Date Presented 4/20/2018
The results of this study suggest it is feasible for occupational therapy practitioners to use Lee Silverman Voice Treatment BIG® (LSVT–BIG) with a client with chronic stroke and aphasia. Further, it is feasible to deliver the home exercise portion of LSVT–BIG using a computer-based gamified system.
Primary Author and Speaker: Rachel Proffitt
Additional Authors and Speakers: Whitney Henderson, Bridget Comparato, Casey Ladlie, Shea Scholl, Molly Tedrow
PURPOSE: Evidence suggests that the Lee Silverman Voice Treatment BIG® (LSVT–BIG) program is an effective intervention for people with Parkinson’s disease (Ebersbach et al., 2015). LSVT–BIG is an intensive program with hands-on treatment sessions 4 days/wk for 4 wk. Clients complete home exercises every day that enhance the hands-on treatment and help promote carryover of skills learned to daily tasks. However, no research exists on the use of this program as an intervention for people with stroke. We completed a case study using the LSVT–BIG intervention with a woman with stroke, and those results are currently in press. The purpose of this case study was to further explore the feasibility of the intervention with a man with chronic stroke who had aphasia.
METHOD: This case feasibility study gathered measurements at pretest, posttest, and 6-wk follow-up. One person with chronic stroke (1 yr poststroke) and was recruited from a no-fee student-run clinic. The participant was a man aged 57 who was community dwelling, was independent in all activities of daily living and mobility, had severe expressive aphasia, and had mild upper extremity hemiparesis affecting the right side.
The intervention followed the standard LSVT–BIG protocol and was delivered by a trained intervener. Each treatment session lasts 60 min and includes a combination of exercise and functional tasks. For this study, the client completed the associated home program via a virtual reality–based game called Mystic Isle (University of Southern California Institute for Creative Technologies, Los Angeles). Movements are tracked and recorded via the Kinect (Microsoft Corp., Redmond, WA), which is used to interact with the virtual world.
The primary outcome measures included the Canadian Occupational Performance Measure (COPM), Patient-Reported Outcomes Measurement Information System 29, Performance Assessment of Self-Care Skills, Modified Ashworth Scale, Wolf Motor Function Test (WMFT), range of motion, and manual muscle testing. Scores on all assessments were compared over time and to clinically significant values (e.g., minimal clinically important difference, minimal clinical difference); no statistical methods were used because this was a case study.
RESULTS: The client completed 100% of in-clinic visits and 90% of the home program using Mystic Isle. The client demonstrated self-reported improvements in performance of (change score = 1.6) and satisfaction with (change score = 1.8) identified occupations on the COPM. Upper extremity function data revealed that LSVT–BIG had a positive effect (26% decrease in average WMFT task time). The client’s spouse stated in a follow-up interview that the client had started eating dinner with the family and cooked for the first time since his stroke (he had been a chef).
CONCLUSION: The results of this study suggest it is feasible for rehabilitation professionals to use LSVT–BIG with people with chronic stroke, including those with aphasia. LSVT–BIG has the potential to have a positive effect on motor function and occupational performance as evidenced by findings on the subjective and objective outcome measures. The next step in this research is to deliver LSVT–BIG and the gamified home program to a larger, more diverse population with chronic stroke to further determine the effectiveness and appropriateness of this intervention.
IMPACT STATEMENT: This is the first study investigating the use of a standardized protocol, the LSVT–BIG program, with the chronic stroke population. The positive findings from this case study suggest that this intervention can be effectively used with clients with stroke and in occupational therapy practice.
References
Ebersbach, G., Grust, U., Ebersbach, A., Wegner, B., Gandor, F., & Kühn, A. A. (2015). Amplitude-oriented exercise in Parkinson’s disease: A randomized study comparing LSVT–BIG and a short training protocol. Journal of Neural Transmission, 122, 253–256. https://doi.org/10.1007/s00702-014-1245-8
