Utilizing Telehealth to Deliver LSVT BIG Treatment for Young Onset Parkinson Disease: A Case Report

Abstract

Background and Purpose: Young-onset Parkinson disease (YOPD) is characterized by an age of onset before 40 years and slower disease progression. Lee Silverman Voice Treatment (LSVT) BIG is an amplitude-based treatment performed to decrease symptoms of Parkinson disease (PD), administered inperson by certified physical and occupational therapists utilizing standardized exercises and patient goaldriven activities. Telehealth services allow for patient and clinician interaction when barriers exist for the delivery of traditional healthcare services. The goal of this case report was to investigate the effectiveness of LSVT BIG treatment delivered via telehealth. Case Description: LSVT BIG treatment was delivered via telehealth to a 46-year-old male with Hoehn and Yahr Stage II YOPD who was unable to access an LSVT BIG certified clinician in a rural area. Doctor of physical therapy students who had completed LSVT BIG certification training were supervised by an LSVT certified physical therapist. Maximal daily exercises, functional tasks, a hierarchy task, and BIG walking were performed via telehealth over the course of four weeks with focus on high intensity and modeling big movements. Initial, discharge, and six month follow-up examinations were performed inperson.Outcomes: Following completion of LSVT BIG via telehealth, the patient improved 9 Hole Peg for dominant hand, mini-BESTest, 10 Meter Walk Test, 30 second Sit to Stand, and UPDRS III scores. At the six-month re-evaluation, the patient improved or maintained mini-BESTest, 30 second Sit to Stand, and UPDRS III scores. Subjectively, the patient reported increased amplitude in daily movement patterns, improvements in gait, tremor, voice volume, typing, handwriting, energy level, and ability to think big. Conclusion: Investigation into the effectiveness of providing physical therapy interventions via telehealth is imperative, now more than ever, as we navigate a global pandemic. This case report suggests that LSVT BIG delivery via telehealth may be effective for treatment of YOPD. Telehealth services could increase access to physical therapy treatment for patients with Parkinson disease. Further research on the delivery of LSVT BIG via telehealth is warranted.