Parkinson’s Disease: Nationally Recognized Expertise

Parkinson’s disease is chronic and persistent. Individuals living with Parkinson’s often have trouble controlling the movement of their bodies due to tremors, and can experience impaired balance, slowness of reflexes, and stiffness in their body. Currently, there is no cure. However, research has shown that movement—fast movements, quick movements—can make the biggest difference for those suffering from this progressive disease.
The Department of Occupational Therapy in Baylor University’s Robbins College of Health and Human Sciences is contributing to novel research in neurological conditions like Parkinson’s. Barbara Doucet, PhD, OTR, Clinical Associate Professor, Program Director of the Post-Professional Doctor of Occupational Therapy (OTD) program, and Director of Faculty Development and Scholarship, has gained national recognition as an expert in Parkinson’s scholarship by providing evidence and information on motor treatment strategies that therapists are using in practice.

“Much of my early career was spent focusing on stroke, up to the point where I started focusing on Parkinson’s,” she said. “We always said, ‘if you’ve seen one stroke patient, you’ve seen one stroke patient,’ and the same is true as what we’re learning about Parkinson’s. If you see one Parkinson’s patient, you’ve only seen one Parkinson’s patient, because it’s very much an individualized disease in the fact that people progress differently. The speed of progression can be very different between individuals, the presentation, and how it impacts a person’s function is all very individualized.”
According to the National Institute of Neurological Disorders and Stroke (NINDS), approximately 500,000 Americans have been diagnosed with Parkinson’s—the second-most common neurodegenerative disorder in the United States, just behind Alzheimer’s disease. As Parkinson’s attacks an individual’s central nervous system, it becomes increasingly challenging for them to complete simple tasks like swallowing, talking, and walking. Experts believe the true number of those living with the Parkinson’s is likely much higher—as many as 1 million Americans—due to individuals being misdiagnosed or undiagnosed.
Currently, many occupational therapists working with Parkinson’s patients use a movement program called LSVT BIG, which can be tailored to an individual’s specific needs and goals. As Parkinson’s tends to make an individual’s range of motion smaller and with less amplitude, the four-week program teaches clients to use big, exaggerated, and repetitive movements to help counteract the effects. Some evidence has shown these exaggerated movements help to recalibrate posture or balance, but it is not yet known if it influences whether people can perform their daily tasks.
“As an occupational therapist, I am focused on everyday living and getting people back to doing things that are important to them. For people with Parkinson’s, depending on the level at which they are functioning, it could be being able to put on a shirt or a jacket, or it could be being able to cook a meal, or it could be as ‘simple’ as manipulating your cell phone and putting it in your pocket,” Doucet explained. “So, it’s important to me that we discover the methods that can have the biggest effect on having people with Parkinson’s be able to participate in their daily living tasks—which eventually impacts their quality of life.”
Doucet began her research while serving as a faculty member at a university in Louisiana where her team launched a training program to certify occupational therapists in delivering the LSVT BIG movement program. They then partnered with clinics and hospitals in the area and were able to examine outcomes before and after clients participated in the program.
Shortly after initiating the training program and research, a dearly loved family member of Doucet’s was diagnosed with Parkinson’s.
“Ironically, about a year after we had begun, my husband was diagnosed. So, it was a blessing, for sure—not that anybody wants that diagnosis—but how blessed I was to be able to be in the research, to be at the forefront of what is most effective, and to be helping people maintain their function,” she recalled. “That certainly spurred things on, and it has helped me. Obviously, it intensified my passion and drive to do this, but it also allowed me to see things very differently—I saw people with Parkinson’s as a therapist before, and now, I am the wife of a person with Parkinson’s, my loved one—so it’s a different perspective. I’ve learned so much, and it’s certainly been an experience.”
Doucet’s ongoing work in the field has included national publications, showcasing her contributions to advancing research and treatment strategies. The American Occupational Therapy Association (AOTA) also asked her to be a part of a group tasked at creating a stronger body of evidence for occupational therapy, in which she and colleagues published a systematic review examining the occupational therapy interventions that can impact activities of daily living (ADL).
It was a first for Doucet, having never gone through the official process of publishing an AOTA-sponsored systematic review. The process took two years, and it was “quite extensive.” She and her colleagues started out with 600 articles and narrowed it down to identify which interventions were effective in improving ADLs in Parkinson’s patients. Through that review, Doucet and her time made several important discoveries. First, while there was evidence that exercise and movement programs can have significant effects on areas such as balance, gait, and posture, very few research studies had been dedicated to looking at whether people with Parkinson’s can participate in their important daily living tasks afterwards.
“We realized that there needs to be more research to really look at whether these people can resume their activities, not just that they’re having improvement in some of these impairment areas—but that they can actually go back and enjoy the things they love. It must have a bigger impact on their quality of life,” she said. “That has driven a couple of my colleagues, and myself, to really pursue looking at these movement programs and then measuring task performance.”
The team created a preliminary study that examined the LSVT BIG program to determine whether it made a difference in the speed at which people were able to perform three simple tasks: putting on a jacket, putting on socks, and putting a pillow into a pillowcase. In using those three basic tasks, the study found that those who participated in the LSVT BIG program were able to significantly reduce the time it took to perform these tasks—a notable finding given the predominance of bradykinesia (slowness of movement) in Parkinson’s. For the first time, evidence showed movement programs have the potential to improve how people perform daily living skills.
Doucet’s next project is to examine the effectiveness of programs that keep Parkinson’s patients moving after LSVT BIG is completed. For example, BIG for LIFE serves as a maintenance program, Dance for Parkinson’s offers free creative dance classes emphasizing smooth and coordinated movements, and Rock Steady Boxing uses the quick movements and mechanics of boxing to focus on balance, coordination, and core strength. Doucet’s husband is enrolled in Rock Steady Boxing, and Doucet will collect similar task-based outcomes that can result with participation in these programs. She is determined to find therapy strategies that are effective and successful with these individuals, and to promote engagement in movement programs that will make a difference in their quality of life.
Doucet believes her research can translate smoothly into academics, and ultimately, it will impact work in both the academic and clinical communities. She also wants to create an enthusiasm in some of her Baylor OTD students who might be interested to work with this population.
“I have been fortunate to publish on some of our work in national publications,” she said. “I love when our students can see that the faculty here within Baylor Occupational Therapy is disseminating research to our professional community. They know that their instructors are on the forefront of research, and that we are teaching them methods that we have found to be effective and to be evidence-based. And, hopefully, this gives them success in what they do when they treat patients in their own careers.”