Twist, shout and button up. It was just what the doctor ordered last March when Dan Lockman, a 71-year-old Rockwood man, was diagnosed with Parkinson’s disease.
That’s because Roane Medical Center’s Big & Loud program is helping patients with Parkinson’s break out of their fast-shrinking world using exaggerated movements and speech to overcome problems common to the disease.
For Lockman, those problems included shaking hands, shrinking handwriting, smaller steps, stooped posture, lack of facial expression and arm swing and a once-booming radio voice that had been reduced to a whisper.
“When he first came to me, his voice was very soft,” said speech therapist Ann Ross, with more than 25 years of experience in treating patients with Parkinson’s, who spent four days a week in hour-long sessions for four weeks teaching Lockman how to pump up the volume of his speech. “Parkinson’s can make your voice continually get softer and softer. The patient feels like they are talking loud enough, but they are not getting the results they had before they had Parkinson’s.”
Before Parkinson’s, Lockman’s voice was his livelihood, serving as a news anchor on the American Forces Vietnam Network (AFVN) at the height of the Vietnam War. There he delivered military news from the same broadcasting booth in Saigon as the legendary Adrian Cronaur who was depicted by the late Robin Williams in the 1987 film, “Good Morning, Vietnam.” Cronaur had left three years earlier but his signature sign-on was still in use at the station.
“The Army had me doing newscasts on the radio, and then they made me anchor on TV,” said Lockman, who came to AFVN from Long Binh where he had served as Sector Defense Non-Commissioned Officer just before the Tet Offensive of 1969. “I did that awhile and then they put me in charge of teaching the uses of radio and TV to the Office of Propaganda for the RVN (Republic of Viet Nam). Then, I went in country, just going place to place reporting.”
Years later, Lockman was still using his voice to make a living as a consultant to the utility industry where he would speak at about 15 conferences a year.
“As a consultant, you’ve got to be able to talk to groups of anywhere from five to 500 people and display all of the knowledge and confidence and sincerity you possibly can,” said Lockman. “When you’ve got Parkinson’s, you can’t do that. I didn’t know that, but I just wasn’t able to keep it going. It got to the point where I was dreading conferences. The last year I opted out as much as I could. I just wasn’t making any impression and I knew it.”
Lockman was experiencing something typical to a patient with Parkinson’s, said Ross. “That’s one thing I hear from a lot of patients, that they start to withdraw from social functions,” she said. “Whether they realize it’s their voice or not, they realize that people are not responding to them the way they used to. They don’t get the reaction from people they want because they are not being heard. Or because their voices are very flat and monotone, people think their bored or uninterested, but really they’re not. It’s just that they can’t show it in their voice and facial expressions. So they start to withdraw. That’s what Parkinson’s can do, but it can be overcome. He’s a prime example of that.”
Four times a week, Ross and Lockman would practice a set of exercises that focused on sustaining phonation (voice), high and low pitch and monitored his vocal loudness, pitch and duration via a computer on the therapist’s desktop. There, Lockman would also say a set of functional sentences each session, trying to increase the loudness and the effort to get the voice up to a level where he can be heard in any situation.
“We start out saying just words, then increase to sentences, then reading paragraphs and then to conversation using that loud voice so that he can eventually be heard with background noise or in conversation at a distance,” said Ross. “He achieved every goal. He’s at 75 decibels (akin to a TV playing or the sound of a vacuum cleaner) or higher on every activity we do, and he’s told me that he’s now being heard in group settings, he can be heard at home, and others aren’t asking him, ‘What? Didn’t hear you!’ He’s getting responses.’”
“I had a client yesterday tell me that was the best I’ve sounded in years,” said Lockman.
But more challenges awaited over in occupational therapy, where Linda Preston, with 31 years of experience working with patients with Parkinson’s, worked on Lockman’s fine motor skills like buttoning up a shirt.
“It’s is the hardest of all the things they had me do,” Lockman said recently. “It’s stupid. It’s really stupid.”
His frustration is understandable. “People with Parkinson’s have a lot of trouble with dexterity,” said Preston who initiated Roane’s “Big & Loud” program in April 2014. “They have bradykinesia where their movements are very slow. So I taught him to consciously do it quicker, and to stretch the button holes first and to retrain him from going really slow to going faster. It took a couple of weeks, but he’s much faster and is able to do it more efficiently without getting frustrated.”
“That was a major problem, but she’s given me the tools to get over it mostly,” said Lockman. “I very rarely have to get my wife to help me now.”
After attending the LSVT (Lee Silverman Voice Treatment) Big & Loud training in New York City, Preston returned convinced that she alone could not adequately handle the demands of treating patients with Parkinson’s with gait and balance issues. “It was very obvious to me that gait and balance were the main goals of the program, and I would need a physical therapist’s assistance.”
That assistance came from physical therapist Andrea Branson. Branson, who became certified for the “Big” program last December and has over sixteen years of experience, worked on improving the motor skills Lockman had lost due to a lack of dopamine. A core group of eight exercises teaches patients with Parkinson’s to exaggerate all their motions – twists, turns, walking and arm swings.
“He was very stiff through his neck and through his trunk. He was very, very rigid,” said Branson. “His balance was OK – just a little off. One of his chief complaints was he couldn’t move his neck. He had a lot of stiffness. We worked on arm swing because he tended to do smaller steps with his arms just hanging by his side. Toward the end (of therapy), he was able to get in and out of bed without problem, his walking improved a lot, he had a lot more arm swing, a lot longer stride and he could turn his head while driving.”
“I think one of the good things about our program is that we do have both PT and OT doing it,” Branson added. “Because, if you ask me how to button a shirt, I’m not going to know how to teach that or how to teach somebody to write. That would be something that would totally get ignored if it was just me doing it, but Linda is wonderful at doing the fine motor skills part of it. So I think we complement each other nicely because I do the balance-and-walking activities and she does her buttoning-and-writing activities.”
Twist, shout and button up – Lockman has done it all, and is glad he did. “Each element – the occupational, the physical and the speech therapy – all have been a tremendous help. It really has,” said Lockman. “Just knowing what to do about the problem makes a major difference.”
For more information on services available at the Patricia Neal Outpatient Therapy Center at Roane Medical Center, click here.