Blog Travel OT

LSVT and Me

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What is LSVT/ LSVT LOUD?: “LSVT LOUD is an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions.  Named for Mrs. Lee Silverman (Lee Silverman Voice Treatment [LSVT]), a woman living with PD, it was developed by Dr. Lorraine Ramig and has been scientifically studied for over 25 years with support from the National Institute for Deafness and other Communication Disorders within the National Institutes of Health (NIH) and other funding organizations. LSVT LOUD trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Key to the treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level.” (LSVT GLOBAL)

While LSVT LOUD treatment has helped people in all stages of PD, the majority of research has been on those in moderate stages of the disease. LSVT LOUD has also helped people with atypical parkinsonisms, such as progressive supranuclear palsy (PSP), and has recently shown promise for adults with speech issues arising from stroke or multiple sclerosis and children with cerebral palsy or Down syndrome. Beginning your work with LSVT LOUD before you’ve noticed significant problems with voice, speech and communication will often lead to the best results, but it’s never too late to start. LSVT LOUD has the potential to produce significant improvements even for people facing considerable communication difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

What is LSVT BIG?: “LSVT BIG trains people with Parkinson disease (PD) to use their body more normally.  People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.” (LSVT GLOBAL)

Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in early or middle stages of your condition, when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

Method: Completed the online certification program (also an in-person program with same materials) I would personally would have done the in-class program if it were available to take around me and with the changes associated with COVID I was limited to the online course. I am a hands-on learner but still feel prepared to implement a LSVT program via the online certification course. Certification acquired by completion of LSVT Global’s LSVT BIG Online Course Modules (40) while achieving an 85% or higher on the final examination.

Time: 12.5 hours of course material with average of 16 hours of completion for clinicians, over 90 day period. If you need extra time, you can purchase extensions in 30 day increments. I used almost all of the 90 days (83 days total) to complete the course. Some barriers were working full time, traveling between multiple areas (travel therapy), and lack of motivation to start. Once I completed the first 5 or so modules, I was able to speed through multiple modules at a time. 

Cost: $580.00, $50.00 every two years for renewal. Fortunately, with a bonus from extending my travel placement, I was able to cover the cost of the certification.

Program: At least 4 1-hour sessions per week for 4 weeks, with daily exercises and tasks to completed outside of clinic time. If a patient requires additional time then you continue the program, with supportive documentation and assessment. Consists of 7 daily exercises, functional component tasks, carryover tasks, and hierarchy tasks. Facilitation of the program includes specific and simple cues from the clinician, with the use of modeling and tactile cuing techniques. There is daily homework for the patients that must be completed for the best outcome. 

Why I chose to pursue the LSVT BIG certification as an Occupational Therapist: I have always loved all thing neuro/neuro rehab! I have started the quest to enhance my knowledge in neuro-focused areas through continuing education unit courses (CEUs), certification programs, books, journal articles, podcasts, and research articles. In my year and a half long career thus far as an OT, I have worked with many individuals who live with a diagnosis of Parkinson’s Disease (PD). I briefly learned about the certification course (LSVT BIG) in college and also know friends/colleagues that had already obtained the certification. I have always heard positive reports about the LSVT program and decided to look into in further. An online course was the best option for me and I was in a financial position to purchase the course so I decided to go for it. I am also looking into the Impact OT (ITOT) certification and the Certified Brain Injury Specialist (CBIS) certification for the near future to continue on my neuro-focused journey!

Pros of LSVT Certification/Program: Set protocol to follow, but also individualized based on client’s goals and functional needs. Can be completed in multiple settings, and initiated by a LSVT certified OT in SNF and completed by LSVT OT in HH. The program is evidence-based. The exercises and task are modifiable to patient performance level, with multiple options on grading the activities up/down as absolutely needed. When the certification program is purchased, one receives an LSVT resource book with the modules, exercises, and handouts inside (also available online). I started with re-writing all of the notes from the modules by hand because I didn’t want to wait for the resource book to arrive, as I usually start with this method for studying. I would recommend just waiting for the book or taking online notes if that’s more your style, because re-writing by hand definitely slowed down my completion of the modules. The program has a ton of built in repetition so if you have to complete it in chunks like I did then this is really helpful. There is also a quiz at the end of each module to check for learning of objectives and course material. The repetition and quizzes made it so I had minimal final exam prep to do. The LSVT BIG program is able to be generalized to other neuro populations as long as they meet certain criteria. 

Cons of LSVT Certification/Program: A patient must complete at least 4 weeks, with 4 1-hr session per week, as the evidence only supports a program of this length or more. Program is more affordable than a lot of certifications, but cost is still a barrier to obtaining certification. Program not yet available via telehealth.

Overall, I think the LSVT BIG certification program for Occupational Therapists is worth it!

Blog Travel OT

Experiences as a Home Health OT in Multiple States

During my travel therapy career, I have worked in California, New York, and am also licensed in/planning to work in Colorado. So far, I have worked in subacute inpatient rehabilitation and home health settings, with more placements in home health at this time.

To be as transparent as possible, my time in home health in California was less than desirable. Not because of the setting itself, but because of the company I was working for. This was my first job after passing the OT board exam. My best friend and long time education partner, Sydney, and I drove from Rochester, NY to San Jose, CA to start travel therapy together.

The company I signed a contract with required me to cover two areas, including but not limited to: Antioch, Orinda, Vacaville, Vallejo, Rio Vista, Concord, Bethel Island, and Oakland. San Jose was a halfway point (or so we thought) for both Sydney and myself to commute to our respective work areas. Sydney was working in school-based pediatric, covering a county. Unbeknownst to the both of us, California traffic is no joke, especially in the Bay Area. I had to commute approximately an hour and a half to two hours to see my first client, and then repeat that for my drive home. I had to see six patients a day, with most of them being evaluations, revisits, and discharges. My orientation consisted of a three day in-class lecture series and no field training. At the time, I had no understanding of the coveted home health point system, from which your productivity is calculated. Thankfully, productivity was never mentioned for me, so I would be safe to assume I was meeting their requirement. We were provided with a bag including wipes, soap, sanitizer, barrier sheets, a laptop, a work cellphone, charging cord, theraband, and theraputty. Though I am thankful for the resources provided, the laptop was cumbersome to carry around and needed to be charged 2-3x per day. As a practitioner that is focused on providing quality, evidence-based, and client-centered therapy, I took most of my documentation home with me. Another part of home health is regularly scheduling patients, calling MDs or related providers, and coordinating with schedulers and office staff. So, with the daily commute to and from the areas, patient care, and documentation, I regularly spent 16-18 hours per day doing work or completing work-related tasks. In retrospect, I was in the perfect environment for burnout and that’s exactly where I landed. I specifically remember breaking down on the phone with my recruiter because I just couldn’t do it anymore. We were able to work a new system out with the OT supervisor due to an opportunity for me to move my area to San Jose. My commute drastically decreased and I was spending 8-12 hours per day on work and work-related tasks, though I was almost always behind on documentation due to a high-level of burnout. I made an effort to battle the burnout with weekly trips to various National Parks and hikes in Northern California, and completed daily documentation outside at parks or near the beach as much as possible. The contract was originally for 13 weeks, and we extended to 16 weeks to take us right up to Christmas time. There was an offer to return after the holidays, but I knew that my time with that company needed to end. Sydney also experienced burnout covering an entire county of under-served pediatric populations and decided to stay at home and not return to travel therapy. I am so thankful for having her with me for that journey, I really don’t know how I would have made it out of their with the little bit of energy that I had left without her.

A year later, I finally encouraged a close friend Sara to jump into the travel therapy world with me. We got lucky with an offer of two contracts with the same company, in the same area of NY. I was resistant to accepting another home health contract due to my previous experience, but I knew it was fair to give the setting another try with a new company. Due to gained experience both as a practitioner and interviewer/interviewee, I was able to determine that this company had an ethical outlook, manageable coverage area, and manageable productivity expectation. With the added bonus of working for the same company, Sara and I jumped on the opportunity and were both offered contracts with the company. Their orientation was a full week, with class time and field time. It was refreshing to have training under an OT preceptor, just to learn the ropes of the tablet and company operations. We were provided with the same protective equipment and bag, a balance pad, cones, a gait belt, a car charger, a tablet (instead of laptop), theraband, and theraputty. I covered one area that consisted of a cluster of 5-6 towns within a 30 minute radius, which seemed rather easy when compared to the 60 minute radius that I covered in California. I worked with a few COTAs in the area who took over a majority of my routine visits. Halfway through the contract, I moved to an area closer to where my partner and I were living and worked with one COTA, Shekera, who is out-of-this-world amazing. I extended my contract to mid-may with the company, though my contract was cut short due to PDGM. I was served a 30-day notice per my contract, and recently ended my contract on March 20th. The caseload was much more manageable, the scheduler and certain patient care managers were incredibly supportive. I was lucky to work with an amazing COTA, and didn’t have much experience with COTA supervision during my time in CA. The change to the Patient Driven Grouping Model (PDGM) did make working in the home health setting in general more difficult. The home health company I signed on with was bought out by a larger home health company shortly before my contract began. The company that shall not be named did continue to seek financial gain and stray from quality patient care in response to PDGM, in my opinion. The frequency of therapy visits was cut, there were conversations regarding cases being OT or PT only, and that OTs/PTs could cover each other’s scopes of practice, and OTRs became evaluation and discharge machines, while COTAs took over most routine visits. Through persistent advocacy and discussion, were were able to get the director to agree to providing the necessary visits per the practitioners discretion in order to meet each individual’s needs.

Pros: I enjoy the home health setting due to the fact that we get to evaluate, assess, and plan to provide interventions in an individuals natural environment. As an OT, what is better than that? I love the creativity that is required to use available resources and collaborate with a client to complete tasks they need to get through each day, with the greatest level of safety and independence. I love the change of environment throughout the day and ability to binge music or podcasts during the commute to each patient.

Cons: Even with a mobile tablet, I found that I continued to take work home with me. I don’t know about you, but when I get home I want to be completely done with work that is required of me. I found that I cannot compromise on maximizing direct client and face to face time during visits, as home health visits are not always lengthy in nature. If you own a car, expect to rack up some serious mileage. Though not an issue in California, hazardous weather can affect productivity and ability to see patients, especially in a state like New York during the winter months. The time spent on technology, whether it was my phone or tablet, was frustrating. In a time of technology, I found it difficult to step away from my phone or tablet and enjoy parts of my day. As someone who is 6’1″, the time in the car and looking at technology throughout the day definitely took a toll on my body.

Overall, I don’t think home health is my happiest place. I am thankful for my experience in the setting. As someone who strives to enter academia in the future, my experiences will allow me to share valuable information and speak on the reality of the setting.

References of OT practice guidelines and COTA Supervision:


New York: