The hardship of Parkinson’s disease includes a trend toward small. Steps get shorter. The voice gets softer. The range of motion constricts.
Therapists are combatting that trend by thinking big, as in big sound, big steps and big punching motions with boxing gloves.
The latest ideas in large-motion exercise and voice therapy – called high-amplitude training – will be presented at the 12th annual Rev It Up for Parkinson’s Symposium & Expo, Aug. 13, at the Oasis Conference Center in Loveland, Ohio.
Logan Waddell PT, DPT, a physical therapist at Superior Care Plus, will talk about the four-week, high-amplitude training program that he uses to help people with Parkinson’s maintain mobility and quality of life. The program, called LSVT BIG, is an extension of the Lee Silverman Voice Treatment Program (LSVT LOUD).
Another symposium speaker, Sarah Krumme Palmer, MS, an exercise physiologist at foreverfitness, will explain how the new Rock Steady Boxing program also helps patients by focusing on high-amplitude movement.
The symposium and expo is presented by the James J. and Joan A. Gardner Family Center for Parkinson’s Disease & Movement Disorders at the UC Gardner Neuroscience Institute. The event is free to patients, families and caregivers.
Paradigm shift in approach to exercise
“In the last 10 years there has been a paradigm shift in how we treated Parkinson’s,” says Waddell. “Therapists switched from focusing on strength and balance training to going after it as a neurologic issue. The underlying idea is that we’re working with activity-dependent neuroplasticity. If you practice something repeatedly, you make changes in the brain.”
Specifically, physical therapists adopted the high-amplitude concepts of speech therapists, who helped patients regain normal voice strength by forcing them to shout during therapy sessions. Translated to physical therapy, this means engaging patients in large motor movements, such as long steps and arm-swinging.
Alberto Espay, MD, MSc, director of the Gardner Center, says high-amplitude exercise programs “integrate both the stretching and cardiovascular components needed” for a regimen to benefit people with Parkinson’s disease.
Palmer, whose father lived with Parkinson’s for many years, became a certified Rock Steady Boxing Cincinnati coach in February and now offers her classes at the Loveland TITLE Boxing Club. “It may seem surprising, but this non-contact boxing-inspired fitness routine is dramatically improving the ability of people with Parkinson’s to live independent lives,” Palmer says.
“Amplitude and intensity are at the core of this class and all the classes that we provide for people with Parkinson’s,” she continues “It is an intensive and rigorous regimen. There has to be enough intensity to get the neurological effects needed to be beneficial. We push our boxers pretty hard in our classes. We call it tough love, and they love it!”
Research has shown that patients who perform large-motor exercises for one month can experience benefits for up to two years. Those benefits also include some carryover to small motor skills involved in eating, writing and getting dressed.
The training helps patients reassess what is normal. “Parkinson’s patients are always nagged to take longer steps,” Waddell says. “But they don’t perceive the steps they’re taking as too small. By making these longer, high-amplitude movements, they are recalibrating their brain to recognize what an appropriate step is.”
A moral pull toward healthcare
Logan Waddell earned an undergraduate degree in engineering but felt a moral pull toward healthcare. “My grandmother had MS, my uncle had ALS and my grandfather developed Parkinson’s disease in a later stage of life,” Waddell says. “Witnessing therapy that was not as effective as it could be drove me to pursue a career in physical therapy so that I could have an impact on people’s lives.”
Waddell’s engineering background has proved valuable. “I think the best way to think of human body is that it’s almost like a machine itself. Physical therapy involves the biomechanics of how the body is moving.”
Waddell works with patients in their homes through his position at Superior Care Plus, a home healthcare company. He also recently started his own outpatient practice, Superior Rehab and Balance Center.
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For more information about high-amplitude training for people with Parkinson’s disease, contact Logan Waddell at (513) 368-5212. For more information about Rock Steady Boxing, call Sarah Krumme Palmer at (513) 404-1918.
— Cindy Starr