SOUTHERN PINES PHYSICAL THERAPY

Now I understand that October is National Physical Therapy Month and that Southern Pines Physical Therapy has a special event to celebrate the month. Can you tell us about the event?

• Yes, October is National Physical Therapy Month and Saturday, October 17th has also been named as the Global PT Day of Service.
• PT’s all across the county and the world will be doing what we do so well, which is creating opportunities to care for the members of our communities. On Saturday, October 17th, the PTs from Southern Pines Physical Therapy will again have a tent at the Moore County Farmers Market and will be offering free posture assessments and balance screens, and yes, you can come get more information about LSVT BIG and other services for patients with neurologic conditions.
• 8-12, market hours
• Hope to see you there

Laura Teeter Beck, PT, DPT, NCS
Physical Therapist Specializing in Neurological Conditions
Southern Pines Physical Therapy

Tell us a little about yourself and life before Moore County.

I was born and raised in the Finger Lakes region of Upstate New York, which is beautiful and agricultural and actually looks a lot like it does here… except in NY there’s quite a bit more snow in the winter! I attended Ithaca College and earned my Doctor of Physical Therapy. After school I moved to Atlanta and worked at a large rehab hospital for five years before coming to Moore County.

What brought you to Moore County?

My husband has lived here for years. He graduated from NC State and is a local wildlife biologist. He specializes in the conservation of the endangered Red-cockaded woodpecker that is so well known in this area. I moved here in January 2014 to be with him.  We spend a lot of our time outdoors, hiking, kayaking, and camping. I’m getting a lot better at identifying the local songbirds and plants.

How did you come to start working at Southern Pines Physical Therapy?

As soon as I moved to Moore County, I kept hearing from friends about Sue Stovall, and that I should talk to her about joining her physical therapy practice. I very quickly realized how well respected and loved Sue is as a member of this community. The physical therapy practice Sue started, SPPT, is a therapist-owned private practice, offering physical therapy services for all conditions, but especially for orthopedic issues, including pain and injury to the joints, back pain, and rehab following surgery for a joint replacement or rotator cuff repair.

One of the niches that I hope to fill in this community, is to serve those with neurological conditions, including stroke, brain injury, spinal cord injury, balance problems, multiple sclerosis and Parkinsons disease.

Tell us about your background in neurologic physical therapy.

• Previous experiences working with patients with neurological conditions, especially stroke, spinal cord injury, and brain injury.
• This is the area of Physical Therapy that has always really excited me to learn more!
• I am a Board Certified Neurologic Clinical Specialist

o             Advanced clinical knowledge and skills in working with patients with these conditions.

o             As of June 2014 there were 1500 NCS’s in the country

o             I am currently the only NCS in the Sandhills.

What can physical therapy do for someone who has had some sort of injury like a stroke or brain injury?

• Exercise as a tool to promote healing
• Used to think brain and spinal cord were hard wired and unable to repair if damaged
• Now well accepted that there is neuroplasticity
• Neuoplaticity

o             how our brains and spinal cords (the central nervous system) are constantly making new connections, strengthening some pathways and pruning others, based on our experiences.

o             This is the basis for both learning in an un-injured brain, as well as relearning in the injured brain as a result of physical therapy.

o             For example, say someone had a stroke and the part of the brain that controls movement of the arm was damaged and their arm is too weak to move it much.

o             Studies have shown that even though the area of the brain that controls arm movement may have damaged by the stroke, a nearby, undamaged area can take over that role.  This may contribute to improved strength and function use of the arm.

• Some of these improvements can be attributed to the body’s spontaneous healing even in the absence of rehabilitation.
• The role of the physical therapist is to optimize the movement and sensory experiences that someone has after an injury in order to facilitate the most neuroplasticity, the most positive change, that the nervous system is cable of producing.

How can physical therapy affect neuroplasticity?

• Actively moving and using the body after injury

o             Produce greater quantities of the substances that promote neuron sprouting and growth, which is thought to coincide with functional recovery.

o             Increase sprouting of blood vessels that will support these new nerve cells.

o             Through specific exercise, we can create an internal environment that actually helps the injured brain and spinal cord heal.

• Factors related to how a patient exercises or practices a functional task during rehabilitation that promotes optimal neuroplasticity.
• “Use it or lose it!”, meaning that you must practice using the weak limb instead of just using the unaffected side to complete a task, even though using the weaker side may be more difficult or slower.
• And more than just “using” a weak arm or leg, the use should be task-specific.  This means if you’re trying to improve your ability to feed yourself, you practice feeding yourself. If you are trying to improve how you walk, you practice walking. You’re re-learning the complex combination of movements that it takes to complete that task.
• Two other major components of optimizing neuroplasticity are repetition and intensity. You can’t just practice it a few times on one day and expect amazing improvements.  In studies looking at arm use and function after stoke, they were recording patients with 2500 reps of a hand movement or 12+ hours of forced use of a limb to create the changes they were after.
• Also, saliency, or practicing activities that are meaningful to that individual pt, can improve neuroplasticity. You cannot just go through the motions when you’re trying to re-train the nervous system, you have to be actively engaged.  If it is really important to a patient that they be able to feed themselves because they really don’t want their spouse to have to feed them in public, that is a meaningful activity for that person to work on and it’s more likely to facilitate neuroplasticity.

We have been talking quite a bit about the brain and some of the ways that physical therapy can promote healing of the brain after injury.  I know that you are certified to teach a program for another condition that involves the brain, and that’s for Parkinsons disease.  For those in our community who are not familiar, can you speak a little bit about what is Parkinsons Disease?

• Parkinsons disease is a progressive disease where there is degeneration of the cells in your brain that make the neurotransmitter, dopamine.
• As a result of having less dopamine, the control of movements are affected.
• The four main clinical signs of PD are 1. A tremor (this usually starts on one side of the body and is present at rest). 2. Bradykinesia, which means slowness of movement. 3. Rigidity, which means that the limbs and trunk can be stiff and difficult to move. And 4. Postural instability, meaning that balance may not be as good, you cannot react to perturbations as you once did.
• People also commonly develop a shuffling gait pattern, a flexed trunk posture and a masked facial expression (little facial expression)
• This disease usually has an onset in the later decades of life, but as with Michael J Fox, the disease can also affect people much younger
• There is no diagnostic testing to confirm Parkinsons.  It is a clinical diagnosis based on the presence of the symptoms above, and based on response to Parkinsons medications.

You have an exercise program specifically for people with Parkinsons disease?

• LSVT BIG is a program that was originally developed by a speech therapist to help his mother and others with Parkinsons to speak louder, it was called LSVT LOUD.
• This concept was then applied by PTs to increase the amplitude of limb and body movements (or Bigness).
• This program was been studied and shown to increase amplitude of trunk rotation and gait, improved gait speed, balance, and quality of life, Decrease fall risk.
• The goal of the program is to recalibrate the size of movement that a person with Parkinsons perceives as normal and having the larger, more functional movements be their new normal.

What is involved with this program?

• LSVT BIG can be only be delivered by a PT or OT who has been certified to teach this program.
• Treatment is 4 days a week for 4 weeks (four individual 60 minute sessions per week).
• This protocol was developed specifically to address the unique movement impairments for people with Parkinson disease, but can be used with people with other conditions that may benefit from increased movement amplitude
• The protocol is both intense in the effort expected and the number of reps performed.  The movements practiced are components of many activities of daily living.
• This is the type of practice that we talked about earlier that is so important for neuroplasticity. This practice is necessary for the learning and carryover of the BIG movements into everyday life!

Can you describe some of the changes that you have seen in patients with Parkinsons who have participate in LSVT BIG?

There is a patient with Parkinsons who I had been working with before I became certified to teach LSVT BIG.  The therapy we had done before this had been to work on improving her walking and balance and were all evidence-based treatments. However, when she enrolled in LSVT BIG, we were able to work together for an hour a day, 4 days a week. These were intense sessions. We were both working hard and giving this our max effort. We joked that I should be in my shorts and sneaker while we did the LSVT BIG exercises together. For LSVT BIG, in addition to the PT sessions 4 times a week, there’s also homework. Patients participating in the program agree to do their exercises, which can take about 20-30 minutes again in the afternoon on days they had PT and two times per day on the days they don’t have PT. This program provides the opportunity for max intensity, max repetitions, saliency for working on applying the BIG principals to functional tasks that are important to her. The first day we did the exercises, there were some that I needed to keep a hand on her for because she was starting to lose her balance. Within about a week I was able to take my hand off her and stand next to her for some of the more challenging exercises, and then by the end, she was doing them without any loss of balance. Her walking also greatly improved. Before LSVT BIG, she had a slower walk, reported she had difficulty keeping up with her husband when they were walking together, and she felt very stiff when she walked. She was aware that her walking made her look different from others. After LSVT BIG, the is walking faster, taking bigger steps, swinging her arms when she walks, and is able to keep up with her husband. She is also now able to dress herself independently, get her legs in and our of her family’s SUV without needing to use her hands to pull them in, and she’s able to get herself on and off the floor independently. One of the biggest things I noticed with her was no so much physical, but had to do with her affect and communication. The volume and clarity of her voice improved, she smiles more, she had more spontaneous conversations, she makes jokes. It’s like the mask of Parkinsons has been removed.

What if someone has just been diagnosed with Parkinsons disease or they have had the disease for years? Who can benefit from this program?

• For someone who has recently been diagnosed with Parkinsons, start exercising now!
• Typically, PTs do not see patients with Parkinsons until much later in the disease, for example, when someone’s walking and balance have declined to a point where they fall and are being seen by PT after a fractured hip.
• Physicians rarely refer their patients at diagnosis because medications are usually very effective early for managing most of the symptoms, and patients experience little change in function.
• Yet, according to a recent survey it is at the time of diagnosis that patients often begin to consider lifestyle changes and seek education about treatment options.
• Referrals to exercise and physical therapy would be best initiated at diagnosis, when it may have the most impact on quality of life.
• For patients who have had Parkinsons disease for longer, this program can also be modified so that more of the exercises can be done in sitting.
• For folks who are unsure if they can tolerate or benefit from such an intense program, we would be able to determine whether this program is for you or whether more traditional, yet evidence-based PT care may be more appropriate.