Posted on 9/13/2017 by Andrew Piraino, P.T., DPT, OCS, CSCS
Low back pain is common. It’s so common that about 80 percent of adults will at one point experience this condition. It ranks among one of the top reasons to see a physician and costs the United States more than $100 billion dollars every year.
When faced with an episode of low back pain, it’s easy to go into crisis mode. You may be routed through various specialists and receive various imaging tests, such as X-rays and MRI. These tests can reveal scary findings, such as “herniated discs,” but don’t panic.
First, many of these findings are normal. Researchers have found that in adults without low back pain, two of out three have an abnormality at one disc or more. This makes imaging of limited use, unless something like a fracture is present that needs surgical management. Physicians agree; the American Academy of Family Physicians recommends against any imaging for low back pain for the first six weeks unless serious signs are present, such as trauma.
Often, you may be referred for physical therapy. You may have some familiarity with various exercises and hands-on treatment provided by therapists. But why is physical therapy unique, and what exactly does it do?
Physical therapists today are doctoral-level trained specialists in human movement, completing four years of undergraduate education, three years of doctoral training and often further residency or fellowship training in addition to board certification. Poor movements and postures can cause low back pain and, therefore, physical therapists are optimally equipped to address the cause of the problem rather than treating the symptoms. Just like the song lyrics to ‘Dem Bones,’ each area of the body affects another, which is what physical therapists are trained to observe and address.
For example, take a truck driver who has worsening low back pain with sitting in his truck and bending (pictured below). While a massage at his back area makes him better temporarily, his pain always returns several days later. A physical therapist may look at this driver and find he has tight hamstrings (the muscles on the back of the thigh). Every time he straightens his right leg to reach his pedal, his tight hamstrings pull his back into a bent position (Figure B). And so, all day long, as he drives, his back is bent over and over while he operates the gas and brake pedals. Try sitting up straight and then straightening your knee. You may find it’s hard to do!
Low Back Pain
A - Driver at rest.
B - Driver's hamstring pulls on his pelvis and bends his back whenever he tries to use the pedal.
C - Driver after physical therapy treatment to improve his hamstring flexibility... no more dysfunction!
While physical therapy may provide hands-on treatment to alleviate pain, it would also include exercise to decrease stiffness of his hamstrings, which would allow him to move without causing his back to compensate every time (Figure C). Therefore, our truck driver is able to sit and drive all day without pain. Rather than seeking symptom relief, he now knows what caused the pain, and the exercises and positioning to prevent it from returning.
This is a simple example, but it appreciates the entire body’s contribution to movement and pain, rather than focusing on the area of pain alone. Hopefully this demystifies what physical therapists do, and how they work to optimize each person’s movement and prevent their painful condition from returning!
If you are experiencing low back pain, please call one of our conveniently located centers in your area to experience the power of physical therapy today! For more information and to watch a brief informational video, please click here.
Andrew PirainoBy: Andrew Piraino, P.T., DPT, OCS, CSCS, treats at Select Physical Therapy in Pasadena, TX and is involved with our orthopaedic physical therapy residencies at the market and national level. He completed doctorate and residency training at the University of Southern California in 2012 and 2013, respectively, and is board certified in orthopaedics. Andrew specializes in orthopaedic movement dysfunction across the lifespan, from young, recreational athletes to adults with complex multi-system involvement.
Posted on 3/5/20 Haley Taffera
Whether it’s on the athletic field, a job-site or in one of our outpatient centers, our athletic trainers are counted on to be the frontline support for injury prevention, treatment and ongoing management of care for athletes, workers and patients and customers. In honor of National Athletic Training Month, we asked our National Director of Sports Medicine John Gilmour, M.A., ATC, to share how our incredible team of athletic trainers makes an impact in the lives of thousands of people across the country on a daily basis. View the video here...
Be sure to visit our Facebook, Twitter and Instagram pages throughout the month of March as we recognize and celebrate our colleagues.
Posted on 5/10/2017 by Jamie McGaha, OTD, OTR, COMT, CEASI
Join NovaCare Rehabilitation and Select Physical Therapy as we celebrate National Arthritis Awareness Month! Recognized each May by the Arthritis Foundation, arthritis impacts more than 50 million people in the United States and is the number one cause of disability in the country. Did you know there are more than 100 types of arthritis? Currently, one in five adults is affected by at least one type of arthritis1. By 2030 an estimated 67 million adults will have doctor-diagnosed arthritis, with two-thirds being women2.
The hands are one of the most common sites for arthritis. The most functionally limiting type of hand arthritis affects the base of the thumb, also known as basal thumb arthritis or first carpometacarpal osteoarthritis (OA).
In the past, we thought the only way to alleviate pain from thumb OA was to rest the joint in a splint and not exercise. Now we see too much time in an orthosis can make the thumb weaker and it may even be harder for you to do things when you take the brace off.
New evidence in the field of hand therapy has taught us that there is so much more we can do other than rest and that it is important for the joints’ health to move! We have found that by understanding our own thumb anatomy and learning how to find the correct muscles in the thumb, we can strengthen weakened or disused muscle, helping to stabilize the arthritic joint. We can also decrease overuse and tightness in muscles that are working too hard because others are not helping. Better muscle function and greater stability can contribute to less pain and decrease time you need to rest or use an orthosis.
Not all thumb OA is alike. A visit to your hand therapist would allow you to find out which muscles are tight and which are weak. Together, you and your hand therapist would then design an individualized plan of care for your symptoms related to the activities you desire to do.
The right exercises can be so effective that the joint can become better aligned; this has been shown with healthy thumbs on X-ray3. Your hand therapist can also help you to determine when to wear your orthosis and when not to, so your thumb has the appropriate support at the correct time.
There are many new techniques being used in therapy. It’s even hard for the physicians to keep up to date on all the new techniques! Checking in regularly with a hand therapist may provide solutions to many of your aches, pains and limitations from hand and thumb arthritis.
Barbour KE, et al. Vital Signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitations- United States 2013-2015. MMWR 2017; 66(9); 246-253.
Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;58(1):26–35.
McGee C, Adams J, Van Nortwick SS, O’Brien VH, Van Heest AE. Activation of the first dorsal ineterossesous muscle results in radiographic reduction of the thumb CMC joint: Implications for arthritis prevent [abstract] Paper presented at The British Society for Surgery of the Hand; January 2015.
Jamie McGahaBy: Jamie McGaha, OTD, OTR, COMT, CEASI. Jamie is a licensed occupational therapist focusing on hand therapy and upper extremity rehabilitation with Select Physical Therapy in Austin, TX. She completes ergonomic assessments and has experience with ergonomic interventions. Jamie is also an assistant faculty member for anatomy at the University of St. Augustine’s occupational therapy program. She is a certified orthopaedic manual therapist for the upper extremity, has current and ongoing research on the subject of thumb arthritis and is a member of the American Society for Hand Therapists and the Central Texas Hand Society.
Posted on 3/1/2019 by NovaCare Rehabilitation and Select Physical Therapy
National Athletic Training Month is held every March in order to spread awareness and celebrate all that athletic trainers do: provide vital health care services for life and sport. The National Athletic Trainers’ Association’s theme for 2019 is “ATs Are Health Care.”
This year’s theme is a great way to educate folks that athletic trainers spend their days helping people in diverse settings with injury prevention, treatment and ongoing care management. They play a vital role in enhancing an athlete's performance and work closely with team physicians, athletic directors, coaches and employers to ensure that athletes are healthy and performing at their peak potential.
Take a moment to think about the term/word “athlete.” You may think of the traditional athlete, from high school to professional – on the playing field, ice, court, you name it. But, there’s also dancers, gymnasts, first responders and military personnel, all of which require specific training and care due to their dynamic and unique movements.
And, let’s not forget athletes working in an industrial setting, such as airline personnel, warehouse and retail workers, hotel/resort and theme park staff. We are proud to treat such individuals as part of our WorkStrategies® Program.
“Within Select Medical’s Outpatient Division, we employ more than 900 athletic trainers who work in diverse settings across the country. We are proud to employ hardworking, dedicated and talented athletic trainers who spend their days treating and helping to assess and provide care to athletes. Truly, athletic trainers are a vital part of the health care process.” - Michael E. Collins, P.T., ATC, MBA, vice president of sports medicine
In celebration of National Athletic Training Month, NovaCare Rehabilitation and Select Physical Therapy are spotlighting our all-star team of athletic trainers throughout the month on our Facebook, Twitter and Instagram pages. Don’t forget to “Like” us and “Follow” us, too! And, check out this great video on our YouTube page.
Visit the National Athletic Trainers’ Association website at www.nata.org or contact a NovaCare Rehabilitation or Select Physical Therapy center near you today to learn more!
Posted on 3/13/2017 by Select Medical Outpatient Division WorkStrategies Program
National Athletic Training Month is held every March in order to celebrate and spread awareness about all that athletic trainers do: provide vital health care services for life and sport. Athletic trainers play an integral role in the physical rehabilitative process on the playing field and keeping industrial athletes healthy and safe within the workforce. We count on our athletic trainers to be on the frontlines in prevention, treatment and ongoing management of care for our customers.
Our athletic trainers partner with high schools, colleges/universities and professional sports teams and work closely with team physicians and coaches to ensure athletes compete at their highest potential and avoid injury. Through our WorkStrategies® Program, athletic trainers partner with employers to help keep workers on the job. They provide preventative programs and services to ensure that a company’s workforce remains healthy and productive.
The National Athletic Trainers’ Association’s theme for 2017 is “Your protection is our priority.” Protecting our customers out in the workforce is most certainly a priority for us, and we’d like to shine a spotlight on some of our trusted WorkStrategies athletic trainers!
Heather Procopio, ATC, M.S., CEAS, WorkStrategies Coordinator
While working as an athletic trainer at various highs schools and universities, Heather Procopio scheduled her life around the practices and games of her athletes. While there were many memorable moments as she cheered, cried and helped athletes return to their passion, the common thread among all of her athletes was they eventually would hang up their cleats. That realization led Heather to transition from the athletic field to an industrial setting where she could help keep employees healthy by using some of the same skills she used with her athletes.
While pre-season conditioning is integral to athletes having a successful season on the athletic field, post-offer employment tests are key in determining whether an employee can meet the requirements needed for a job. Instead of offering advice on areas that her student-athletes needed to improve on, Heather provides vital information to an employer about perspective job candidates. These tests consist of a series of physical exercises that best represent whether an employee can complete required tasks, such as lifting, pushing and pulling substantial weight amounts, crawl under equipment and work at a certain pace without the risk for musculoskeletal injuries or cardiovascular accidents.
Victoria Vintevoghel, MHSA, A.T., WorkStrategies Site Supervisor
Victoria Vintevoghel’s dream job was to work with a Division 1 soccer program, but her goals started to change after completing her graduate assistant program. Her focus shifted to individuals who didn’t always have an athletic trainer readily accessible to them. Victoria realized the focus in the industrial setting was on injury prevention and encouraging early reporting of aches and pains. Much of her time is spent creating injury prevention programs, including mobility screens, improving strength deficits and analyzing proper biomechanics.
Working onsite in the airline industry allows Victoria the privilege of assisting baggage handlers who undoubtedly have one of the most physically demanding jobs. These men and women lift, carry and stack luggage that could weigh anywhere between 20 to 70 pounds. During some flights, these employees could be loading thousands of pounds of freight and mail in a span of 30 to 60 minutes. Since these individuals haven’t always had an athletic trainer as their advocate, Victoria has not only been able to educate them about the benefits of an industrial athletic trainer, but also make a significant change in how employees and employers view injuries that may occur on the job site.
Caroline Crowley, M.S., ATC, WorkStrategies Coordinator
Caroline Crowley’s career began on the sidelines, but she traded in her fanny pack for a pair of steel-toed boots and safety glasses. Working in a number of factories in Louisville, KY, Caroline’s day is never the same and each day brings new challenges. Louisville offers its residents a number of career options, from online distribution centers to companies that manufacture automobile parts. And as home of the bourbon industry, distilling and botting some of America’s favorite beverages generate many opportunities for injuries.
No matter what the job is, it’s Caroline’s responsibility to quantify their job demands, such as how much an employee can lift, push or pull and then develop injury-prevention strategies, like post-offer employment testing, stretch programs or educational seminars.
While they may not receive as much notoriety as traditional athletic trainers, our industrial athletes still improve the lives of their athletes on a daily basis. They help to keep employees safe at work so at the end of the day those employees can go home and do the things they enjoy with the people they love. That’s a reward that beats any trophy won on the athletic field!
Heather Procopio, ATC, M.S., CEAS, is a WorkStrategies Coordinator with Select Physical Therapy in Connecticut. Heather provides a variety of injury prevention services to numerous companies, including a medical parts manufacturer, an electric company and an airplane parts manufacturer.
Victoria Vintevoghel, MHSA, A.T., is a WorkStrategies Site Supervisor with Physio in Michigan. She is responsible for developing injury prevention and health and wellness programs onsite for a major airline.
Caroline Crowley, M.S., ATC, is a WorkStrategies Specialist and athletic trainer with KORT Physical Therapy in Louisville, KY. She provides a variety of injury prevention services to numerous.
WorkStrategies, Select Physical Therapy, KORT Physical Therapy and Physio are part of the Select Medical Outpatient Division family of brands.
Heather ProcopioVictoria VintevoghelCaroline Crowley
Posted on 4/23/2019 by NovaCare Rehabilitation and Select Physical Therapy
For the management of some types of pain, prescription opioids can certainly help. However, there is not enough evidence to support prolonged opioid use for chronic pain. And, unused or expired prescription medications are a public safety issue that can lead to accidental poisoning, overdose and abuse. If thrown in the trash, unused prescriptions can be retrieved and abused or illegally sold. The misuse and abuse of over-the-counter medications, illicit drugs, alcohol and tobacco affect the health and well-being of millions of Americans.
With that in mind, mark your calendar for Saturday, April 27, 2019, from 10 a.m. to 2 p.m. Eastern Time, as the Drug Enforcement Administration (DEA), in partnership with federal, state, local and tribal law enforcement, businesses, medical offices, agencies and first responders, hosts events to collect and safely dispose of unwanted medications.
Removing unwanted or expired medications from the medicine cabinet is an easy way to make a difference in the opioid crisis. Make plans to dispose of unused and unwanted medications during DEA National Rx Take Back Day at a location near you.
And, remember: To achieve pain-free movement for enhanced quality of life and independence, rely on NovaCare Rehabilitation and Select Physical Therapy’s team of extensively trained and licensed therapists. Our clinicians are movement experts who can identify, diagnose and treat your pain or injury and get you back to work, athletics and daily life.
Working with a physical, occupational and/or certified hand therapist through a plan of care that is designed specifically for your needs is a safer and more effective long-term option than opioid use. Let us help you to experience the power of physical therapy today!
Side effects include:
Increased strength and flexibility
Prevention of future injury
Improved quality of life
…And much more!
Medicine dispensed includes:
…And much more!
For more information or to request a complimentary consultation, please contact a center near you today.
Posted on 5/16/2018 by Erin Longhurst, P.T., DPT
National Women’s Health Week is hosted each year by the U.S. Department of Health and Human Services’ Office on Women’s Health. The week serves a reminder for all women to be vigilant of their health and wellness and to make healthy habits a priority for life.
During National Women’s Health Week, we are proud to recognize some of the more under-served issues that women deal with regarding their health. At NovaCare Rehabilitation and Select Physical Therapy, some of our physical therapists who treat women’s health issues have received specialty training specific to the pelvis and pregnancy and provide specialized treatment, education and training to help overcome challenges.
If you or a loved one are experiencing any of the below conditions, physical therapy may be able to help you maximize function, minimize pain and improve overall quality of life. Patients are evaluated by a licensed physical therapist and a personalized plan of care is designed to meet individual needs. Together, we will establish clear goals and begin treatment to help the healing begin in a positive and encouraging environment.
Incontinence refers to the accidental loss of urine, gas or stool. This most commonly happens during a cough, sneeze, laugh or force from exercise (stress incontinence) or with a strong urge to urinate or defecate (urge incontinence). Incontinence is generally caused by weakness of the pelvic floor muscles, whose primary functions include supporting the pelvic organs. Our conservative physical therapy approach includes bowel or bladder retraining, an exercise plan to strength the muscles that support the pelvic floor and non-invasive biofeedback or electrical stimulation, as needed.
Pelvic organ prolapse occurs when one or more pelvic organs (bladder, uterus or rectum) moves out of its normal position, usually in a downward direction, because of weakness of the pelvic floor muscles or pressure exerted downward on the pelvis, e.g. long pushing phase of labor. Usually, this causes a sensation of heaviness or pressure in the lower abdomen or vagina. Guided strengthening of the pelvic floor muscles by a pelvic-trained physical therapist can help reverse early stage prolapse and prevent worsening of symptoms.
Pelvic pain is experienced by many women, but it is not considered normal if the pain persists longer than three months or occurs during sexual intercourse. Women experiencing pelvic pain may also complain of pain (or referred pain) in their hips, back or abdomen. Treatment of pelvic pain by a specialized physical therapist may include exercise to stretch or strengthen muscles in the hips, core and pelvis; relaxation and breathing techniques; hands-on soft tissue work; and, biofeedback for muscle retraining.
Studies estimate that 40 to 50 percent of expectant mothers will experience some form of aches and pain during pregnancy. These pains are often caused by the dramatic changes in posture and increased demand that weight gain and weight distribution can place on the woman’s body. Following birth of the baby, mothers then spend a lot of time bent over, which can cause pain in the back, neck and arms. Physical therapy treatment during or after pregnancy includes education in proper posture and body mechanics, soft tissue manual therapy and muscle strengthening to help manage and treat pain.
Normal urinary frequency is between two and four hours, but some women experience urinary urgency that leads them to urinate more than every two hours or that wakes them up at night. Women’s health physical therapy can assist with bladder retraining and help you take back control of your bladder.
Diastasis rectus abdominis is separation of the abdominal muscles and happens frequently during the later stages of pregnancy. This often resolves on its own in the 13 weeks following birth; however, sometimes the abdominal muscles stay separated and can contribute to poor core strength and back pain. A women’s health physical therapist can help to create a targeted exercise program that resolves the diastasis recti and allows for a return to full activity.
Contact a center near you today for more information!
By: Erin Longhurst, P.T., DPT. Erin is an orthopaedic physical therapist with NovaCare Rehabilitation in Washington, D.C. She specializes in treating women's health conditions, with primary focus on pregnant and postpartum women and women struggling with pelvic pain or incontinence.
Posted on 4/19/2018 by Inessa Soden, O.T., CHT
Occupational therapy has been an established profession for more than 100 years. Yet, to this day, many people, and even medical professionals, are confused about what this field has to offer. It could be described as one of the disciplines in a rehabilitation team, focusing on restoring people’s ability to perform normal daily activities and resume valued roles in life. Thus, occupational therapy could be applied in general public health and the rehabilitation of many medical diseases.
Cancer diagnosis and treatment is a devastating life event that throws unexpected hurdles on the road of survivorship. Cancer patients may experience:
Weakness and fatigue
Stiffness in joints
Numbness and altered sensation in extremities
Difficulty remembering and performing daily activities
Some of these difficulties occur at the time of diagnosis, while others might become apparent during treatment and long after.
Medicine has been making great strides in treating and curing some cancers and better prognoses for life expectancy. There are currently more than 15 million cancer survivors in the United States, and the projected number is more than 20 million in the next 10 years. However, the courageous victory of beating the disease often comes with paying the price of temporary, residual or lasting side effects from the cancer treatment. Yet, after going through such a hard battle one doesn’t have to succumb to suffering or giving up so many of one’s previously enjoyed activities.
Life might be changed after experiencing cancer, but that means that one needs to learn to adjust and do things differently. This is where occupational therapy and our ReVital Cancer Rehabilitation program can improve quality of life.
ReVitalFor example, pain could be addressed by multiple manual therapy techniques and stretches, sometimes utilizing the application of special tools such as instrument-assisted soft tissue mobilization or cupping. Different physical agent modalities, such as ultrasound, electrical stimulation, and physiological techniques, like deep breathing and sensory reeducation, could be beneficial. Based on the cause of pain, the therapist will choose an appropriate course of treatment.
In cases of weakness and fatigue, an occupational therapist will develop an individualized program focusing on activities to build up strength and eliminate unnecessary strain on the body. The program may consist of exercises and activities as well as learning energy conservation principles and use of adaptations and adaptive techniques. In addition, each person will get an individualized home exercise program that is modified based upon progress.
For altered sensation, such as pins-and-needles, burning or numbness, an occupational therapist can help to control symptoms, which may be temporary due to swelling or nerve compression. The therapist may recommend and fabricate a custom orthosis, incorporate manual therapy to release the bound neve and design an individualized exercise plan. Other modalities, such as therapeutic taping, may be performed as necessary.
Sometimes unexpected difficulties arise in a battle with cancer. Survivors may experience difficulties focusing on a task, forgetting important information or have trouble multitasking everyday schedules. This may become a safety issue or cause severe emotional distress. In this case, a trained occupational therapist will help to set priorities and come up with suggestions and adaptations in order for the person to be as safe and independent as possible.
Teaching family members how they can help their loved ones to cope is part of the education that an occupational therapist provides. Learning how to access some local and national resources, finding support groups and leisure/recreation activities may also be of benefit.
These are just few examples of what occupational therapy can offer to ease the burden on a cancer survivor and promote a happier, healthier life. Working in a close relationship with a team of doctors, nurses, physical/speech therapists and local communities to help establish a strong support system so one does not need to go through this journey alone.
Consultation with your local occupational therapist trained in the ReVital Cancer Rehabilitation program could be requested at any time, be it right after the diagnosis, prior to surgery or during or after cancer treatment throughout the survivor’s lifespan.
By: Inessa Soden, O.T., CHT. Inessa has been a NovaCare Rehabilitation team member in South New Jersey since 2011. She treats patients of varying diagnoses, including orthopaedics and neurological and oncologic conditions. She focuses on building an individualized treatment plan for each of her patients to ensure they achieve their best level of independent participation in every day roles and activities.
Posted on 9/8/2020 by Aileen Lysaught, M.S., CCC-SLP/L
As a therapy team, we understand that parents and children are experiencing many unexpected challenges this year. Parents are adapting to e-learning and facing difficult decisions around what to do for the upcoming school year. Children are learning to adjust to a new and different way of learning. They are also navigating the new experience of wearing masks and social distancing from their friends. As a parent myself, I have struggled with my child missing out on the socialization and hands-on learning that comes from school, as well as how to explain the current situation to him in the best possible way.
As parents, you have difficult decisions to make; however there is no “wrong” choice. You have to do what is best for your child during these unprecedented times. That choice may be in-person learning, remote learning or homeschooling. All of these options have their own challenges and benefits.
Additionally, parents of children with special needs are faced with especially complicated decisions. Many children may struggle with mask compliance due to sensory processing difficulties and benefit from in-person learning and therapy. Other children may have compromised immune systems and in-person learning or therapy is not necessarily an option for them.
My son receives physical therapy for low muscle tone and coordination issues and is in need of occupational therapy to address fine motor skills. We have been lucky enough to receive this therapy in-person throughout the pandemic in order to ensure he continues to make progress. Although we haven’t made our final decision on whether or not to send him to school, we are grateful to have the option to receive the additional help he needs in a safe, one-on-one setting, regardless of what we decide.
As autumn approaches, NovaCare and Select Kids Pediatric Therapy are here and available to support families in their individual decisions. We are committed to assisting your child’s unique needs by providing in-person physical, occupational, speech and ABA therapy in a safe environment. Our centers are taking extensive preventative measures – guided by the CDC, state and local government – to protect children and their families. We are also pleased to offer care virtually via telerehab. Through web-based technology, telerehab lets you and your child connect with our therapists from the convenience of your home.
Our therapists also provide parents with consultation to support e-learning at home. We will communicate with school teachers and school-based therapists to carry out your child’s IEP goals and promote continued progress. We also provide e-learning and hybrid learning resources to help your child succeed.
Please contact your local NovaCare or Select Kids center to discuss the various options for your child and determine if therapy may be beneficial.
By: Aileen Lysaught, M.S., CCC-SLP/L. Aileen is a speech-language pathologist for our NovaCare Kids centers in Orland Park and DePaul Fullerton, IL.
Posted on 1/12/2018 by Laila Hasham, P.T., DPT
Parkinson’s disease is a chronic, progressive movement disorder that affects one in 100 people over the age of 60. While the average age at onset is 60, people have been diagnosed as young as 18. It is the second most common degenerative brain disorder affecting adults (Alzheimer’s disease is the most common). Recent research indicates that at least one million people in the United States and more than five million worldwide have Parkinson’s, and there are around 50,000 new cases diagnosed each year.
Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Some of these dying neurons produce dopamine, a chemical that sends signals to the brain to control movement and coordination. As Parkinson’s progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. People with Parkinson’s disease are at risk of falling and sustaining injuries due to their movement and balance impairment.
Treatment includes a combination of medication and physical therapy, and in some cases surgery. A physical therapist who has experience treating Parkinson’s can help a person improve mobility, strength and balance.
The universal benefits of exercise in helping everyone feel better and improving overall health are well documented. There is evidence that exercise has specific benefits for people with Parkinson's in staying active and improving balance and coordination. Exercise approaches have long played a role in the management of Parkinson’s disease, to maximize function and minimize secondary complications and inactivity.
For decades, the Lee Silverman Voice Technique (LSVT) has been an effective way to treat the symptoms of impaired voice and swallowing from Parkinson’s called LSVT LOUD®. In 2005, a new approach to therapy called LSVT BIG® was developed. LSVT BIG is a research-based exercise program specifically designed for people with Parkinson’s. It has been shown to improve function with significant improvements noted in trunk rotation, balance and faster walking with larger steps1. LSVT BIG is provided by physical and occupational therapists who have received specific training in this technique.
LSVT programs include the combination of:
An exclusive target on increasing amplitude, or loudness in the speech motor system, and bigger movements in the limb motor system.
A focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel ‘too loud’ or ‘too big.’
Training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning2.
The LSVT BIG program includes 16 sessions of therapy over four weeks, at a frequency of four days each week. These sessions are provided in a one-to-one manner and include high intensity, whole body movements. Depending on the nature and severity of the condition, treatment sessions may focus on activities that are important to the patient and education to help transfers, bed mobility and hand movement. While other exercise interventions may focus on external cues and breaking down task components, LSVT BIG focuses on movement amplitude to achieve bigger and faster movements in the attempt to restore normal movement patterns and improve gait speed.
The program is both intensive and fun, and the hard work and dedication of the patient is integral to the success of the program. Find a local Select Physical Therapy center to see if the LSVT BIG program is offered near you.
For more information on Parkinson’s disease and the LSVT BIG program, please visit the LSVT Global website at www.LSVTGlobal.com.
Farley et al (2008) Intensity amplitude-specific therapy for Parkinson’s disease. Topics in Geriatric Rehabilitation 24(2) 99-114.
Cynthia Fox, Georg Ebersbach, Lorraine Ramig, Shimn Sapir. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinson’s disease. 2012;2012.
By: Laila Hasham, P.T., DPT. Laila is a physical therapist with Select Physical Therapy in Austin, TX. Her primary expertise is in orthopaedics, but she is passionate about treating people with Parkinson’s and similar movement disorders in order to improve quality of life and overall function. Laila is pictured above treating a patient.