Loud & Proud: Therapy Programs at John Heinz Help Those with Parkinson’s Disease

Re-posted from The Times Leader

She has strength in her voice and a solid range of motion — and always a smile on her face. Although 81-year-old Rose Ostopick was diagnosed with Parkinson’s disease a year and a half ago she’s been taking steps — big ones — to help improve her health.

“I’m speaking louder, and I’m speaking better,” Ostopick said, an ever-present grin on her face as her husband, Sam, stood by, also smiling. “I can move better, too.”

Rose, of Jenkins Township, has completed the Lee Silverman Voice Treatment Big and Loud Therapy programs at The John Heinz Institute of Rehabilitation Medicine in Wilkes-Barre Township, a program in which more than 60 physical therapists, physical-therapy aides and occupational therapists were certified during a course sponsored by Allied Services Integrated Health System last year.

LSVT is designed to help those with Parkinson’s, a progressive neurological disorder that results from degeneration of neurons in a region of the brain that controls movement. It causes shaking and difficulty with walking, coordination and speech. Many patients will think they’re talking loudly or moving just fine but, in reality, they may be whispering or barely moving at all. Enter Big and Loud Therapy.

The program is divided into two parts. The Big portion works with the patient’s movement, while the Loud portion helps the patient increase the volume of his or her voice and speaking overall.

Sessions are one hour per day, four days per week over four weeks for each section, though patients can choose to do just “big” therapy or just “loud” therapy.

“If it wasn’t for this, she’d be falling down,” Sam said of his wife. Physical therapist Hollie DiMare has helped prevent such a thing, working with Rose on the “big” side of things.

“Motion is greatly affected in Parkinson’s patients, so we want to over-exaggerate that to help their mobility,” she said. “Patients work on big walking, taking larger steps. They practice getting up from different surfaces, as well as functional tasks. If they’re having difficulty at home doing certain things we incorporate that into the program. It all goes back to the concept of using very large movements to get the patients’ mobility back to where they want it to be.”

Speech is the main focus of the “loud” therapy.

“They say 89 percent of Parkinson’s patients have problems with speech, and a lot of that is volume,” speech therapist Joanne Orlando said. “When we work with someone to improve speech intelligibility we tell them to take a deep breath, slow down, over-exaggerate your articulation, which can be a lot to remember. With this program, all the patient has to do is increase their volume, and all these great things happen. By increasing volume you automatically take a deeper breath, open your mouth wider for better articulation. Your speech production is better. It’s all those things, but the patient just has to focus on one thing: being loud.”

Patients will start with smaller exercises, such as saying and holding the word “ah” for as loud and as long as they can. They then will read words and sentences louder and repetitively. Orlando uses a calibrated microphone and software designed specifically for the Big and Loud program to determine a patient’s progress.

Both therapists have seen great results with all their patients, which they anticipated. The hardest part, though, they said, is what happens when patients leave the program.

“Once they’re done with the program, will they follow through with it?” Orlando asked. “We give them homework that they need to do for the rest of their lives, so that way this becomes so regular and routine that they do things without thinking about them.”

“It’s what they do afterwards that really matters the most,” DiMare said.

It can be difficult to stay on task, and one thing DiMare said might help is attending a Parkinson’s support group. The Ostopicks attend a group DiMare runs from 4:30 until 5:30 p.m. every third Tuesday of the month.

“The key is repetition,” DiMare said. “Keep at it, keep practicing and doing homework, and soon things will start happening without the patient even giving it a second thought.”