Large, loud, learned: A proactive and integrative group to maximise independence and wellness in people with Parkinson’s Disease (PWPD)

Mrs  Natalie Grainger1, Mrs  Rachael Marlow1, Mrs Karen Thomas1

1NSLHD NSW Health , Ryde Hospital Eastwood , Australia

Maximising allied health resources to improve health outcomes for PWPD to live an independent and fulfilling life. This program is unique and innovative increasing value on available resources, collaborative practice and patient centred care.

Parkinson’s Disease (PD) is a common chronic neurodegenerative disease in the aged population. As the disease progresses the symptoms begin to amalgamate and the resulting complexities include freezing of gait, falls, micrographia, dysarthria, dysphagia, fatigue, continence, sleep and cognitive disorders. Exercise can minimise the progression through neuroplastic and neuroprotective changes. These symptoms and existing co-morbidities demonstrate the need for value based health care where the PWPD is empowered to be proactive in the management of their own disease.

Whilst LSVT LOUD and BIG programs are currently utilised and effective, they train targets in isolation. Long term gains from these interventions are usually decreased due to poor consumer motivation and maintenance of treatment effects as the disease progresses.

Neurological rehabilitation needs to be integrated so the health service can respond to growing numbers of chronic conditions in aged populations. The Large, Loud and Learned group will combine inter-disciplinary treatments and shared goal setting enabling an improved sense of wellness and re-enablement. High intensity of practical tasks will facilitate cortical drive and provide opportunity for social engagement and education.

The weekly group will run for 8 weeks with 9-12 consumers. Eligibility includes idiopathic PD, Hoehn & Yahr 1-2, commitment and no moderate-severe cognitive impairment. Exclusion criteria includes untreated depression and those house bound. Outcomes will be measured at 8-weeks for six months. Primary outcome measures include the UPDRS, Decibel readings, freezing of gait questionnaire and timed functional tasks. Secondary outcomes include carer burden, well-being, social participation and self-confidence. Carry over effects will be evaluated at 3 months post completion.

Currently there is limited research to determine the effectiveness of an inter-disciplinary group on functional gains in PWPD. The group will evaluate if combining treatments to replicate everyday tasks leads to greater functional change and well-being for PWPD living in the community.


Rachael Marlow is a Senior Occupational Therapy with over 20 years’ experience in neurological and community rehabilitation. She is currently employed as the Acting Manager in the Community Aged care and Rehabilitation Service (CAReS) within the Northern Sydney Local Health District at Ryde Hospital. Rachael has worked in a variety of settings including Inpatient, Community, Day hospital and Out Patients and is passionate about patient centred care.

Karen Thomas is a Senior Physiotherapist with over 30 years experience in adult rehabilitation including orthopaedic, geriatric, aquatic physiotherapy, musculoskeletal caseloads. She is committed to health coaching and incorporating exercise prescription as an ongoing lifestyle intervention. Karen is currently employed within the Northern Sydney Local Health District as the fracture liaison coordinator, part of the Osteoporosis Refracture Prevention Service (ACI). Her second role is the senior physiotherapist within CAReS.

Natalie Grainger is a Speech Pathologist employed within the Northern Sydney Local health District at Ryde Hospital. Her experiences range between inpatient, outpatient and community services across geriatrics, neurology, respiratory, disability and palliative care. Natalie is dedicated to achieving patient objectives and enhancing community well-being for elderly patients and those living with chronic conditions.

As a team we are committed to enhancing the lives of PWPD living in the community by collaborating together and providing innovative, evidence based, patient centred care.

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