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Published: May 31, 2009 3:00 a.m. Parkinson's plan takes Big step Michael Schroeder The Journal Gazette Sitting at home in Huntington, Bill Bieghler, 81, turns a golf putter over in his hand, studying it. His wife, Mary, brought the club to him at the request of a visitor, but there's another putter he favors more, he says, his stiff fingers cupping the familiar rubber grip. Putting was the last thing to go when Bieghler gave up golf a couple years ago - advanced Parkinson's disease making what was once a daily pleasure impossible. But Bieghler's hoping he'll get another swing at it after undergoing a new intensive in-home therapy program guided by clinicians at Parkview Home Health and Hospice. Parkview was the first in Indiana to have clinicians certified in the therapy program. Bieghler was diagnosed with Parkinson's in 1990, and his balance has suffered, making walking difficult. The degenerative disease disrupts the brain's production of a chemical called dopamine, which is crucial to smooth, coordinated muscle function and movement. He uses a walker, or else Mary puts all of her slight frame into stabilizing him by grabbing a bright blue belt he wears for just that purpose. Sometimes he walks without any assistance, though she wishes he wouldn't. Swinging a club is even tougher, with all the whirling motion's implications for balance. But, "This exercise has loosened me up," said Bieghler of the four-week physical and occupational therapy program he completed this month. That's got him pining for another round at Norwood Golf Club on the edge of Huntington, where he once worked and played golf for free. Therapy catches on Called LSVT Big, the therapy program Bieghler underwent encourages big, exaggerated steps and stretches. This is meant to counter progressively smaller, slower movements that restrict life for many people with Parkinson's. The program stems from the success of a speech therapy program introduced in the late 1980s, now called LSVT Loud, which Bieghler completed prior to LSVT Big. (The acronym LSVT comes from the name of a woman with Parkinson's, Lee Silverman, for whom voice training was first developed.) The therapies are a complement to - not a replacement for - medications and surgical interventions, said Cynthia Fox, chief clinical officer and cofounder of Tucson, Ariz.-based LSVT Global, which trains clinicians on the programs. The first training and certification courses on LSVT Big started in 2007, and more than 350 clinicians are now certified. Patients are guided through one-hour sessions four days a week and are expected to do stretching exercises on their own time as well. Having completed the formal part of the program, Bieghler is expected to continue doing daily exercises, though other things - computer games, visitors - compete for his interest, Mary said. The payoff: The couple, who will be married 60 years in August, find it easier to go out now. Bieghler has missed working in the yard and hopes to do some of that as well. In addition to four Parkview clinicians certified in LSVT Big, another clinician in Indianapolis is now certified to provide the therapy. Many more - including at Parkview - are also certified in LSVT Loud. Parkview competitor Lutheran Health Network has clinicians trained in LSVT Loud and plans to have two physical therapists trained in LSVT Big at the beginning of June. LSVT Big and Loud are essentially - at least to patients - about being just that, big and loud. People with Parkinson's tend to slow down, to get quieter and to draw within themselves as their sense of motor control diminishes. The change can be imperceptible. Often times, their spouse thinks they need a hearing aid, said Cynthia Fox of LSVT Global. In reality, they can hear just fine. LSVT therapies focus on retraining sensory perceptions, Fox said. So, what a patient might think too big or loud, they recognize as within the normal range. For LSVT Big, clinicians remind patients to "think big" in all they do. Clinicians model movements. They reach toward the ceiling and the floor; they rotate at the waist, stretching seated and standing; they step out. The simple visual cues are a departure from more complex verbal instruction, said Betsy VanMarkwyk, clinical manager of rehab for Parkview Home Health and a speech pathologist. Seven patients have completed the program locally, and it has shown early promise. "Our traditional methods for working with Parkinson's patients . have not always proven to be very effective," VanMarkwyk said. Optimistic, realistic Fox said long-term studies are still needed to document the effect of behavioral intervention in people with Parkinson's disease. But she said a study on rats showed that intensive exercise soon after the onset of the disease slowed or in some cases almost halted the progression of the disease. Rose Wichmann said Parkinson's research on animals showing how behavioral intervention can protect brain cells is exciting. Wichmann is an LSVT Big-certified physical therapist and manager of the Struthers Parkinson's Center. The underlying message is that people with Parkinson's need to remain active, she said, and enlist the help of a rehab professional to find a program that's right for them. Wichmann and her team use the protocol for patients with early to mid-stage Parkinson's. Limited research on LSVT Big has focused on patients in this subgroup showing improvement in range and speed of movement. The more severe a patient's condition, the milder the improvement was measured to be. Wichmann said she wouldn't recommend LSVT Big for those with the most advanced stages of Parkinson's disease. Apart from a lack of research on this group, patients with more advanced Parkinson's have more physical and perceptual limitations that make it harder for them to follow the protocol. Parkview charges $180 per day for the therapy, the same it charges for other therapies. The therapy is covered by Medicare and most other private insurers. The increase in function and independence resulting from the therapy is likely to save money on associated care, Parkview officials said. Slowing the march of Parkinson's might seem pie-in-the-sky to some, but clinicians hope to help patients maintain physical and speech functions as long as possible. "The hardest thing" about Parkinson's disease, Bill Bieghler says, "is not knowing what it's going to do." [log in to unmask] Rayilyn Brown Director AZNPF Arizona Chapter National Parkinson Foundation [log in to unmask] ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn