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Patient Case Study


Nancy is a 72 year old patient admitted to Great Lakes Caring Home Health post discharge from a
long term facility. Her health problems include Parkinson’s, CHF, HTN, lumbago and dementia.
She presents with altered mobility, strength, balance, speech and ability to perform normal day
to day functions without effort. Nancy lives alone in an ADA-compliant apartment. She receives
intermittent assistance through other community resources. She wants to regain as much function
as possible to remain in her own home rather than a long term facility.

Nancy was identified as qualifying for the LSVT BIG & LOUD® program through Great Lakes
Caring. This is an Evidence Based Practice (EBP) program consisting of innovative and clinicallyproven
methods for improving communication and movement in individuals with Parkinson’s
disease. This program enables Parkinson’s patients to improve their speech and mobility.

The principles of LSVT BIG® were added to Nancy’s regular therapy plan of care. LSVT BIG®
teaches repetition of core movements that are used in daily living, trains a single target of amplitude
(bigger movements) improving trunk rotation/gait that generally improves speed of upper/lower
limbs and balance. The speech pathologist initiated the LSVT LOUD® program to improve Nancy’s
communication due to softness of speech that was muffled and difficult to understand. Exercises
were introduced to improve her vocal loudness, intonation, and voice quality. Nancy was taught
the amount of effort required to produce her normal speech and trained to self-generate loudness
to make her speech understood.

By the end of a 60-day episode, Nancy was able to increase her energy level and walk longer distances
which resulted in a weight loss. Nancy also reports sleeping better at night. Nancy’s speech also
improved with Nancy reporting that people no longer have to ask for clarification on what she says.

By receiving LSVT® intensive rehabilitation, the patient’s symptoms of declining voice strength,
muffled speech, tremors, impaired balance and stiffness were relieved. Nancy recently had a
neurology six month checkup since returning to independent living. Her physician was surprised at
her progress with her Parkinson’s status stabilizing and showing marked improvement. Nancy
continues the daily exercises instructed by both physical therapy and speech pathology to maintain
strength and safety for improved quality of life. Nancy states she is happier than she has been in years
and has an improved sense of self-worth.


Presented by Sarah Thurston, LMSW
Great Lakes Caring Director of Education
October 2017