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LSVT Global® Public Webinar Series
Title: Research and Clinical Advances in LSVT LOUD® and LSVT BIG®
Presenters: Cynthia Fox, Ph.D., CCC-SLP
Laura Gusé, MPT
Date Presented: December 18, 2019
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)
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Research and Clinical Advances in LSVT LOUD® and LSVT BIG®
Cynthia Fox, Ph.D., CCC‐SLP
CEO and Co‐Founder
LSVT Global, Inc.
Laura Gusé, MPT
Chief Clinical Officer, LSVT BIG
LSVT Global, Inc.
Innovation in Science. Integrity in Practice.
Instructor Biographies
Cynthia Fox, PhD, 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, 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.
Supported by• National Institutes of Health ‐ National Institute Deafness and Communication
Disorders (NIH‐NIDCD)• Office of Education‐National Institute for Disability and Rehabilitation Research (OE‐
NIDRR)• Coleman Institute • Hearst Foundation• Axe‐Houghton Foundation• Family of Lee Silverman• Davis Phinney Foundation• Parkinson Alliance• Supported by NIH grants: R01DC01150, R21 RFA‐NS‐02‐006 R21DC006078, R21NS04371
R43DC010956, R43DC010498, R43DC00741
DisclosuresDr. Fox and Ms. Gusé have both financial and non‐financial relationships with LSVT Global. Non‐financial relationships include a preference for LSVT BIG as treatment techniques. Dr. Fox is an employee of LSVT Global and receives lecture honorarium. Additionally, Dr. Fox has ownership interest in the company. Ms. Gusé is an employee of LSVT Global and receives lecture honorarium and travel reimbursement.
Plan for Webinar
• Logistics
• Presentation of Content
• Address your questions
• Survey
Information to Self‐Report CE Activity
• This LSVT Global webinar is NOT ASHA or state registered for CEUsfor 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‐[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.
Learning Objectives At the end of this webinar, participants will be able to:
Define EBP and differentiate
between guideline and protocol based
therapies
Briefly review foundational LSVT LOUD and LSVT BIG
research
Describe new LSVT LOUD and LSVT BIG research in 2019
Provide a rationale for how LSVT research
supports and benefits clinicians and patients
Summarize future research and
clinical innovations
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Polling Question Who are you?
• Speech Therapist• Physical or Occupational Therapist
• Person with Parkinson’s disease (PD)
• Family/friend of person with PD
• Other
Prevalence of PD is expected to DOUBLE by 2040
The need for treatments with proven efficacy
is great!
Up to 8 million
people worldwide
are living with PD.
Dorsey ER, Bloem BR (2018) The Parkinson Pandemic—A Call to Action. JAMA Neurol. 2018;75(1):9‐10. doi:10.1001/jamaneurol.2017.3299
Our MissionTo empower people with Parkinson’s to
restore and maintain their highest levels
of functional communication, mobility and
independence with ADL’s through
scientifically supported rehabilitative
treatment programs:
• LSVT LOUD® Speech and voice therapy
• LSVT BIG® Physical and occupational therapy
Research is essential to provide the strong foundation we need as
therapists!
Research → Clinical Implementa on
How do I choose which evidence-based treatments to use or receive?
Amount and quality of research?
Feasibility for clinician and clients?
Reimbursement/cost of the treatment?
Accessibility?
Are there ethical or safety issues?
https://www.asha.org/evidence‐maps/
ASHA Evidence Maps SpeechBitehttps://speechbite.com/
Speech Evidence MapsIndependent (non‐biased) reviews
PT/OT Evidence Maps
http://www.otseeker.com/“OTseeker is a database that contains abstracts of systematic reviews, randomized controlled trials and other resources relevant to occupational therapy interventions.”
https://www.pedro.org.au/“PEDro is the Physiotherapy Evidence Database, a free database of over 42,000 randomized trials, systematic reviews and clinical practice guidelines in physiotherapy.”
Comparing exercise in Parkinson's disease ‐‐ the Berlin LSVT BIG studyEbersbach G, Ebersbach A, Edler D, Kaufhold O, Kusch M, Kupsch A, Wissel J; Movement Disorders 2010 Sep 15;25(12):1902‐1908 clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow‐up: Yes; Intention‐to‐treat analysis: No; Between‐group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*
Independent (non‐biased) reviews
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Evidence-Based Practice
Guideline
• “A statement or other indication of policy or procedure by which to determine a course of action”
• "You may if you want”
• Does not require compliance and allows for deviations at the individual therapists’ discretion
• Cause/effect behaviors in research are more difficult to define as variations may occur in delivery of guideline‐based treatments
• E.g., European Guidelines for Parkinson’s disease (PT/OT/ST)
• “A precise and detailed plan for the study of a biomedical problem or for a regimen or therapy”
• "You shall"
• Requires compliance to a predefined (researched) set of behaviors allowing for review of compliance with these behaviors
• Can be researched more precisely for direct cause/effect behaviors
• E.g., LSVT LOUD and LSVT BIG
Protocol
Clawson, Martin & Hauert, 1994
Guideline and protocol‐based therapies
Guideline and ProtocolConsiderations
• One is not better than the other.• Guidelines are often the basis of a good protocol.• LSVT LOUD and LSVT BIG are researched protocols, thus treatment behaviors are clearly defined, and outcomes can be predicted in the populations studied.
• A protocol system does allow for personalization. Therapists must think independently and use their good judgment. They must follow all protocols per se, but have options for personalization that enhances, not replaces, the protocol.
30+ year LSVT 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
Phase I, II
Invention
Phase III
Research
Phase IV, V
Clinical Im
plementation
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• Repeated measures
for reliability• Uncued tasks• Data collected by
someone other than therapist
What does this research tell us?
What we do in therapy matters!
• Not just activity or speech instruction in general; Specific activity matters
• Thus far our research would suggest voice(respiratory/laryngeal) is special versus respiratory or articulatory targets
• Voice focus and sensory calibration addresses sensorimotor integration deficits affecting autophonic perception of normal vocal loudness in people with PD
• LSVT LOUD may provide a cortically driven enhancement of speech network (sensorimotor and auditory)
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Evidence for LSVT BIG2 Randomized Controlled Trials
1st RCT; n=60LSVT BIG: 20Nordic Walk: 20Home Exercise: 20Pre, Post, 16 weeks
Ebersbach et al., 2010
2nd RCT; n=34AOT‐SP: 17 LSVT BIG: 17Pre, Post, 16 weeks
Ebersbach et al., 2014
Study Designs• Blinded data analysis
• Uncued gait tests
• Data collected by someone other than therapist
Change in UPDRS‐Motor Score
70.6 % of patients reporting to be ‘‘much improved’’ or ‘‘very much improved’’ in LSVT BIG
What does this research tell us?What we do in therapy matters!
• For mobility and function in daily life with PD:• Training amplitude improves speed and efficiency of gait and transfers
• Intensive training and adequate repetition of practice is needed for re‐calibration of the sensory motor system and for the patient to perceive changes in function
• Low intensity or unsupervised exercise programs may not be as beneficial in improving mobility or motor function in people with PD
Resources to review all foundational LSVT LOUD and LSVT BIG research
https://academy.pubs.asha.org/2018/08/special‐collection‐lee‐silverman‐voice‐treatment/
https://blog.lsvtglobal.com/research/
Delivering group speech maintenance therapy via telerehabilitation to people
with Parkinson's disease: A pilot study. Quinn R, Park S, Theodoros D, Hill AJ. Int J Speech Lang Pathol. 2018 Jun 7:1‐10. doi: 10.1080/17549507.2018.1476918. [Epub ahead of print]
• Study summary: Feasibility study. Eight participants post LSVT LOUD attended 2 90‐minute online maintenance sessions a week for four weeks. Pre, post and FU (3 mos.) measures in SPL. Improvements in SPL identified pre‐post for ah, reading, conversation; maintained at FU for ah and reading. High satisfactory ratings for telerehabilitation setting.
• Conclusion: Feasibility for online group maintenance post LSVT LOUD established with potential to improve and maintain vocal loudness
Long‐term effects of Lee Silverman Voice Treatment on daily voice use in Parkinson's
disease as measured with a portable voice accumulator. Körner Gustafsson J, Södersten M,
Ternström S, Schalling E. Logoped Phoniatr Vocol. 2018 Feb 15:1‐10. doi: 10.1080/14015439.2018.1435718. [Epub
ahead of print]
• Study summary: Prospective pseudo‐single case, experimental design with one participant with PD and a healthy control. Wore vocal accumulator device pre, post‐LSVT LOUD, and follow‐up time points. Post SLP increases 4.1 dB outside clinic and 5.6 dB inside clinic; at one year 1.4 dB outside clinic and 3.8 dB inside clinic.
• Conclusion: First step towards vocal monitoring outside of the treatment room
Technology Updates (external labs)
Spectral/Cepstral Analyses of Phonation in Parkinson's Disease before and after Voice Treatment: A Preliminary Study. Alharbi GG, Cannito MP, Buder EH, Awan SN.Folia Phoniatr Logop. 2019 May 22:1‐11. doi: 10.1159/000495837. [Epub ahead of print]
• Study summary: Small group study. Nine participants post LSVT LOUD. Measured sustained vowels for specific acoustic parameters (e.g. cepstral peak prominence). Improvements in harmonic structure and voice quality reported post‐treatment
• Conclusion: Cepstral analysis documented improved vocal quality (consistent with non‐PD speakers) following vocal loudness training
Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson's disease. Saffarian A, Amiri Shavaki Y, Shahidi GA, Hadavi S, Jafari Z.Med J Islam Repub Iran. 2019 Feb 13;33:5. doi: 10.34171/mjiri.33.5. eCollection 2019.
• Study summary: 23 participants with PD (13 treated with LSVT LOUD; 10 untreated) and 13 non‐PD speakers. Evaluated voice handicap index (VHI) pre to post treatment. VHI scores worse in speakers with PD pre‐treatment. Significant improvements in VHI post‐LSVT LOUD
• Conclusion: Improvements in VHI post‐LSVT LOUD documented in Persian speakers; could reflect improved self‐monitoring and self‐regulation of voice
Other LSVT LOUD Publication Updates (external labs)
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Intelligibility Study
Objective. To evaluate real‐world listeners’ ratings of speech pre/post LSVT LOUD intervention using online crowdsourcing technologies.
Methods. Stimuli were drawn from a previously published study (Sapir, Spielman, Ramig & Fox, 2007). Productions of words pre/post LSVT LOUD from people with Parkinson’s disease were included.
Pre/post samples of the words “key” and “stew” were randomly paired. Thirty‐six online naïve listeners rated which paired sample that they perceived as “more clearly articulated.”
Using Crowdsourced Listeners’ Ratings to Estimate the Functional Impact of Intensive Voice Treatment for Hypokinetic
Dysarthria: A Feasibility StudyNightingale, Swartz, Ramig, & McAllister. (in press). American Journal of
Speech‐Language Pathology.
Results. Mixed‐effects logistic regression indicated that words elicited post‐treatment were significantly more likely to be rated “more clear.”
Nightingale, Swartz, Ramig, & McAllister. (in press). American Journal of Speech‐Language Pathology.
Cognitive‐linguistic contributions to speech disorders
Retrospective look at our data in collaboration with language experts (Ramage and colleagues)
Reviewed Cookie Theft descriptions (PD‐UnTX, PD‐TX, HC) two time points
# Pauses: pauses (“the boy …”), filled pauses (“the boy um)
MLU: utterances, words and morphemes
Types of words: type‐token ratio (TTR)
Verbs: verbs/utterance, %verbs
Question: do improvements in voice control with LSVT transfer to other communication behaviors, specifically, to language production?
Emerging Work
Because LSVT is designed to recalibrate certain sensory processes, affecting the sensorimotor mapping of actions and the motor system underlying them, our finding of LSVT‐related increases in verbs/utterance, MLU morphemes, and MLU words may be a reflection of that recalibration. That is, strengthening of the semantic representations of physical actions may improve access to verbs, as well as the clauses and other morphemes inherent in their use.
**PreliminaryAnalysis
Shannon L. Bryant Advisor: Amy E. Ramage
What are we continuing to learn in LSVT LOUD? How can we apply this to practice?
• Technology may enhance maintenance of LSVT LOUD and our ability to monitor “real‐world” carryover of louder voice
• Spread of effects: training vocal loudness as a single target improves voice quality (i.e., harmonic structure), speech intelligibility, and potentially language. This adds to existing evidence of spread of effects
• Spread of effects: enhances confidence in our single therapeutic target of vocal loudness; efficiency of treatment is valuable for improving communication in complex patients with a degenerative condition
• Findings in different languages suggest that the target in LSVT LOUD may be “universal” due to targeting underlying deficits in hypokinesia/impaired self‐perception of vocal loudness, which is important across all languages
Future LSVT LOUD Research• Publication of RCT data comparing LSVT LOUD, LSVT ARTIC,
Untreated and healthy control:• Speech intelligibility in noise (Levy & Forrest, 2016; Schulz,
2016)• Facial expression (Borod, 2016)• Swallowing (Martin‐Harris & McFarland, 2016)• Language (Ramage)• PET imaging (Narayana, 2016)
• Prospective studies looking at nonmotor scales pre/post LSVT LOUD
• Continued technology‐enhanced LSVT LOUD• Impact of LOUD for LIFE maintenance groups on long‐term
outcomes
• Clinical implementation studies
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Update on new LSVT BIG research in 2019
Objective: To discover whether LSVT BIG could impact occupation goals chosen by 2 clients late post stroke (3 years and 12 years previous)
Methods: Single case experimental design. LSVT BIG trained 3/6 of the clients’ choses tasks. COPM and Everyday Arm‐Use in the Community and Home measured repeatedly. Results: “Performance improved on either self‐ assessment or blinded rater assessment for all but one activity, (trained or untrained).”
LSVT BIG in late stroke rehabilitation: A single‐case experimental design study
“LSVT BIG is a promising intervention to improve occupational performance. Further research is required to clarify elements of the program essential to improving
occupational performance.”
Metcalfe, V., Egan, M., & Sauvé‐Schenk, K. (2019). LSVT BIG in late stroke rehabilitation: a single case experimental design‐study. Canadian Journal of Occupational Therapy, 1–8. doi: 10.1177/0008417419832951
Update on new LSVT BIG research in 2019
Objective: To determine if LSVT BIG improves dynamic balance and gait in persons with PD
Methods: 3 phase, single subject experimental design in 2 people with PD. Phases: A) 2 week pre‐treatment baseline B) 4 weeks LSVT BIG and C) 7‐8 weeks home exercise program post‐LSVT BIG. Assessed 6 times in phase A (3x/wk); 4 times in phase B (1x/wk) ; 8 times in phase C using the MiniBESTest and the 10MWT‐fastResults: MiniBESTest and 10MWT‐fast improved significantly in both subjects. Clinical relevance: surpassed cut off scores for fall risk. Continued to improve in phase C
Dynamic balance and gait speed improve in persons with Parkinson’s disease after Lee Silverman Voice Treatment (LSVT) BIG
training: a single subject experimental design study.
Kleppang, T. T., & Jørgensen, L. (2019). Dynamic balance and gait speed improve in persons with Parkinson’s disease after Lee Silverman Voice Treatment (LSVT) BIG training: a single subject experimental design study. European Journal of Physiotherapy, 1–11. doi: 10.1080/21679169.2018.1551420
Update on new LSVT BIG research in 2019
Objective: Explore the impact of LSVT BIG to ensure efficacy in meeting its stated goals and effective use of health care resources.
Methods: LSVT BIG provided to 69 year‐old male with H & Y Stage III. History of 3 falls in the 2 weeks before LSVT BIG. Subject had complex PMH with multiple co‐morbidities including DM II; CVA; cellulitis, respiratory failure, CHF, HTN, obesity; dementia. Results: Increases in Tinetti POMA; Functional Reach Test, 10 MWT exceeded Minimal Detectable Change. 13 second improvement in TUG. Became independent with many functional tasks which were his personalized goals.
Impact of LSVT BIG on functional outcomes in a patient with Parkinson’s disease: a case study.
Hampton, B. A., Tunney, N., & Dubal, D. (2019). Impact of LSVT BIG on functional outcomes in a patient with Parkinson’s disease: a case study. GeriNotes, 26(1), 20–23.
Table 1. Outcome Measure Data
Outcome Measure Initial Evaluation Score
Discharge Score
Timed Up and Go 23 seconds with AD 10 seconds without AD
Tinetti 23/28 with AD 28/28 without AD
Functional Reach 10 inches 20 inches
30 second sit to stand 12 repetitions 15 repetitions
5 time sit to stand 18 seconds 9 seconds
6-minute walk test 480 ft with AD 600 ft without AD
10-meter walk test 22 seconds (.45m/sec)with AD
6 seconds (1.67m/sec)without AD
Abbreviation: AD, assistive device
Table from GeriNotes, Vol. 26, No. 1 2019 21
Functional Impact PRE‐LSVT BIG
• 7 steps with help + rail
• Mod A supine to sit
• SBA sit to stand
POST‐LSVT BIG• 7 steps‐ rail+ supervision
• Modified (I) supine to sit
• (I) Sit to Stand, faster
Became independent with: rising from recliner pouring a glass of water carrying a glass of water and sitting without spilling getting in/out of car walking at a similar speed as his wife (with walker)
Update on new LSVT BIG research in 2019
Objective: Determine the effects of LSVT BIG on occupational performance in a 73 year‐old subject with PD.
Methods: Used Canadian Occupational Performance Measure (COPM) and Performance Assessment of Self Care Skills (PASS) to measure changes. Results: Improved client perceptions of the occupational performance and satisfaction on the COPM which were clinically significant and improved independence and adequacy on the PASS (no date on MDC for the PASS).
Use of Occupation‐Based Measures in LSVT BIG Research: A Case Study.
Henderson W, Boone AE, Heady J, Nettleton M, Wilhelm T, Bliss J. (2019) Use of Occupation‐Based Measures in LSVT BIG Research: A Case Study. OTJR (Thorofare N J), Nov 15:1539449219886261. doi: 10.1177/1539449219886261. [Epub ahead of print]
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Training amplitude improves Patient Reported Outcomes
Retrospective chart review (n=66) Canadian Occupational Performance Measure
AOTA presentation: Doucet & Blanchard, 2018; Doucet, Blanchard & Bienvenu (in preparation)
Emerging WorkWhat are we learning in LSVT BIG? How can we apply this to practice?
• LSVT BIG may be feasible and applicable in other neuro populations – (e.g. stroke)
• Therapists should carefully select outcome measures which have lesser risk of ceiling effect
• Assess not only static balance, but dynamic balance
• Include occupational–based performance measures focusing on client centered goals, not just impairment‐based measures
• Consider collaboration between OT and PT in the delivery of LSVT BIG to comprehensively assess and address client goals
Future LSVT BIG Research
• RCT of LSVT BIG compared to another evidence‐based approach
• Impact of LSVT BIG on fall prevention, freezing of gait, activities of daily living
• Prospective studies looking at nonmotor scales pre/post LSVT BIG (e.g., anxiety, apathy)
• Duration of treatment effects• Longer term effect on symptom progression and ability level • Effects on aerobic capacity and lower extremity strength
• Impact of BIG for LIFE maintenance groups on long‐term outcomes
• Clinical implementation studies
We are in this together!The research is there to help YOU.
6 key reasons LSVT research supports therapists!
1. Provides therapists with assurance they are providing patients with a treatment that works, based upon strong research evidence to support its efficacy
2. Gives therapists confidence in providing an intensive treatment which has sufficient repetition of practice and which includes sensory calibration, resulting in lasting changes as demonstrated clinically and in published research
3. Shows through multiple Randomized Controlled Trials (RCT) (3 for LSVT LOUD; 2 for LSVT BIG) the cause and effect relationship between the treatment delivered and the outcomes measured. The RCTs controlled for factors that influence treatment outcomes, such as attention, dosage, bias, etc.
6 key reasons LSVT research supports therapists!4. Dispels concern of research bias when similar improvements
post LSVT LOUD and LSVT BIG have been published from multiple laboratories and countries providing external validity of research results.
5. Supports core components of LSVT LOUD and LSVT BIG as solid neural‐based treatments by having application in other neurological populations, such as stroke, MS, cerebral palsy.
6. Offers confidence that technology does not diminish the effectiveness of LSVT LOUD
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How does LSVT research benefit people with Parkinson’s disease?
1. Offers clear expectation of treatment requirements (i.e., protocol) and potential therapeutic outcomes
2. Gives confidence that repetition of training and calibration are required to drive brain changes
3. Allows people with PD or family to advocate for practices that prioritize and offer evidence‐based therapy treatments
4. Protects physical, financial and emotional resources by participating in treatments with efficacy versus potentially ineffective treatments
“Knowledge is Power!”
SummaryIt is essential in our field that we develop research‐based treatments that are based on solid evidence and theory.
HOWEVER, you can have the best model/theory in the world, but the crucial questions are:
• Can therapists learn how to correctly deliver the treatment?
• Can they implement it?
• Can patients participate in it?
What is unique about LSVT LOUD and LSVT BIG is the answer is YES!
• You can help people with early through late stage disease
• We have emerging research and implementation!
• Research outcomes and clinical knowledge are feeding successful implementation, and as a result, people with PD and other neuro conditions benefit.
• There is more to be done and we would love your help.
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!
Opportunities to learn more about LSVT LOUD
and LSVT BIG
• Monthly Live Webinars
• On Demand Webinars
• Website
• Blog
• Live Seminars
• LSVT Global Facebook Page
• Ask our experts!
FIND IT ALL AT
www.lsvtglobal.com
Upcoming 2020 LIVE Certification Coursesfor Speech, Physical and Occupational Therapists:
LSVT BIG Courses
Largo, FL: 2/22‐2/23
Columbia, MD: 3/13‐3/14
Muenster, Germany: 3/27‐3/28
Lenexa, KS: 4/3 ‐4/4
Birmingham, AL: 4/18‐ 4/19
LSVT LOUD Courses
New York, NY‐ 1/24‐1/25
Istanbul, Turkey‐ 2/2‐2/3
Jacksonville, FL‐ 2/28‐2/29
Abu Dhabi‐ 2/28 – 2/29
Lenexa, KS‐ 3/27‐3/28
Free Seminar for People with PD and their family2‐hour free seminar from 12 noon – 2:00 PM on DAY 2https://blog.lsvtglobal.com/events/category/free‐educational‐seminars/
Online Training and Certification offered on demand, anytime!
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