physicaltherapist – The Rainbow OT

Out in Healthcare: Madison Kirkpatrick, SPT, M.S, CSCS, LSVT BIG

Name: Madison Kirkpatrick

Pronouns: She/Her/Hers

Identity: Pansexual and asexual cisgender female

Background: I was born and raised in Eureka, CA. I grew up in an extremely conservative household that made me feel unsafe and forced me to repress my emotions and my identity. I completed my B.S. in Kinesiology: Pre-Physical Therapy with a Health Education minor in three years and then earned my M.S. in Kinesiology: Exercise Science in one year, after which I published my thesis research. I was accepted into the Doctor of Physical Therapy program at the University of St. Augustine for Health Sciences- Austin, TX campus. I will graduate with my DPT at the end of November 2020. I met my now wife during my M.S. and we got married in 2019. In my free time I enjoy spending time outdoors with my wife and our two puppies.

Profession: Physical Therapist

Area(s) of Practice or Interest: Pelvic floor PT with an emphasis on the LGBTQ+ population and outpatient orthopedics so I can treat other types of impairments beyond the pelvic floor.

What does being ‘Out in Healthcare’ mean to you?: Being out in healthcare means being visible to others so the future generations have the representation I did not have growing up, and it means fighting for health equity, justice, and healthcare inclusion for all marginalized communities. As someone that understands what it is like to have to deal with healthcare disparities simply based on my identity, being out in healthcare is taking on the system full force to improve the lives of my community and the lives of all marginalized communities.

What is one thing everyone should know about your identity?: I don’t like labeling my identity. I label my identity for the people that “have” to know. I am asexual, an identity that doesn’t get a lot of attention, and where I am on the asexual scale personally is that I have never been attracted to anyone I have ever met other than my wife. I am theoretically attracted to all identities of humans, hence why I use pansexual, but in reality, my asexual identity and my lack of interest in the labels another person uses are more who I am at my core (I respect everyone’s labels, but that doesn’t influence whether I am attracted to them or not).

How do you feel when your identity is included?: I feel seen and respected when my identity is included. I feel like my identity is as valuable as the heterosexual identity has been systematically respected historically.

What does “taking up space” mean to you?: Taking up space means taking ownership of the space that has historically given to heterosexual people but denied to members of the LGBTQ+ community. It means demanding that my identity and needs get as much attention as anyone else and it means fighting for more and more space for those that come after me. It is advocacy, it is radical, and it is vital to equity and justice for the LGBTQ+ community.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Put the work in to find the answers to the questions they have about how to honor the identities of their patients. It is not the job of a marginalized community to educate the majority, but there are a number of people from marginalized communities that do fill the role of educator and their resources are plenty and widespread. All it takes is a little Google searching and/or social media perusing. Once they have answers to their questions, it is time to put in the work and put those answers into action. Once the action is being taken guess what? It’s time for more work. It is time to continue to learn and grow, and it is time to teach others and fight for the rights of their patients. The work never stops.

Has your identity influenced healthcare that you’ve received?: My identity has caused me to deal with subpar care from my primary care provider who asked me about my sexual activity and then spent a lot of time asking if I could be pregnant (multiple questions about this, to which I answered no every time), didn’t ask me if I was using protection, and then was shocked when I told him I was in a relationship with a woman, which I only told him because he wouldn’t stop grilling me about pregnancy. The visit was really uncomfortable after that, and it felt like he was rushing to get my visit done as quickly as possible. Ultimately, I was not educated on STIs, asked if I felt safe in my relationship (thankfully my wife isn’t an abusive person), or anything else that would normally be routine.

Where can people find you?: I am on Instagram @lgbtqphysicaltherapists and my email is lgbtqphysicaltherapists@gmail.com.

LSVT and Me

Picture property of https://www.lsvtglobal.com/ — Citation

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!