A comprehensive approach to treating Parkinson’s

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As Parkinson’s Disease progresses, patients face losing their ability to walk, talk and complete their daily activities. There is no cure for the disease, but a proven therapy is here to help. Tri-County Health Care utilizes a comprehensive approach of certified therapists in physical, occupation and speech-language therapy when treating Parkinson’s. This approach, known as the Lee Silverman Voice Technique (LSVT), offers relief and treatment for patients with Parkinson’s.

Tri-County Health Care Treating Parkinson's Disease Rehab Physical Therapy Occupational Therapy Speech Therapy LSVT BIG LSVT LOUD

Parkinson’s Disease Awareness Month

April is Parkinson’s Awareness Month, making it a perfect time to explain the disease and its treatments. While it’s likely you’ve heard of the disease; it may not be well understood. The condition occurs when there is a loss of brain cells that produce dopamine. It usually presents itself in people over 60, and approximately 60,000 people in the U.S. are diagnosed each year.

The four common symptoms include tremors, limb and trunk stiffness, bradykinesia (the slowing down of movement) and weak balance or coordination. Parkinson’s symptoms exacerbate over time and as they become worse, patients may start to have trouble with everyday tasks.

What is LSVT?

LSVT is an effective, evidence-based approach to treating Parkinson’s. Its programs have been scientifically and clinically proven to improve balance, walking and general movement and speech patterns of patients.

Through targeted and repetitive exercises, the therapy takes advantage of the brain’s ability to adapt and form new neural connections. It enables people to create new motor-skill and language memories and apply them to their real-world situations.

Get back to everyday activities – LSVT BIG

For people living with Parkinson’s or other neurological conditions, gestures and actions become smaller. They may find everyday activities like getting around or getting dressed become difficult.

LSVT BIG effectively trains improved movements for any activity. It improves walking, self-care and other tasks by helping patients “recalibrate” how they perceive their movements with what others see. Research has shown the program improves ratings on tests of motor functioning in people with Parkinson’s, including:

  • Faster walking with bigger steps
  • Improved balance
  • Increased trunk rotation
  • Improvements in activities of daily living such as bed mobility
  • Improved UPDRS Motor Score

LSVT BIG utilizes program-certified physical and/or occupational therapists, including Trenda Hoemberg, physical therapist, and Caitlyn Wolter, occupational therapist. Our staff provided their perspectives on the value or the LSVT program:

Tri-County Health Care Treating Parkinson's Disease Rehab Physical Therapy Occupational Therapy Speech Therapy LSVT BIG LSVT LOUD

“Individuals with Parkinson’s disease often struggle with daily tasks such as getting up from the chair, walking and balance. Providing the LSVT BIG program has allowed me to increase a patient’s independence throughout the day and limit support needed from their caregiver,” said Trenda. “My favorite part of being an LSVT BIG provider is when patients tell me they can walk outside without the use of a walker or cane, getting in or out of the car without help, and being able to visit with family or friends. I love watching individuals achieve their goals and engage in activities they previously enjoyed.”

“Parkinson’s disease can, unfortunately, take a lot of independence away from people. Our patients often have difficulty with basic daily tasks that were once easy to them, such as getting dressed or doing household chores. Being an LSVT BIG provider has given me the opportunity to watch my patients take back some – or all – of their independence,” said Caitlyn. “My favorite part of this program is when patients tell me they are able to button their shirt again, climb back into the tractor, or be able to play with their grandkids again on the floor. It is a rewarding program to be a part of.”

Effective speech treatment – LSVT LOUD

LSVT LOUD is an effective speech program for treating people with Parkinson’s disease and other neurological conditions. It trains people with Parkinson’s to use their voice at a more normal loudness level while speaking at home, work or in the community. One key to the treatment is helping people recalibrate their perceptions to know how loud or soft they sound to other people and feel comfortable using a stronger voice at a normal volume.

These programs were developed and scientifically researched for over two decades and have led to an improved impact on multiple levels of functioning in people with Parkinson’s, including:

  • Increased vocal loudness
  • Improved articulation and speech intelligibility
  • Improved intonation
  • Improvements in facial expression
  • Changes in neural functioning related to voice and speech

This treatment is delivered by over 16,000 certified LSVT clinicians around worldwide, including Meghan Current-Cary, speech-language pathologist.

“Providing the LSVT LOUD program to patients with Parkinson’s disease has allowed me to watch big gains in their ability to communicate. Talking with family and friends is a vital part of our lives and something that most of us take for granted. Communication difficulties cause a decrease in one’s ability to state their wants and needs and impacts connections with loved ones,” said Meghan. “I enjoy hearing LSVT LOUD patients’ voices become stronger. My favorite aspect of this therapy is observing patients tell their family and friends ‘I love you’ in a loud, clear voice which they may not have been able to do prior to completing this therapy.”

Getting help at Tri-County Health Care

Our team of LSVT-certified physical, occupational and speech therapists are trained in treating Parkinson’s. This treatment is customized to the needs and goals of each patient. Patients attend treatment four days a week for four weeks and must be referred by a provider or specialist. Achieving improved walking, balance, vocal loudness, and speech intelligibility are all available. Ask your provider about this treatment program today. To learn more, visit TCHC.org/rehab.

Occupational Therapy Month-Getting back to normal

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Occupational therapy is a hands-on science designed from the ground up to get you up and moving. After an injury or illness, some find it difficult to return to work or complete chores. It can be a tough moment for a person to realize they can’t make their bed anymore or go to the restroom without help. That’s where an occupational therapist can help. April is Occupational Therapy Month and the occupational therapists at Tri-County Health Care stepped up to share some of the finer points of their care mission.

Occupational therapists do more than help a patient get back to the 9-to-5 grind. They help people of all ages, from infants to the elderly. They have one mission, and that’s to get you back to normal.

Occupational Therapy Month Occupational therapists OT Tri-County Health Care

Caitlyn Wolter

“Occupational therapy is a profession that addresses the health and well-being of people through the entire lifespan,” said Caitlyn Wolter, an Occupational Therapist at Tri-County Health Care. “We focus on their ability to participate in everyday occupations such as dressing, working and household management.”

What to expect

During the initial meeting with Caitlyn, to figure out your functional limitations and establishes a plan of care to get you back to your baseline, or as close to it as possible. She wants to know exactly what’s holding you back from enjoying life to the fullest like you once did. Each person is unique, so her strategy of care is equally unique. Every step of the process is tailored to the patient’s activity level, profession and goals.

One challenge is that patients often have an expectation that they are able to regain function in just a couple of visits. Caitlyn explains to patients that the road to recovery is not always a quick process. She believes the key is to be truthful and have a direct conversation about the body’s healing process and the time it can require.

Occupational Therapy at Tri-County Health Care

So, how does occupational therapy differ at Tri-County Health Care versus other organizations? Caitlyn explains: “We can practice in a wide array of settings – all of which are different and unique in their own ways. This is especially true working at Tri-County as we get to dabble in a variety of patient populations every day.” These patients include those from orthopedics, neurology, inpatient, pediatrics and more!

Katie Boutiette

Occupational Therapy Month Occupational therapists OT Tri-County Health Care

“I chose occupational therapy because I wanted to join a profession that serves others. I also have a passion for helping kids with disabilities,” said Occupational Therapist Katie Boutiette.


Katie helps her pediatric patients to gain or regain skills needed for playtime, school, self-care, or emotional regulation. The process is gradual but little by little, they can increase independence in their everyday tasks. Working as an OT helps make those personal moments of freedom happen.

“Occupational therapy to me is people reaching their full potential. It’s meaningful occupations made up of self-care, leisure, play skills and emotional regulation,” said Katie.

The therapy doesn’t stop at the end of an appointment. The idea of continued growth needs to be a concern for all patients. Katie stated that one part of her job is teaching caregivers and parents to initiate strategies at home to maximize their child’s progress. Increasing patient’s function requires daily work but with guidance from Katie and a fighting spirit, patients can accomplish it.

Kids and care

Much of the work Katie does centers on kids. According to her, the most rewarding part of her job is watching parents’ reactions when their child does something for the first time. This can be a toddler who now stacks blocks, a child with emotional outbursts who can now self-regulate, or a school-aged kid who is now able to write their name.

Watch and listen

Treatment is guided based on whether a child has behavioral issues or a developmental delay, which Katie determines during her evaluation. The next step is looking at how the child performs at school and home. Is playtime difficult? Do they have emotional outbursts? After getting to know the child, Katie provides specific strategies for the child and family to initiate at home.

Celebrate and grow

To observe Occupational Therapy Month, reach out and thank your local OT. While you recognize their work, look to the people they helped. We all know someone whose life was changed by an occupational therapist. Take some time to recognize those who suffer in silence and the people that help them.

Tri-County Health Care is hosting a FREE developmental screening for all children – infancy through adolescence – on May 25 from 4-6 p.m. This screening will identify areas of concern that may need further evaluation. Call 218-631-7475 to reserve your screening appointment!

Click here to learn more about Occupational Therapy Month and all of the rehabilitation services at Tri-County Health Care!

April is Occupational Therapy Month. Occupational Therapy Month Occupational therapists OT Tri-County Health Care

Grow Strong with Pediatric Rehab

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Parenthood comes with challenges, big and small. Nothing is more anxiety-inducing than noticing your son or daughter isn’t developing as they should. New parents will have a whirlwind of questions and concerns. The Pediatric Rehab Team at Tri-County Health Care is here to help so your kids can grow up strong!

Pediatric Rehab offers speech therapy

Free screening

Have you noticed that your baby has a difficult time crawling? Is it taking longer for your child to speak their first words? Concerns like this may indicate developmental issues that can be detected with screening. No parent should have to go it alone, so Tri-County’s pediatric rehab team is hosting a free screening event on Nov. 17. The screening will take place from 4 to 6 p.m. at the Wadena Rehabilitation Clinic.

This is the first time Pediatric Rehab has offered free screenings. Each step of the process allows for the efficient flow of patients. “One goal is to offer parents more access to services. It’s a way to talk to each discipline about concerns,” said Meghan Current-Cary, Tri-County’s Speech-Language Pathologist.

COVID-19 precautions will be in place during the screening. To participate, parents will need to call and reserve a 20-minute time slot. After checking in, the child will have 10 minutes with physical and occupational therapy, then 10 minutes with speech. After the screening, the parent will receive feedback on their next-steps. If follow-up carry is necessary, your child will receive personalized care best suited to meet their needs.

Grow strong with pediatric rehab and reserve an appointment by calling 218-631-7475. Time slots are limited, so act quickly to reserve your spot.

For more information about Pediatric Rehab, click here.

New additions to the team

Pediatric Rehab is growing. They recently welcomed Kathryn Boutiette, OTR-L to the department. She will be assisting with occupational therapy.

Occupational Therapist Kathryn Boutiette works in the Pediatric Rehab Department

Kathryn Boutiette, OTR-L

Steamroller provides children a new sensory experience

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Preston Porter is a smiley, active and enthusiastic 8-year-old. But sometimes, because of his ADHD, autism tendencies and sensory issues, he has a difficult time controlling his hyperactivity.

More than a year ago, Preston participated in occupational therapy (OT) at Tri Rehab Services in Wadena to help him regain control, and he recently came back for another round. This time Steamroller device with Preston standing in between the rolls.around, the OTs had a new device in their arsenal of treatments.

It’s called a steamroller. It uses soft but firm rollers with adjustable tension bands to put deep pressure on children as they crawl through the device. This produces a calming effect and allows children to gain control of their motor activity and achieve a more accurate sense of touch. It also promotes shoulder strengthening and stability as the children pull themselves through the machine.

“He really, really enjoys it,” said Preston’s mother, Karen. “He thinks it’s the coolest thing in the world.”

“Preston loves the steamroller,” confirmed Lora Foust, Preston’s occupational therapist. “The hardest part for him is slowing down enough to get the full benefit. One of his goals is to stick with one activity for at least five minutes. He can get to four with the steamroller. We hope to get him up to 10 minutes, as needed for focusing in school or to receive instructions at home.”

Children revel in the challenge of pulling themselves through the rollers while being flattened by it. They can also hang out in the steamroller while working on other activities such as reading a book or completing a puzzle. Sitting in the steamroller during these activities helps to focus their attention and calm them down.

Preston excitedly looks forward to his OT appointments each week and knows exactly what to do when Lora pulls out the steamroller. Karen also noted that Preston’s school in Sebeka recently added its own steamroller to its sensory room, giving Preston even more opportunity for progress.

Now that Preston has been working in OT and with the steamroller for a number of weeks, his improvement is evident.Preston being squished through the steamroller.

“Preston’s mother reports that the teacher at summer school states that when Preston has OT before going to school, he does much better in school,” Lora said. “He went through it 10 times at the onset of the session, then was able to sit down to a fine motor activity for 17 minutes!”

Karen believes there is a lot of misconception out there about children who have ADHD, autism spectrum disorder or sensory issues. If children do suffer from these issues, she said that they should get them checked out and try treatment such as occupational therapy.

“I never thought something like this would help my son. Before OT, he had no control,” Karen said. “He learned how to control his impulses and hyperness. He learned to calm himself down. It has made a world of difference.”

The steamroller was funded by a Moen Brothers grant through the Tri-County Health Care Foundation.

The Moen Brothers grant assists area youth throughout the year. It is used for equipment or educational programs that specifically benefit youth in the Tri-County Health Care service area with physical or cognitive impairments. For more information about this grant or the Foundation, please contact Ryan Damlo at 218-632-8148 or ryan.damlo@tchc.org.

Of willpower and wonders: overcoming the odds with occupational therapy

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By Jessica Sly, Communications Specialist


Holding a fish for a photo. Playing in the snow. Assembling a Lego creation. These are all typical activities of a young kid, and yet, up until September of 2017, they were things that 10-year-old Jacob Cronk couldn’t do.

Jacob has severe sensory issues, meaning he doesn’t like to touch certain textures or be touched. He also has a plethora of diagnoses, including autism spectrum disorder, attention-deficit hyperactivity disorder, mood dysregulation disorder and oppositional defiant disorder.

Jacob’s parents, Tina and Phil, have been managing his sensory issues for as long as they can remember. “Anytime he would get anything on his hands, he would go into a major meltdown,” Tina said. “His meltdowns went as far as throwing himself on the ground or head-butting the wall.”

The problems became more evident when Jacob started preschool. Even the simplest tasks such as using scissors or eating lunch were nearly impossible.

There are very few foods he will eat, so most of his meals consist of a salad or sandwich. His parents have since had to supplement his diet with nutritional drinks but are struggling to gain insurance coverage.


Coping as a parent

Tina and Phil recently enrolled Jacob at White Pine Academy/Leaf River Academy in Deer Creek, a school for autistic and special needs children. On top of regular schoolwork, the educators help the kids develop social, behavior and coping skills.

“I’ve been in denial over having to put him there,” Tina admitted. “As a parent with a kid of special needs, putting him there makes you always think, ‘I’m going to be looked at different. I’ll be looked at as if I can’t handle my child.’ I feel like that all the time.”

Those fears occasionally come true when Tina brings Jacob along on shopping errands. When he acts out, Tina becomes the target of stares and whispered words such as, “He just needs to be spanked,” or “He just needs to be disciplined.”Photo of Jacob during his occupational therapy session with therapist, Lora Foust.

“Obviously, just because kids melt down doesn’t mean they’re not being disciplined,” Tina said. “Kids with special needs have meltdowns. But they don’t see the big picture. And I want to open my mouth so bad some days.”


Trying something new

Last year, during one of Jacob’s appointments at Tri-County Health Care’s behavioral health, Tina and Aaron Larson, M.D., developed a new plan to help Jacob’s sensory issues: occupational therapy (OT).

Jacob attends OT twice a week with Lora Foust, certified occupational therapist, one day on land and one day in the pool for aquatic therapy. Lora works with Jacob in a sensory-rich environment to help him adapt to various textures or movements. They also focus on hand-eye coordination and dabble with light weights in the gym.

“Lora has done wonders for him,” Tina said. “He’s had a couple bad meltdown incidents, and I thought she wouldn’t want him to come back or she’s not gonna want to work with him anymore. She doesn’t let that bother her. Lora always has him come back. She says, ‘You know what? It was a bad day. Everybody’s allowed to have bad days.’”

Jacob participates in Taekwondo with brother as a supplement to his occupational therapy.Lora’s treatment reaches far beyond their appointments at the rehab clinic. Each week, she creates goals that incorporate OT for Jacob to work toward at home. For instance, she challenged Jacob to clean his room twice a week for two weeks straight. As a reward, she treated him to a pizza party.

“That was something he looked forward to,” Tina said. “He made his goal. He worked so hard for that.”


A life changed for the better

Now more than seven months later, consistent OT has made all the difference in Jacob’s life and then some.

“From the time he was little, he would never ever even go near a fish, touch a fish, whatsoever.” Tears welled in Tina’s eyes. “Since he has started working with Lora, he will now touch them. He will go fishing. And that’s all he wants to do.”

Jacob has also begun playing outside in the snow, building with Legos, and washing his own hair in the shower, activities that used to be far out of reach for him.Jacob coloring Easter eggs.

“He’s hit a lot of milestones since he started OT,” Tina said. “He has had more willpower to learn now than he ever has.”

To further build his behavioral skills, Lora recommended taekwondo at Mid-Minnesota Taekwondo in Wadena. The experience has done wonders for both him and his younger brother, Maverick, who joined with him. Jacob has learned self-respect, as well as how to treat adults and other children with respect.

The road going forward for Jacob will likely contain more setbacks and successes, but Tina is proud of how far her son has come.

“I would never change him for the world because he is made how he is,” Tina said. “He’s the sweetest kid ever. We all have our good days and we all have our bad. He’s just made how he is.”

Occupational Therapy Turns 100!


By: Lora Foust, Occupational Therapist (O.T.)

This April we are celebrating the centennial anniversary of Occupational Therapist (O.T.) becoming a profession. The profession has changed much over the 100 years since it started as a profession, even in the past 30+ years since I’ve been involved. Since then, we’ve created practices, workshops, certifications, academic programs, accreditation standards, and much more! The American Occupational Therapy Association (AOTA) represents 213,000 occupational therapy practitioners and students in the United States.

The United States Department of Labor describe the work that occupational therapists do as: “treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working.”

I personally chose to go into this field because it’s a helping profession that uses my psychology training, creativity, and my belief that meaningful activity is healthy. My favorite thing about my job is to see the smile on a patient’s face when they do something they did not think they could ever do again or do a desired activity for the first time.

There are several misconceptions that I see with the O.T. profession. Some people have a belief that our job is to help someone

Lora Foust, O.T.

get a job, or that it’s the same exact thing as a Physical Therapist. Both of these are untrue. The word “occupational” is used to indicate meaningful or functional activity, such as eating, dressing, or casting a fishing line. Physical therapists (P.T.) traditionally use physical modalities, such as heat, massage, or exercise. Occupational therapists traditionally use therapeutic activity, such as games, crafts, or self-care tasks. These roles are more blended now with both using physical modalities and therapeutic activity; however, the P.T.s are experts on the lower body, spine, and neck, while the O.T.s are experts on the upper body and sensory issues.

A favorite memory of mine was of a two-year-old boy who was so uncomfortable with any sensory experience; he would not sit on a swing, even 2” from the ground. After working with us for a while he could climb to the top of the waterslide at the Maslowski Center, slide down and swim to the rope by himself! Another patient that sticks out to me was of a woman that I treated who was 100-years-old. She could no longer see or hear baseball games on TV. I got her set up with a digital book player that could be adjusted to a low and slow tone she could hear. She could now listen to baseball stories! These things change the patient’s lives, but also me as their Occupational Therapist. What keeps me motivated every day is seeing my patient’s progress.

About the Author: Lora Fourst, O.T., has worked for Tri-County Health Care for nearly six years. She received her Bachelor of Art Degree in Psychology and a Bachelor of Science in Occupational Therapy. She also completed her Master’s Certificate in Low Vision Rehab.