Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
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Application of Lee Silverman Voice Treatment-BIG(LSVT-BIG) Intervention to Improve Motor Functions and Quality of Life in People With Parkinson Disease

파킨슨병 환자에게 Lee Silverman Voice Treatment-BIG(LSVT-BIG) 프로그램의 적용이 운동기능과 삶의 질에 미치는 효과

  • 박강현 (혜전대학교 작업치료과) ;
  • 김재환 (서울 시니어스 타워(주) 주야간보호센터) ;
  • 장종식 (강원대학교 작업치료학과)
  • Received : 2019.01.07
  • Accepted : 2019.01.31
  • Published : 2019.02.28
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Abstract

Objective: The purpose of this study is to compare the effect of Lee Silverman Voice Treatment-BIG(LSVT-BIG) intervention which consisted of standardized exercise programs and occupation-based activities for people with Parkinson Disease(PD) on motor functions and quality of life Methods: This study applied a one group pretest-posttest design. The experiment was divided into two parts: pre intervention and post intervention period. Before and after LSVT-BIG intervention, Unified Parkinson's Disease Rating Scale(UPDRS), Time up and go(TUG), Parkinson's Disease Questionnaire-39(PDQ-39) were used to measure the participants' motor functions and quality of life. Based on the LSVT-BIG protocol, three participants received 16 one-hour sessions over 4 weeks by a certified occupational therapist. The results were analyzed by using SPSS. Results: There were improvements in UPDRS and TUG. Additionally, PDQ-39 scores decreased in all participants, which means that their quality of life was improved. Conclusions: The study demonstrated positive effects of LSVT-BIG intervention on motor functions and quality of life of patients with PD.

목적: 파킨슨병 환자를 위해 개발된 표준화된 운동프로그램과 작업기반의 활동으로 구성된 Lee Silverman Voice Treatment (LSVT) BIG 치료 프로그램을 지역사회에 거주하는 파킨슨병 환자에게 제공한 후 파킨슨병 환자의 운동기능과 삶의 질에 어떠한 영향을 미치는 지를 알아보고자 하였다. 연구방법: 본 연구는 단일군 전후실험설계(one-group pretest and post test design)를 사용하였다. 치료 전 후에는 통합형 파킨슨병 평가척도(Unified Parkinson's Disease Rating Scale-III: UPDRS-III), Time up and go(TUG), 파킨슨 질병 검사지(Parkinson's Disease Questionnaire-39: PDQ-39)을 사용하여 운동기능 및 삶의 질의 변화를 측정하였다. LSVT-BIG치료는 프로토콜에 의거하여 매일 1회 주4일 60분간 실시하여 대상자별로 총 16회기를 실시하였다. 결과분석은 그래프를 통한 시각적 분석과 치료 전 후 측정값의 변화를 비교하였다. 결과: 치료 전 후로 UPDRS, TUG에서 모든 대상자들의 수행능력이 향상되었다. 또한, PDQ-39의 감소로 치료 후 모든 대상자들의 삶의 질 또한 긍정적으로 향상되었다. 결론: 지역사회 내에서 거주하는 파킨슨병 환자에게 LSVT-BIG 치료의 적용은 파킨슨환자의 운동기능 증진 및 삶의 질 증진에 긍정적인 영향을 주었다.

Keywords

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Figure 1. Course of Research

Table 1. General Characteristics of Participants

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Table 2. LSVT-BIG Program

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Table 3. Pre and Post Results of UPDRS-III Among Participants

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Table 4. Pre and Post Results of TUG Among Participants

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Table 5. Pre and Post Results of PDQ-39 Among Participants

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References

  1. 보건복지부 (2015). 파킨슨 병_ 약물조절 및 운동 등이 도움. 보건복지부 보도자료.
  2. Abbruzzese, G., & Berardelli, A. (2003). Sensorimotor integration in movement disorders. Movement Disorders, 18(3), 231-240. https://doi.org/10.1002/mds.10327
  3. Bloem, B.R., de Vries, N.M., & Ebersbach, G. (2015). Nonpharmacological treatments for patients with Parkinson's disease. Movement Disorders, 15(11),150-420. https://doi.org/10.1002/mds.26363
  4. Behrman, A., Teitelbaum, P., & Cauraugh, J. (1998). Verbal instructional sets to normalise the temporal and spatial gait variables in Parkinson's disease. Journal of Neurology, Neurosurgery & Psychiatry, 65(4), 580-2. https://doi.org/10.1136/jnnp.65.4.580
  5. Cha, Y. J., Song, Y. J., Kim, E. Y., Kim, S. J., & Kim, D. J. (2017). Analysis of medical rehabilitation's fee using national health insurance service's big data: Focusing on ICF model. The Journal of Korean Society of Occupational Therapy, 25(4), 1-17. https://doi.org/10.14519/jksot.2017.25.4.01
  6. Corcos, D., Comella, C., & Goetz, C. (2012). Tai chi for patients with Parkinson's disease. The New England Journal of Medicine, 366(18), 1737-8. https://doi.org/10.1056/nejmc1202921
  7. Combs, S., Diehl, M., Staples, W., Conn, L., Davis, K., Lewis, N., & Schaneman, K. (2011). Boxing training for patients with Parkinson disease: A case series. Physical Therapy, 91(1), 132-42. https://doi.org/10.2522/ptj.20100142
  8. Crizzle, A. M., & Newhouse, I. J. (2006). Is physical exercise beneficial for persons with Parkinson's disease? Clinical Journal of Sport Medicine, 16(5), 422-425. https://doi.org/10.1097/01.jsm.0000244612.55550.7d
  9. Ebersbach, G., , Ebersbach, A., Edler, D., Kaufhold, O., Kusch, M., & Wissel, J. (2010. Comparing exercise in Parkinson's disease-The Berlin BIG Study. Movement Disorders, 25(12), 1902-1908. https://doi.org/10.1002/mds.23212
  10. Ebersbach, G., Grust, U., Ebersbach, A., Wegner, B., Gandor, F., & Kuhn, 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(2), 253-256. https://doi.org/10.1007/s00702-014-1245-8
  11. Farley, B., & Koshland, G. (2005). Training BIG to move faster: The application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson's disease. Experimental Brain Research, 167(3), 462-467. https://doi.org/10.1007/s00221-005-0179-7
  12. Farley, B. G., Fox, C. M., Ramig, L. O., & McFarland, D. H. (2008). Intensive amplitude-specific therapeutic approaches for Parkinson's disease: Toward a neuroplasticity-principled rehabilitation model. Topics in Geriatric Rehabilitation, 24(2), 99-114. https://doi.org/10.1097/01.tgr.0000318898.87690.0d
  13. Fox, C., Ebersbach, G., Ramig, L., & Sapir, S. (2012). LSVT LOUD and LSVT BIG: Behavioral treatment programs for speech and body movement in Parkinson disease. Parkinson's Disease, 1-12. https://doi.org/10.1155/2012/391946
  14. Fisher, B., Wu, A., Salem, G., Song, J., Lin, C., Yip, J., & Petzinger, G. (2008). The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease. Archives of Physical Medicine and Rehabilitation, 89(7), 1221-1229. https://doi.org/10.1016/j.apmr. 2008.01.013
  15. Fahn, S., & Elton, R.L. (1987). Recent development in parkinson's disease. New York, Ravan press.
  16. Goodwin, V. A., Richards, S. H., Taylor, R. S., Taylor, A. H., & Campbell, J. L. (2008). The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta-analysis. Movement Disorders, 23(5), 631-640.https://doi.org/10.1002/mds.21922
  17. Hantz, P., Caradoc-Davies, G., Caradoc-Davies, T., Weatherall, M., & Dixon, G. (1994). Depression in Parkinson's disease. The American Journal of Psychiatry, 151(7), 1010-1014.https://doi.org/10.1176/ajp. 151.7.1010
  18. Hirsch, Toole, Maitland, & Rider. (2003). The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Archives of Physical Medicine and Rehabilitation, 84(8), 1109-1117. https://doi.org/10.1016/s0003-9993(03)00046-7
  19. Hu, M., Szewczyk-Krolikowski, K., Tomlinson, P., Nithi, K., Rolinski, M., Murray, C., & Ben-Shlomo, Y. (2014). Predictors of cognitive impairment in an early stage Parkinson's disease cohort. Movement Disorders, 29(3), 351-359. https://doi.org/10.1002/mds.25748
  20. Hackney, M., & Earhart, G. (2010). Effects of dance on balance and gait in severe Parkinson disease: A case study. Disability & Rehabilitation, 32(8), 679-684. https://doi.org/10.3109/09638280903247905
  21. Im, J. H., Kang, J. H., & Lee, M. C. (2001). Treatment of Parkinson's disease. Journal of Korean Neurological Association, 19, 315-336.
  22. Jobges, E. M., Spittler-Schneiders, H., Renner, C. I., & Hummelsheim, H. (2007). Clinical relevance of rehabilitation programs for patients with idiopathic Parkinson syndrome. II: Symptom-specific therapeutic approaches. Parkinsonism and Related Disorders, 13 (4), 203-213. https://doi.org/10.1016/j.parkreldis.2006.07.018
  23. Jenkinson, C., Fitzpatrick, R., Peto, V., Greenhall, R., & Hyman, N. (1997) The Parkinson's disease questionnaire (PDQ-39): Development and validation of a Parkinson's disease summary index score. Age and Ageing, 26 (5), 353-357. https://doi.org/10.1093/ageing/26.5.353
  24. Kim, S. Y., Han, J. T., Choi, M. O., Min, H. S., & Sung, H. R. (2012). The effect of e-exercise program on balance, gait, and endurance in patients with Parkinson's disease. Korean Society of Physical Medicine, 7(3), 259-265. https://doi.org/10.13066/kspm.2012.7.3.259
  25. Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Stock, R., Galver, J., & Batya, S. (2012). Tai Chi and postural stability in patients with Parkinson's disease. The New England Journal of Medicine, 366(6), 511-519. https://doi.org/10.1056/nejmoa1107911
  26. Lehman, D. A., Toole, T., Lofald, D., & Hirsch, M. (2005). Training with verbal instructional cues results in near-term improvement of gait in people with Parkinson disease. Journal of Neurologic Physical Therapy, 29(1), 2-8. https://doi.org/10.1097/01.npt.0000282256.36208.cf
  27. Marchese, R., Diverio, M., Zucchi, F., Lentino, C., & Abbruzzese, G. (2000). The role of sensory cues in the rehabilitation of parkinsonian patients: A comparison of two physical therapy protocols. Movement Disorders: Official Journal of the Movement Disorder Society, 15(5), 879-83. https://doi.org/10.1002/1531-8257(200009)15:5<879::aid-mds1018>3.0.co;2-9
  28. Martignoni, E., Godi, L., Citterio, A., Zangaglia, R., Riboldazzi, G., Calandrella, D. ... Nappi, G. (2004). Comorbid disorders and hospitalization in Parkinson's disease: A prospective study. Neurological Sciences, 25(2), 66-71. https://doi.org/10.1007/s10072-004-0232-5
  29. Millage, B., Vesey, E., Finkelstein, M., & Anheluk, M. (2017). Effect on gait speed, balance, motor symptom rating, and quality of life in those with stage I Parkinson's disease utilizing LSVT BIG. Rehabilitation Research and Practice, 8. 1-8, https://doi.org/10.1155/2017/9871070
  30. Miyai, Fujimoto, Yamamoto, Ueda, Saito, Nozaki, & Kang, J. (2002). Long-term effect of body weight-supported treadmill training in Parkinson's disease: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 83(10), 1370-1373. https://doi.org/10.1053/apmr.2002.34603
  31. Nieuwboer, A., Kwakkel, G., Rochester, L., Jones, D., Van Wegen, E., Willems, A., & Lim, I. (2007). Cueing training in the home improves gait-related mobility in Parkinson's disease: The RESCUE trial. Journal of Neurology, Neurosurgery & Psychiatry, 78(2), 134-140. https://doi.org/10.1136/jnnp.200x.097923
  32. Nonnekes, J., Snijders, A., Nutt, J., Deuschl, G., Giladi, N., & Bloem, B. (2015). Freezing of gait: A practical approach to management. The Lancet Neurology, 14(7), 768-778. https://doi.org/10.1016/s1474-4422(15)00041-1
  33. Olanow, C. W., Stern, M. B., & Sethi, K. (2009). The scientific and clinical basis for the treatment of Parkinson disease. Neurology, 72(4), 1-136. https://doi.org/10.1212/wnl.0b013e3181a1d44c
  34. Podsiadlo, D., & Richardson, S. (1991). The timed 'Up & Go': A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142-148. doi:10.1111/j.1532-5415.1991.tb01616.x
  35. Rubinstein, T., Giladi, N., & Hausdorff, J. (2002). The power of cueing to circumvent dopamine deficits: A review of physical therapy treatment of gait disturbances in Parkinson's disease. Movement Disorders, 17(6), 1148-1160. https://doi.org/10.1002/mds.10259
  36. Ramig, L., Sapir, S., Fox, C., & Countryman, S. (2001). Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: A comparison with untreated patients and normal age-matched controls. Movement Disorders, 16(1), 79-83. https://doi.org/10.1002/1531-8257(200101)16:1<79::aid-mds1013>3.0.co;2-h
  37. Shulman, L., Katzel, L., Ivey, F., Sorkin, J., Favors, K., Anderson, K., & Macko, R. (2013). Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurology, 70(2), 183-190. https://doi.org/10.1001/jamaneurol.2013.646
  38. Siderowf, A., McDermott, M., Kieburtz, K., Blindauer, K., Plumb, S., & Shoulson, I. (2002). Testretest reliability of the unified Parkinson's disease rating scale in patients with early Parkinson's disease: Results from a multicenter clinical trial. Movement Disorder, 17(4), 758-763. https://doi.org/10.1002/mds.10011
  39. Sohng, K. Y., Moon, J. S., Lee, K. S., & Choi, D. W. (2007). The development and effects of a self-management program for patients with Parkinson's disease, Journal of Korean Academic Nurse, 37(6), 891-901. https://doi.org/10.4040/jkan.2007.37.6.891