How LSVT BIG Helped me in my Fight Against COVID: A Clinician’s Perspective

A Letter from Capt. William E Riley III, LPTA, LSVT BIG Certified, BS, USMCR.

William E Riley III, Elizabeth Saldana Riley at the Navy, Marine Corps, Coast Guard Foundation

Before I was accepted to Northern Virginia Community College for the PTA Program with Dr. Diana Venskus, PHD, PT, I was enrolled at Villanova University as a Marine Option, NROTC Scholarship recipient, which meant that I experienced first hand the Intense Training of Vietnam Vets at the Officer Candidate School in Quantico Virginia. The training was very similar to what is seen in the Movie “Full Metal Jacket” and the Actor who portrays the Drill Instructor, was an actual Marine Drill Instructor.

I actually got to experience the “Bulldog” Training two summers in a row and it was a life changing event to be able to accomplish that and I was one of the fastest runners in my Company, running the 5K in 17 minutes, being to do 20 pullups, and 100 sit ups along with 100 pushups if the Drill Instructor felt I needed some more motivation. I was stationed at 29 Palms, California, and my Battalion did not rotate, but instead we were the Experts who trained the other 26 Battalions on the finer points of Live Fire Desert Operations. Several people told me that God wanted me to be join the Oblates of St. Francis de Sales, so I put in my request to stay in the Reserves while I trained to be a Priest in the Wilmington, Philadelphia Chapter. I was in the Oblates for 7 years, taught High School for 3 of those years and then eventually studied at the Consortium in Washington, D.C. for the last two years where I developed a Chronic Case of Plantar Fasciitis.

The path to becoming a PTA.

The Physician that I saw for the condition was an avid Runner and he told me it would go away on its own and that Physical Therapy was expensive and not necessary. However the pain was excruciating and was 8/10 every day whenever I put weight on it. Podiatry did not help, the Surgeon wants to release both Plantar Fascia, requiring 6 months Bed Rest, and the Superior speculated that it was a factitious disorder and so I was allowed to see a Psychological Counselor. Nothing seemed to work so I took a Leave of Absence and joined a Church Choir and worked in a Computer Support Outfit called Laserquipt. In this capacity I met a coworker who told me that Physical Therapy would fix the Condition. I then used some of my Seminary Health Care and was referred to the Eng Brothers who had Physical Therapists who were very good at treating this Condition. One of the Therapists directed me to NIH to get the answers to explain why Physical Therapists were so good at fixing this condition was so elusive with the other Healthcare Providers, and that lead to my decision to join Dr. Diana, Assistant Professor Patty Ottavio, and Assistant Professor Karen Morey in the PTA program.

I did volunteer work at Fairfax Physical Therapy where the Owner Keith Scott, PT, Myofascial Release Expert, furthered my understanding of why the fascia is so important, and the proper way to utilize the techniques of John Barnes to treat Chronic Conditions in order to prepare me for the rigors of the Physical Therapy Program at Northern Virginia Community College. During the Clinicals, the most interesting treatment challenges were the Parkinson’s Patients and I noticed that additional training would be necessary to understand how Motor Control, Motor Planning, would be needed to implement “Physical Activity that Boosts Health and slows Aging.”

Genesis Health Care provided training for NDT and Neuro IFRAH which was very helpful but as I went from Genesis, to Sunrise Facilities, and Rehab Care I started hearing about LSVT BIG. I was a PTA at all the Military Retirement Centers and met my wife Elizabeth at the Navy Marine Coast Guard Facility and the Program Director was a PTA named Jamie Armstrong and she suggested that I transfer to The Hebrew Home of Greater Washington to sharpen my skills.

The decision to get LSVT BIG Certified.

My Supervising PT there was Dr. Max Collins, and he had just recently been trained at the Fox Rehab Center in Cherry Hill New Jersey and even though there were several PT’s at the Hebrew Home who had gone through the course, he suggested that I take the course and Rehab Care reimbursed for the training. The course reminded me of my Marine Corps Training at Quantico, Virginia, because there was a strong “Motivational Aspect” to being with 200 plus therapists from all up and down the East Coast. Phrases Like “Motion is Lotion,” “Load to Explode,” “No Pain No Gain is Insane,” were used to increase my Dopamine Production from the Substantia Nigra.

Even though there were several LSVT BIG Training manuals around the five clinics associated with the Hebrew Home, or the Charles E. Smith Life Communities as they are called today, I felt like it was something that needed to be earned, like the “Break Out Training” with the other Clinicians. I am further impressed with the way LSVT BIG keeps training me, keeps letting me know about changes to the Training based on Ongoing Research efforts, and the “Parkinsonianism Conditions” that can benefit from LSVT BIG.

Because of all the changes that occurred with the Patient Driven Payment Model, I was transferred to Clinton Maryland where I was with other Therapists from Rehab Care who were “transitioned” to “Communicare.” After my three month Probationary Period I was “Checked Out” on the Equipment and the new Computer System and was working with two Outstanding PT’s who were interested in taking the LSVT BIG Course along with the OT’s because they could see that it was compatible with the new Patient Driven payment Model that the previous Clinical Specialist had recommended.

Then I was infected with Covid 19.

Every one of us was eventually infected but I was the only member of the team to be nearly die from Covid. I have been diagnosed with Diabetes since 2004, and according to many Articles and Journals, this diagnosis makes the probability of a Serious Illness more likely. In order to save my Life I was induced into a Coma, given a paralytic medication that allowed me to accept the ventilation, I was “Proned” for two weeks and four days, tubes for food and elimination were fixed, and I lost 25% of my Body Weight.

I was in the ICU and I have no recollection of what transpired in the Hospital but my best friend from High School is a Priest, and he took pictures of what I looked like with all the tubes and the attentions of the Nurses, the Hospitalists, the MD’s, the Anesthesiologists, the CNAs, and he gave me the last rights. And I do remember one of the recurring dreams where I was flying around the Hospital with my Dad and my Grandfather, both were very successful Marines, and are buried at Arlington Cemetery on the Hill next to JFK and RFK on the slope leading up to the Lee Mansion.

The path to recovery.

However when the PTs and OTs came, I was very wobbly since I had lost so much muscle tissue and strength. I could not lift the telephone to call my wife nor could I remember her Phone number. My cell phone was locked up in a closet and I could not do more that Supine “Floor to Ceiling,” “Half Side to Side,” “Exercises to reduce the swelling in my feet,” and Ankle Pumps with Lower Part of the bed raised with help from the CNA since the bed controls were controlled by a Code. When I was discharged, I was sent to a Nursing Home and half the floor I was on succumbed to COVID. Of the million plus who eventually died, 250,000 died in Nursing homes. Americans as a whole have lost 3 years off their life spans from COVID and the Opioid Epidemic.

I thought that after the Hospital Stay, the Nursing Home, and the Home Health I was good to go for work because there was no real criteria at that time to assess “Cognition,” “Work Capacity,” “Liver Abnormality,” “Post-Exertional Malaise,” “Dysautomia,” “Postural Orthostatic Tachycardia Syndrome,” “Mood Swings,” “Diabetic Switch from Type 2 to Type 1.5, verified by a C-Peptide Test” that requires a sharp MD sho knows how to refer to the Endocrinologist, and with elevated ALT, AST, ALP, referral to a Gastroenterologist and a Hepatologist and the MRCP to confirm that I now have “COVID Cholestatis.” I am also on a Liver Transplant List.

Currently I am using a Continuous Glucose Monitor that coordinates with an Insulin Pump because my Diabetes Levels are extreme compared to pre-COVID. This applies to LSVT BIG because I can Calibrate based on the actual effect of the “Big Seven Exercises”, the “Functional Component Tasks” added to my Daily Diabetes Tasks to make sure that my Intake fits into the 70 to 180 glucose targets, that I stay on track with ordering the “Functional Components” I need so that I have enough if I have to go to the Hospital for Tests, for NIH Clinical Trials, to continue to regain Muscular Strength lost with Hospital Procedures, and reactions to Vaccines, reexposure to COVID from my coworkers, the patients I am seeing, and with the ongoing struggle to have my condition recognized by HR, the Insurance Intermediaries, and prospective Employers. I did run the Navy Federal 5 K and it now takes 45 minutes to run it but at least that is a start!

I believe that I have discovered a connection to Parkinsonianism with my Long Covid Survival Guide. The Acronym TRAP is for the symptoms: Tremor, Rigidity, Akinesia (or Bradykinesia) and Postural Instability for Parkinsonism. I am not sure if I have Parkinson’s as a result of my exposure to this Coronavirus. I have had an MRI of the Brain which was negative, but the MRCP shows permanent Liver damage, ischemia to the Bile Ducts, Esophageal damage which affects my Speech and my ability to Concentrate. I think the fact that I was in the Villanova Singers, that I lead a Musical Group on the Base Choir and Father Ken Vialpando is now a Priest in Utah and was my Guitar Instructor and made sure that the harmonies were in tune, can help me now with my voice deficits. I also remember how to issue “Parade Commands” which I practice at Fort Ward Park which is up the road and it is one of the Forts included in President Lincoln’s Defense of the Capitol. The current attraction for visitors to the Museum is the Medical Mission that occurred during the Civil War and there was an attempt by Confederate Forces to penetrate Fort Stevens while General Grant was laying siege against Richmond on July 11 and 12, 1864 (10 months before Lincoln was shot on Good Friday, 1865). In the book “The Day Lincoln was almost shot” by Benjamin Franklin Cooling IIII, he describes in great detail the discipline that was required during those very stressful times and there was a sharp shooter (today called a Sniper) who missed President Lincoln and wounded the Surgeon who was standing next to the President who was overlooking the battle. But the Military Discipline helped the President and the Union Forces to prevail and I am hoping that LSVT BIG will help me to regain my ability to work here in Northern Virginia where I am being given state of the art care for my recovery from COVID!

Thanks again to Jenny and all my LSVT BIG Instructors!

– Capt William E Riley III

If you are interested in learning more, here are some recommended references courtesy of William Riley:

Alhumaid, Saad, et.al. New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review. BMC Gastroenterology Open Access, Published 13 October 2022. https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02507-3
Alzheimer’s Drugs: https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-alzheimers-disease-treatment https://www.yalemedicine.org/news/lecanemab-leqembi-new-alzheimers-drug Lecanemab Information from Yale
Avramidis, Iakovos, et.al. Lessons From a Diabetic Clinic: Achieving Glycemic Goals and Clinical Use of Antidiabetic Agents with Type 2 Diabetes. Clin Diabetes. 2020 Jul; 38(3): 248-255. PMCID: PMC7364453. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364453/ My experience was to not have good glycemic control because I was not referred to a Specialist either for the abnormal Liver readings and also for the very high Hemoglobin A1C. My Physicians were not forthcoming with the growing body of research as is suggested in this article concerning the low success with Type 2 Diabetic patients. Once I finally found a Physician who understood the difference between Type 2, Type 1 and Type 1.5 by referring me to an Endocrinologist, the resolution of my average Glucose of 220 to 135 was achieved in less than 3 months with Dexcom 6 and then to 120 with the Omnipod 5 secondary to conditions that responded to exercise and carb ratio adjustment and feedback that was instrumental in restoring my body to homeostatic control.
Becker L, et.al. Exercise-induced changes in basal ganglia volume and their relation to cognitive performance. Journal of Neurology & Neuromedicine. Published on: August 08, 2016. https://www.jneurology.com/articles/exerciseinduced-changes-in-basal-ganglia-volume-and-their-relation-to-cognitive-performance.html Discusses and proposes that structural changes in the basal ganglia have the potential to diminish cognitive decline with physical activity at the appropriate level of intensity.
Bocancea, Diana I., MSc, et.al. Measuring Resilience and Resistance in Aging and Alzheimer(’s) Disease Using Residual Methods. Neurology. 2021 Sep 7; 97(10): 474-488. PMCID: PMC8448552. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448552/ I believe that Exercise is addressing this, particularly LSVT BIG which combines Speech, OT and PT skills to assess measures of Clinically Meaningful information in the Plasticity of the Intellect even with the challenges posed by the Lesions from Parkinson’s, Parkinsonianism, and the correlation with PASC SARS Cov-2 Long.
Chang-Cheng Chang, MD, et.al. A quantitative real-time assessment of Buerger exercise on dorsal foot peripheral skin circulation in patients with diabetes foot. Medicine (Baltimore). 2016 Nov; 95(46): e5334. PMCID: PMC5120918 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120918/ This was another exercise that I added to my LSVT BIG routine which many of my fellow patients in the Nursing Home were not doing sufficiently because we lost 250,000 elderly patients. I was paralysed and very fortunate to not have any permanent skin issues, but I did do the Buerger-Allen exercises to increase the circulation and to reduce the swelling in the B LE’s and they along with the LSVT BIG in supine initially, then the exercises in sitting and finally at home with the Home Health PT the Standing LSVT BIG along with LSVT LOUD which I still do as well.
Daugherty, Ana M, et.al Multi-modal fitness and cognitive training to enhance fluid intelligence. Intelligence vol 66, jan-Feb 2018, pages 32-43. https://www.sciencedirect.com/science/article/abs/pii/S0160289617300818#bb0465
Diabetes Center of Excellence UMASS Chan Medical School: Insulin Pumps and Continuous Glucose Monitors. https://www.umassmed.edu/dcoe/diabetes-education/pumps_and_cgm/ I use the Omnipod 5 which means that I do not have the Bulky Monitor hanging on my clothes when I exercise. I can have the Omnipod 5 “Phone Transmitter” at my side or next to the bed charging while I am in other parts of the Apartment so it has “Telemetry Capabilities.” The Omnipod needs to be changed every 3 days and they have 24/7 tech support if I inadvertently knock the Pod off of my skin. Likewise there is a Dexcom 6 Sensor that attaches to my skin and I have been very successful with the schedule and have injection through the Pod of Humalog into my blood stream by Automatic or Manual control so that I can sleep and not have to worry about my glucose/insulin levels and I was trained to make sure that I am using the correct analysis to program 175 units over the course of three days for the Omnipod and 10 days for the Dexcom Sensor and Transmitter.
Fletcher, Gerald F. et al. Exercise Standards for Testing and Training: A Statement for Healthcare professionals from the American Heart Association. https://www.ahajournals.org/doi/10.1161/hc3901.095960 This reinforces the principles of LSVT BIG.
Foreman, Judy. Exercise is Medicine. How Physical Activity Boosts Health and Slows Aging. Oxford University Press. NY, 2020.
Inoue, Kosuke, MD, PhD, et.al. Association of Daily Step patterns with Mortality in US Adults. JAMA Network Open. March 28, 2023. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802810
Huang Pei, et.al. Links between COVID-19 and parkinson’s disease/Alzheimer’s disease: reciprocal impacts, medical care strategies and underlying mechanisms. Transl Neurodegener 2023; 12:5 PMCID: PMC9885419. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9885419/
Huseynov, Aydin, et.al. Cardiac Arrythmias in Post-Covid Syndrome: Prevalence, Pathology, Diagnosis, and Treatment. Viruses 2023, 15, 389 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9959721/pdf/viruses-15-00389.pdf
Johns Hopkins Medicine: Health. Liver: Anatomy and Functions. Liver, Gallbladder and Pancreas. https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions
Klein, Christopher. History. Updated May 7, 2020. Abraham Lincoln’s Battlefield Brush with Death. https://www.history.com/news/lincolns-battlefield-brush-with-death
Kulkarni, Anand V. et.al. Post COVID-19 Cholestasis: A Case Series and Review of Literature. J Cain Exp Hepatic. 2022 Nov-Dec; 12(6): 1580-1590. PMCID: PMC9187855. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187855/ Will hopefully have this diagnosis in writing on September 15, 2023.
Kuznik, B.I. et.al Impact of Fitness Status on the Optically Measured Hemodynamic Indexes. Journal of Healthcare Engineering Research Article open Access Volume 2018 Article ID 1674931. https://www.hindawi.com/journals/jhe/2018/1674931/ I have been using various types of pulse oximeters to test for Heart Rate Recovery following exertion, Blood Pressure monitoring at the wrist, the Humerus using EKG feedback since this is a Cardiopulmonary Condition, with an Apple Watch and Phone, Bioelectric Impedance, Grip Strength Testing to make sure that I am not plateauing. LSVT BIG with Resistance using the principles of BORG, Dapre, Delorme, and Oxford has been steady and safe with feedback coming on August 25, Sept 5, and September 15 to see if the exertions are having the desired effect. the Endocrinologist told me that the Pancreas is responding optimally to the Exercise, Diet, Fasting, and LSVT BIG.
Lewis, Thomas A. When Washington, D.c. Came Close to being Conquered by the Confederacy. Smithsonian Magazine. https://www.smithsonianmag.com/history/when-washington-dc-came-close-to-being-conquered-by-the-confederacy-180951994/
The Long Covid Survival Guide. How to take care of yourself and what comes next. Edited by Fiona Lowenstein. Afterword by Dr. Akiko Iwasaki. The Experiment. N.Y. 2022.
Cleveland Clinic Health Library on Magnetic Resonance Cholangiopancreatography (MCRP) This is the “Missing Test” that hopefully will result in a definition of Post Acute Sequelae Covid Long. https://my.clevelandclinic.org/health/diagnostics/24457-magnetic-resonance-cholangiopancreatography-mrcp Cleveland Clinic on Alzheimer’s Disease: https://my.clevelandclinic.org/health/diseases/9164-alzheimers-disease
Macias-Rodriguez, R.U. et.al. Exercise prescription in patients with cirrhosis: Recommendations for clinical practice. Revisit de Gastroenterologia de Mexico. Vol 84, Issue 3, July-September 2019, pages 326-343. https://www.sciencedirect.com/science/article/pii/S2255534X19300660
Matias-Guiu, Jordi A. et.al. “Brain Fog” by COVID-19 or Alzheimer’s Disease? a Case Report. Front. Psychol., 04 Nov 2021. https://www.frontiersin.org/articles/10.3389/fpsyg.2021.724022/full
Michael J Fox: Medications in Trials for Parkinson’s. https://www.michaeljfox.org/medications-trials Accessed August 14, 2023.
Military Fitness Archive. https://www.military.com/military-fitness/workouts/military-fitness-article-archives
Mizumura, Kazue& Toru Taguchi. Delayed onset muscle soreness: Involvement of neurotrophic factors. The Journal of Physiological Sciences. Published 14 October 2015. https://jps.biomedcentral.com/articles/10.1007/s12576-015-0397-0
Peixe, Paula, et.al. Hepatology in the COVID Era: Another C Virus, again Challenging the Liver. GE- Portuguese Journal of Gastroenterology. Volume 27, Issue 4 August 2020. https://karger.com/pjg/article/27/4/230/289287/Hepatology-in-the-COVID-Era-Another-C-Virus-again
Raman, Betty, et.al. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Our Heart J. 2022 Mar 14; 43(11): 1157-1172 PMCID: PMC8903393. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903393/
Parkinson’s Disease. A complete Guide for Patients and Families. William j Weiner, M.D., Lisa Shulman, M.D., Anthony E Lang, M.D. F.R.C.P. Johns Hopkins University Press, Baltimore Md. 2001.
Ping-an Zhu, et.al. Efficacy of Tai Chi on lower limb function of Parkinson’s disease patients: A systemic review and meta-analysis. Front Aging Neurosci. 2023; 15: 1096417 PMCID: PMC9929552. This study shows that there are issues with the lack of consistency with Tai Chi because there are so many different forms, no effect on walking, endurance, stride length and cadence. I believe that Marine Corps Parade Instruction might be helpful, along with Braided Step Training, Backward 3M Walk Training, Perturbations, Kinetic Training with Ping Pong, Balloons, Weighted Vest, ankles and Wrists to increase stride, cadence, and endurance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9929552/
Saudek, Christopher D. M.D. and Jessica C. Brick, B.A. The Clinical Use of Hemoglobin A1c. J Diabetes Sci Technol. 2009 Jul; 3(4): 629-634. PMCID: PMC 2769940. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769940/
Seidel, Kay, et.al The Brainstem Pathologies of Parkinson’s Disease and Dementia with Lewy Bodies. Brain Pathol. 2015 Mar; 25(2): 121-135. PMCID: PMC4397912. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397912/ This analysis demonstrates the complexity of Parkinson’s Disease and compares it to Dementia and Lewy Bodies showing the similarities of these “Parkinsonianisms” which would benefit from LSVT BIG.
Sneha, Mantri, MD, MS, et.al. Early and Accurate Identification of Parkinson(’s) Disease Among US Veterans. Fed Prat. 2019 Jun; 36(Suppl 4): S18-S23. PMCID: PMC6604980. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604980/ Discusses the prevalence of Military Vets in the totality of Parkinson’s Patients: 680,000 including 110,000 veterans from Carolin Tanner, MD, PhD, unpublished data.
Stine, Jonathan, MD, with Penn State. How patients with Liver Disease can benefit from Exercise. https://pennstatehealthnews.org/topics/how-patients-with-liver-disease-can-benefit-from-exercise/ This is from the Penn State Liver Center.
Taousani, Eleftheria, et.al. Effect of Exercise on Resting Metabolic Rate and Substrate Utilization in Women with Gestational Diabetes Mellitus: Result of a Pilot Study. Metabolities. 2022 Oct; 12(10): 998. PMCID: PMC9611075. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9611075/ Discusses “Resting Substrate Utilization” and Resting Metabolic Rate using Usual Care, Walking, Mixed Exercise concluding “Substrate Utilization was indifferent” which would confirm the Medical School Bias that Hemoglobin stays on the Red Blood Cell. My study is showing that with Type 1 Diabetes, Substrate Utilization is affected and proven with Decom 6 and the Omnipod 5 that currently are not used by Type II Diabetics however that is in the process of being changed in order to address the misunderstanding when surveillance is minimal as opposed to comprehensive utilization with 5 minute feedback, graphs, prediction indicators that direct intensification of exercise intensity to target cellular metabolism.
Thaweethai, Tanayott, PhD, et.al. Development of a Definition of Postacute Sequelae of SARS-COV2 Infection. JAMA Network. 2023; 329(22): 1934-1946. https://jamanetwork.com/journals/jama/fullarticle/2805540.
Yaslapati, Sudan, et.al. COVID-19 related biliary injury: A review of recent literature. Discusses the “Multi Systemic Involvement of the Covid 19 Infection with regard to the growing body of literature concerning hepatobiliary involvement. World Journal of Gastroenterology. World J Gastroenterol 2023 April 14; 29(14): 2127-2133. https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1005&context=covid-19