Move BIG - Ryan G., PT
Farley BG, Koshland GF. 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. 2005; 167: 462-467.
The following is a critique I have done on a somewhat recent treatment for Parkinson’s disease (PD). PD is a debilitating progressive disease that is characterized by bradykinesia, episodes of akinesia, resting tremors, and other movement disorders. All of the disorders cause a great deal of functional loss for the patient. In addition, PD’s onset is often associated with an elderly population. This further compounds and ads increased complexity to the treatment of the disease. Numerous studies have been conducted to improve the movement of patients with PD; one such study addresses the concept of “Move BIG” to the production of movement in patients undergoing physical therapy for PD.
The purpose of this study was to test the hypothesis that training large amplitude movements in patients with Parkinson’s disease would help improve the amplitude and speed of movement of functional tasks of the upper and lower extremity thereby reducing the bradykinesia and hypokinesia found with PD. The subjects utilized in this study were 18 elderly people with an age ranging from 58 to 76 (11 males, 7 females). In addition, the participants were eligible if they had no medical complications that would interfere with limb movements or exercise, were diagnosed with PD by a neurologist were required to be stable on medications. Exclusion criteria included other neurological diagnoses and prior participation in a similar PD program.
In the study, the independent variable was the Move Big protocol of “BIG” stretches and “BIG” movements. The dependent variables were the patients’ performances in functional gait tests for stride length, velocity and cadence and functional reaching tests for speed under preferred speed and fast as possible speed conditions. From these dependent variables the results of the study found that with the reaching tasks, velocity increased for the longest distances after training BIG. For the functional gait analysis, the preferred speed condition yielded an increase in velocity and step length after BIG training, and the fast as possible condition yielded an increase in step length without a concomitant increase in velocity or cadence. In summary, the results supported the hypothesis that amplitude and speed of functional movements was increased due to the application of Move BIG.
Some threats to the validity of the study include a small population size. The small population size hurts some of the external validity and generalizability of the study. In addition, the study had to be conducted with the patients on their current medications. For this reason, there will be difficulty in being able to discern whether the improvements were due more towards the medications versus the Move BIG interventions.
The study has a great deal of clinical significance to the OT/PT realm of rehabilitation. For example, the hypothesized Move BIG protocol could be used to help develop a program to aid in the rehabilitation and treatment of patients with PD. The stretches and movements utilized in the Move BIG protocol help to also work on musculoskeletal and cardiopulmonary rehabilitation thru the stretching of soft tissue and active movements. More importantly, based on findings from the study, there is advocacy for as early as possible treatment and interventions. For this reason, the study provides additional evidenced based practice to justify OP/PT interventions to insurance companies and other medical professions.
