Hahaha! This is totally like me when I have a quick comment 
This is such an important topic and I hope we get to review research on it in the future.
I feel like the PDQ-39 is a great tool for starting conversations about a wide variety of QOL issues. Have you ever used it @jennifer27? Iām always curious how widely used it isā¦
Iām happy to see this article, summary and discussion!
In my pre-grad school observations, I had the chance to observe an OP OT work with a few different PD clients. The OT I was shadowing was LSVT Big Certified. Later in grad school, we had the chance to opt in as students to the LSVT Big training to get certified. I highly recommend looking into this protocol if youāre not yet familiar.
The quick pitch is: Itās an evidence-based, high effort/intensity standardized exercise protocol delivered as 4 sessions a week for 4 weeks. The focus is on movement amplitude, effort and sensory calibration.
Iāve done a bit of local research & have noticed that there are a number of local groups that meet up to continue the LSVT protocol exercises together (offering engagement/community support, to one of the points above!).
I could see a huge opportunity for this to be delivered effectively in the home health setting. Iāve also seen Rock Steady Boxing come up in my quick research, though know much less about that.
Iām a new grad still getting my land legs, so am definitely curious if others are familiar with LSVT, if theyāre certified, and how they use it in their practice.
Hi! Have your SLPās heard of LSVT Loud? The research shows it can make an impact on volume of speech calibration, and variation in pitch, which in turn will likely help to address the challenges of conveying emotion and connecting with others, secondary to the PD symptoms of flat affect/facial masking.
https://www.lsvtglobal.com/LSVTLoud
Re: the ALERT program, I saw that used a lot in my pediatrics rotation. Thanks for sharing the link to the study with Adults - I will be pulling that one to read and use!
Yes, LSVT Big is great. I am certified and did a course of the training with this resident, but unfortunately without too much improvement in his functional performance. His Parkinsonās is pretty progressed.
I recently had picked him up for therapy again after a quarterly screen where it was noted that he has been more withdrawn, and as a first course of action they prescribed him meds (zoloft) which is frustrating. In the nursing home I find all mental health issues are addressed by meds alone. They are still not following the evidence. Not sure what the barrier to having psychologists employed in nursing homes. Would love OT and psych to work together. OT often is informally filling in this gap.
And, yes, the SLP I work with knows of LSVT Loud, but sheās unfortunately not interested in taking it unless our company (who paid less than 50% of mine) pays 100%. I think of it as an investment in my toolbox and career, but I think I insulted her when I suggested thatā¦oh well. I know LOUD obviously helps with volume, but Iām curious if it goes into social skills too.
And good for you as a new grad getting these trainings early!!
No Iāve never used it. I just took a peak at the questionsā¦sounds fantastic! Too often I find OT assessments are only focused on physical performance and ADLs, and thereās so much more to QOL than ADLs, especially in long-term care. The documentation software such as rehab optima/net health doesnāt help either with setting QOL goals. Thank goodness for the option of customized goals!
And while weāre on the topic of quality of life. Just an idea for a future topicā¦spirituality! I found assisting residents during Covid to engage in meaningful spiritual practices instrumental in providing hope and aiding recovery while they were isolated for so long, and Iāve been continuing to discuss spirituality with residents that itās appropriate for. Obviously, never to push a discussion on anyone, but to leave the door open on helping them participate (such as obtaining a large print bible, printing out favorite psalms for daily prayer, teaching how to access or setting them up with online Sunday service from their home church to view on smartphone/tablet). I found a couple of assessments, HOPE and FICA, which Iām going to trial with my evals and see how it goes.
Thanks again for this site!
Gotchya - thanks for the response, and the context! Our opportunity to support in the mental health realm is a big part of what pulled me towards this profession. I am frustrated to hear about you and your patientās experience, but really appreciate your examples of applying and advocating for EBP in practice!
Support groups for patients and family are vital! I recall a time when a patientās wife called to thank me for recommending a suppoet group for her, and she said it was in one of the best things I did for her husband.
By the way, I took the USC Sleep hygiene course. I think it was in that class where they said the challenges with the reticulatar acting system and sleep can be identified 10 years before a formal diagnosis of Parkinsonās!