LSVT Global Public Webinar Title: Increasing Amplitude of Small Movements: Improving Fine Motor Skills through LSVT BIG® Presenters: Julia Wood, MOT, OTR/L Heather Cianci, PT, MS, GCS Date Presented: April 22, 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)
Transcript
LSVT Global Public Webinar
Title: Increasing Amplitude of Small Movements: Improving Fine Motor Skills through LSVT BIG®
Presenters: Julia Wood, MOT, OTR/L Heather Cianci, PT, MS, GCS Date Presented: April 22, 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)
Copyright 2020, LSVT Global, Inc. 1
Increasing Amplitude of Small Movements: Improving Fine Motor Skills through
LSVT BIG®
Innovation in Science. Integrity in Practice.
Instructor BiographiesHeather 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 Co‐coordinator and 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. Julia Wood, OTR/L, MOTMs. Wood received her Master’s Degree in Occupational Therapy from the University of Minnesota and her Bachelor of Science in Exercise Science & Wellness from Ball State University. She completed a clinical internship in neurological rehabilitation at the Mayo Clinic Hospital. She serves as the occupational therapist at the Dan Aaron Parkinson’s Rehabilitation Center and in multidisciplinary clinics for neurological movement disorders at University of Pennsylvania’s Parkinson’s Disease & Movement Disorders Center for Excellence. She serves as faculty for the Parkinson Foundation’s Allied Team Training for PD program, as a facilitator for the PD SELF program and as an ambassador for the Davis Phinney Foundation.
Disclosures
• All of the LSVT BIG faculty have both financial and non‐financial relationships with LSVT Global.
• Non‐financial relationships include a preference for the LSVT BIG as a treatment technique.
• Financial Relationships include:
Ms. Cianci and Ms. Wood are consultants of and receives lecture honorarium and travel reimbursement from LSVT Global, Inc.
Plan for Webinar
• Logistics
• Presentation of Content
• Address your questions
• 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.
What you will learn!
Give examples of fine motor tasks and how they are impacted in Parkinson disease
(PD)
Describe how LSVT BIG is used to address difficulties with fine motor control in PD
Overview of an LSVT BIG session
How to get started with LSVT BIG
Identify fine motor tasks that you would like to improve
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Copyright 2020, LSVT Global, Inc. 2
Our MissionTo empower people with Parkinson’s to
restore and maintain their highest levels
of functional communication, mobility and
independence in daily life through
scientifically supported therapy programs:
• LSVT LOUD®
• LSVT BIG®
Fine Motor Tasks: What are they?
• Tasks which require precise manipulations of the hand and fingers. Steadiness, coordination, muscle control, proprioception, sensation are necessary to make accurate and discrete finger movements.
• Examples: Buttoning, writing, typing, tying shoes, putting in earrings, fastening a necklace or clasp, picking up small objects and grasping.
• 75% of people with PD have micrographia
Jarzebska, 2006
Even small movements are TOO SMALL
in people with PD!
Polling Question 1:
If you have Parkinson’s have you experienced any difficulties or changes in your fine motor function?
YES
NO
What is the cause
of fine motor control issues in
PD?
• Limb‐kinetic apraxia• “loss of deftness with a decrease in the ability to correctly perform independent but coordinated finger movements”
• Somatosensory processing deficit possibly due to a change in the “interplay” between the basal ganglia and the supplementary motor area
• Underlying basis poorly understood• Insensitive to dopaminergic therapy
• Bradykinesia• Slow movements• Responsive to dopaminergic therapy
• Tremor
• Reduced hand strength•
Foki et al, 2015, Snider et al, 2014
A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson’s disease
(Cabrera‐Martos et al, 2019)
Evaluate the effects of a functional, client centered intervention based on a specific set of goals compared to a standardized approach in patients with Parkinson’s disease.
Areas of intervention: manual dexterity, hand grip strength and finger prehension
Targeting therapy toward specific goals leads to greater changes in arm function.
People with Parkinson’s disease show greater improvement in goal attainment if therapy is focused on a specific set of goals compared to a standardized approach.
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Relearning of Writing Skills in Parkinson's Disease After Intensive Amplitude Training. (Nackaerts, et al. 2016)
‐ 38 right‐handed people with PD were randomized into 2 groups equally time intensive
‐ 30 min/day, 5 days/week for 6 weeks
‐ Amplitude training focused on writing size vs. stretch/relaxation
‐Automatization, transfer, and retention of increased writing size (diminished micrographia) after intensive amplitude training
Research in Handwriting for PDPolling Question 2:
If you are a person with Parkinson’s or other condition, have you received LSVT BIG Treatment?
YES
NO
How is LSVT BIG used to improve function with fine motor tasks?
• Intensive Exercise‐
• Increase amplitude of hand and finger movements
• Increase “kinesthetic awareness” of hand posture and function
• Functional Task Specific Practice
• Home Exercise Practice
• Carryover assignments
Mode – Intensive and High Effort
Intensity across sessions:Minimum dosage for efficacy!
• 4 consecutive days a week for 4 weeks in a row (16 SESSIONS)
• 60 minute sessions
• Individual therapy, (not group)
• Daily homework practice and daily carryover exercises
(all 30 days of the month) “Make a life‐long habit of practice!”
LSVT BIG Treatment Session
Maximal Daily Exercises
1.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)
Walking BIG
Distance/time may vary
Functional Component Tasks
5 EVERYDAY TASKS– 5 reps each
For example:
‐Sit‐to‐Stand
‐Pulling keys out of pocket
‐Using cell phone
Hierarchy Exercises
Patient 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
Homework
Includes all daily exercises, Functional Component Tasks and BIG walking assigned all 30 days
Core exercises‐“Building Blocks”
Practice using larger amplitude in functional
tasks which are important to
you!
Goal: Calibration
LSVT BIG addresses the MISMATCH between one’s perception of their movement and how others perceive it.
Fox et al, 2002; Sapir et al, 2011
“I can’t walk like this. People will think I’m crazy!”
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Copyright 2020, LSVT Global, Inc. 4
Large Amplitude LSVT BIG Exercises“BIG Hands” in
LSVT BIG!
• Focus on sustained “BIG hands” throughout treatment vs. a closed/ “small” hand posture
• Hand Flicks
Video‐ Flicks
BUT THEN:
Transfer use of BIGGER amplitude movements learned through Maximal Daily Exercises into FUNCTION.
Make it meaningful! Motivate continued practice of Maximal Daily Exercises!
Make the LINK!
Plus… Personalized,PurposefulPractice
What is a Functional Component Task?
5 EVERYDAY TASKS– 5 reps each
• SIMPLE (one step) movement
• Patient‐driven
• Personalized to each patient
• Never change
• Practiced repetitively (300 reps/4 weeks!)
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Copyright 2020, LSVT Global, Inc. 5
Buttoning Video
What is a Hierarchy Task?
COMPLEXTASKS
Complex multi‐step functional activities
Meaningful to your daily life!
Identified through discussion of YOUR specific goals
Fine Motor Specific Hierarchy Task Examples• Dressing (including buttoning, zipping, buckling)
• Featured Blog Articles, Testimonials, and Videos
• Live Seminars
• LSVT Global Facebook Page
• Ask our experts!
FIND IT ALL AT
www.lsvtglobal.com
Where are Other Places One Can Learn More About PD?
• www.parkinson.orgParkinson’s Foundation:
• https://www.apdaparkinson.org
American Parkinson’s Disease
Foundation
• https://www.michaeljfox.org/Michael J. Fox Foundation
• https://www.davisphinneyfoundation.org/Davis Phinney Foundation
• http://www.worldpdcoalition.org/World Parkinson
Coalition
“Here are some activities that I had avoided but which are now part of my routine again: getting up from a low couch, getting into and out of my car (which is low to the ground),
putting bills into my wallet, retrieving my cell phone from a pants pocket and putting it back, properly donning a sports jacket,
buttoning a shirt.All in four weeks!”
‐ Ralph F.
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Copyright 2020, LSVT Global, Inc. 7
How to ask questions1. Type in the question box on your control panel
2. Raise your hand! (click on the hand icon in your control panel)
• Your name will be called out
• Your mic will be unmuted, then you can ask your question out loud.
