Intonation (STSD)

Baumgartner, et al., 2001Voice Quality

Change in UPDRS motor score (blinded ratings)

Change between baseline and follow up at week 16 was superior in BIG (interrupted line) compared to WALK (dotted line) and HOME (solid line), P <0.001. ANCOVA did not disclose significant differences between in intermediate and final assessments.

Comparing Exercise in Parkinson’s Disease —The Berlin LSVT BIG Study

Ebersbach, G., Ebersbach, A., Edler, D., Kaufhold, O., Kusch, M., Kupsch, A., & Wissel, J. (2010). Movement Disorders, 25(12), 1902-8.

Documented Cross-System

Effects –LSVT BIG

Trunk Rotation

Stride length

Speed

Reaction Time

UPDRS motor score

Balance, Coordination, ADLs

Dual Tasking

Occupational Performance

Ebersbach et al., 2010; 2014; 2015; Farley et al., 2008; Farley & Koshland, 2005; Henderson et al., 2019; Isaacson et al., 2018; Janssens et al., 2014; Millage et al., 2017

Training amplitude enhances other levels of motor outputPreliminary studies

The LSVT team approach: Addressing ST, PT and OT

needs collaboratively

Practical ImplementationCollaboration and Communication with

“The Village”

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Where can IPP occur?

Facility • Under the same roof

Network• Within health care organization• Trained experts in PD

(ParkisonNet, Allied Team Training, LSVT Global)

• Bridging care across healthcare sections

Individual • Independent providers

reaching out to each other

Data as of March 2019

Over 24,000 LSVT LOUD Certified Clinicians in 70 countriesOver 22,000 LSVT BIG Certified Clinicians in 43 countries

Today over 40,000 LSVT Clinicians in 75 countries have been trained.

How do we work together?

Screen and Educate

EACH LSVT THERAPIST:

• Fully understands the other’s role and model of care using LSVT LOUD or LSVT BIG

• Is a gatekeeper to help ensure early intervention and appropriate timing of referrals

• Can give education on what the other therapy may offer and what the process is of finding a clinician

From http://www.sidewalkbubblegum.com/fall-through-the-cracks/

OT, PT, Speech – 1, 2, or all 3? PD symptoms span the scope of all 3 disciplines BUT…

• Is one a priority?

• Are the reimbursement considerations?

• Are there scheduling considerations? – Both patient and therapists

• Are there medical complexities which need to be addressed first?

• Will the patient have DBS? Consider timing pre/post

• Are there significant fatigue or cognitive considerations?

All of these require team communication!!

LSVT BIG Delivery Options

•Provided by OT all 16 sessionsoNeeds and goals all related to ADLs, IADLs and home,

work and play

•Provided by PT all 16 sessionsoNeeds and goals all related to mobility and balance at

home, work and play

•Provided by OT and PT each 8 visitsoEach discipline 2x/weekoEach works on discipline specific goals with amplitude

as a means to achieve themoCommunication during handoffs essential

Provide Treatment Support

• Support each other’s amplitude focused treatment goals oWas that your louder

voice? Is that your big posture?

oCollaborative problem solving with team

• Support calibration during treatmentoProvides feedback to the

other therapist on movement and voice during therapy

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Tune-Ups

• Screen for tune-ups and changes

• Help to facilitate referrals for tune-ups

• Educate on community-based exercise opportunities such as BIG for LIFE and LOUD for LIFE

Communication: The KEY Ingredient

• IPP opportunities which benefit the patient will only be actualized when team members can openly communicate with each otheroPhoneoIn-PersonoElectronic Medical Record

• Finding the best method and time to communicate is vital to successful IPP

Facility-based Example: Aurora Sinai Medical Center in Milwaukee

ONE MONTH1-hour LSVT LOUD with SLP1-hour LSVT BIG with OT1-hour Wii gaming with

recreational therapists

POST-DISCHARGEBIG and LOUD Class

6-12 MONTHSTune-ups for both

Facility-based Example: Dan Aaron Parkinson Rehab Center

• Referrals made for Speech, PT and OT to LSVT Certified Therapists

• All three evaluate. PT and OT discuss case and decide on planoLSVT BIG with PToLSVT BIG with OToLSVT BIG with PT and OToOther treatment intervention

• Team Rounds monthly basis

• Frequent Daily Contact

• Post-Discharge Classes

• Scheduled Tune-ups

Home Healthcare

Network Example:

• Later stage, medically complex care

• Comprehensive Start of Care (OASIS) establishes “reasonable and necessary” for PT, OT, ST plans of care

• Clinician coordination of care is DRIVEN by LSVT BIG and LSVT LOUD plan of care!

• Intersects with clinical programs for fall prevention, caregiver training for dementia, chronic condition self-efficacy

• Consider Patient Outreach calls 3-6 months later for Tune Ups

Across Practice Settings

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• You can start LSVT BIG or LSVT LOUD and transfer the client to another setting to complete the protocol

• You can receive patients who have started LSVT BIG or LSVT LOUD in one setting and will complete it with you

• Best practice is a phone call + clear discharge summary showing: o Details on exercise performance

o Progress made with calibration

o Progress toward goals

o Challenges and special information

o Last carryover assignment

Bridging LSVT BIG Across Practice Settings SNF Bridge to Home Health Network Example:

• PDPM and PDGM-friendly: LSVT BIG and LSVT LOUD begin with SNF, move to home health and outpatient

• Diamond Healthcare Group: Continuum of care with smooth transitions, continuity of clinicians

• Bridge to Home

• Partnering across the continuum to deliver best practice care

• “Grass Roots” or health system partnerships

• Continuity and tracking of clinical standardized measures

• Continuity and tracking of community re-entry outcomes significant to future of health care

• E.g. PROMIS survey platform

Network or Individual Provider• Inpatient/homecare/outpatient coordinationoLSVT can span a continuum of care through a well

established LSVT community network

• Independent provider coordinationoSearchable clinician or physician databases of those with

specialized training in PD Movement Disorders SocietyParkinson’s FoundationLSVT GlobalParkinsonNet

• Establish relationships with other professionals in the community who help people with PD

Medical team IPP with LSVT

• Refers to therapy soon after diagnosis

• Gives specific recommendations for evidence- based therapy

• Entrusts therapists with job of making expert recommendations for fitness/exercise plans

• Fully understands therapy treatment goals and plans

Rx:

PT, OT Speech

STAT!

Medical team IPP with LSVT

• Receives valuable info from therapists on medical, psych or other issues

• In 17 hours, we can learn a lot about a patient!

• Refers to therapy on a regular basis for tune-ups

• Therapist will often request new prescriptions

• Reinforces exercise adherence • Exercise is medicine!• Patients respect physicians• Can hold patients accountable

and educate patients

Allied Health Team IPP with LSVT

• LSVT model of care and expectations of outcomes oEarlier is better. Don’t wait until late. oPatients get better! Not just compensatory.oPatient is empowered and not “treated”oExercise does not replace therapy

• How to screen for therapy

• How to find certified clinicians

• How to reinforce simple cue patients if they are in a caregiver role

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Community team with IPP with LSVT

• Build relationships with community fitness providersoEducate on role of therapy and model of careoDevelop collaborative relationship respecting each person’s unique roleoEducate fitness providers how to screen for therapy, tune-ups, and how patient can incorporate BIG or LOUD into fitness.

Summary

• It takes a well-coordinated team to best support the needs of people with PD beginning at diagnosis

• Targeting amplitude as a singular focus in PD among the therapy team makes sense from both clinical and physiological perspectives

• LSVT LOUD and LSVT BIG are examples of evidence-based therapy programs which easily enable therapists to treat patients’ needs comprehensively, collaboratively and efficiently across the disease span

• Other team members are integral in the support of patients receiving LSVT LOUD and LSVT BIG at all stages in the journey

More than one year later, I still continue my

LSVT BIG and LSVT LOUD exercises almost daily.

I have the confidence in my body to continue doing the things I

love - gardening, walking with my wife, spending time with my family, traveling and reading

poetry on the radio.”

“Parkinson's is my enemy, but thanks to the LSVT programs,

I will prevail!” – Jim A.

How to Ask Questions

• Type in the question box on your control panel

• Raise your hand! • Click on the hand icon • Your name will be

called out• Your mic will be

unmuted, • Then you can ask your

question out loud

• Email [email protected] you think of questions later!

Thank you!

[email protected]

Please complete the survey that will launch when you close the program.

It will take five minutes or less to complete!

Join us for our next webinars!

1. The Integral Role of Occupational Therapy in a Parkinson-Specific Rehabilitation Approach: LSVT BIG®Saturday, March 28 8:00 am - 9:00 am PDT/11:00 am – 12:00 pm EDT

2. Evidence-based Occupational & Physical Therapy (LSVT BIG®): An Informational Webinar for OT and PT Students and FacultySaturday, March 28 12:00 - 1:00 pm PDT/3:00 – 4:00 pm EDT

https://blog.lsvtglobal.com/events/category/free-public-webinars/

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LSVT Global Virtual Occupational Therapy Conference · 2020. 3. 27. · 3. Maximum Functional Speech Loudness (Functional Phrases) – 5 reps of 10 phrases Hierarchy Exercises Structured

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