LSVT LOUD Faculty
Lorraine Olson Ramig Ph.D., CCC-SLP
Dr. Ramig received her doctoral degree at Purdue University and master’s degree at the University of Wisconsin-Madison in communication disorders. Dr. Ramig is a Professor in the Department of Speech-Language and Hearing Science at the University of Colorado-Boulder, a Senior Scientist at the National Center for Voice and Speech (NCVS), a division of the Denver Center for the Performing Arts (DCPA), located in Denver, Colorado, and an adjunct professor at Mt. Sinai School of Medicine and Columbia Teacher’s College in New York City. Dr. Ramig is an internationally recognized scientist with an established research record in the areas of aged and neurological voice disorders. She has been investigating neurological voice disorders for over 20 years and has authored numerous refereed journal articles and book chapters. She has been awarded Honors of the American Speech Language Hearing Association.
Cynthia Fox Ph.D., CCC-SLP
Dr. Fox received her doctorate degree in Speech and Hearing Sciences from the University of Arizona, Tucson. Her training included a focus in the areas of neuroscience and motor control. She is an expert on rehabilitation and neuroplasticity and the role of exercise in the improvement of function consequent to neural injury and disease. Dr. Fox is a world leader in administration of LSVT LOUD speech treatment for people with Parkinson disease. Dr. Fox began working with Dr. Ramig over 20 years ago conducting efficacy research on LSVT in people with Parkinson disease. She was the first to apply this treatment to disorders other than Parkinson disease (e.g., multiple sclerosis) and pioneered the application to pediatric populations including children with cerebral palsy and Down syndrome. Dr. Fox worked closely on the development of a physical therapy program, LSVT BIG, that was modeled after the speech treatment protocol. Dr. Fox also serves as faculty for LSVT LOUD and LSVT BIG training and certification courses. She has numerous publications in these areas of research and has presented extensively nationally and internationally. Dr. Fox is a Co-Founder and Vice President of Operations of LSVT Global, Inc.; a Research Associate at the National Center for Voice and Speech in Denver, CO. Recently, Dr. Fox was appointed Chief Executive Officer of LSVT Gobal.
Angela Halpern M.S., CCC-SLP
Ms. Halpern is in charge of facilitating national and international training and certification courses for LSVT LOUD and LSVT BIG. She assists the team in the research and development of new courses and products, and she has worked to develop and advance LOUD for LIFE exercise maintenance classes for LSVT LOUD graduates. Ms. Halpern serves as national and international faculty for LSVT LOUD training and certification courses. She has been a part of Dr. Ramig’s research team at the National Center for Voice and Speech in Denver since 2000, where she has played an integral role in the randomized control trial research for LSVT LOUD. Ms. Halpern received her Masters degree in Communication Disorders and Sciences from the University of Pittsburgh, PA. Ms. Halpern was born and raised in Kansas and currently resides in Golden, Colorado.
Jessica Galgano Ph.D., CCC-SLP
Dr. Galgano received her doctoral degree in the department of Biobehavioral Sciences from Columbia University in NYC. Dr. Galgano has presented at national and international conferences and has authored and co-authored publications related to neurologic communication and voice disorders. She is a faculty instructor at NYU Langone School of Medicine and is the Executive Director of Open Lines Speech and Communication in NYC, where she provides LSVT LOUD® and other types of therapy to adults and children with a wide variety of speech and language diagnoses. She is also an adjunct professor at San Francisco State University. Dr. Galgano conducted research with Dr. Ramig at Columbia University and is a clinical expert, faculty member and workshop leader for LSVT Global, Inc.
Heather Hodges MA, CCC-SLP
Ms. Hodges received her master’s degree in Speech, Language, and Hearing Sciences from the University of Colorado. She has been part of Dr. Ramig’s research team since 2004. Ms. Hodges is a consultant, expert clinician, training and certification faculty and CE Administrator with LSVT Global. She also enjoys her role within LSVT Global collaborating and presenting on Google’s Project Euphonia, which aims to improve voice recognition software for those with dysarthria and dysphonia. In addition to specializing in neurogenic voice and speech disorders, Ms. Hodges worked for 13 years at an outpatient hospital specializing in diagnosing and treating dysphagia, dysphonia, and upper airway disorders. She has presented nationally and internationally on LSVT LOUD, Parkinson’s disease, PVFM/VCD, cough, and dysphagia. Ms. Hodges has published articles and a book chapter on speech treatments for upper airway disorders. Educating others on the diagnosing and treatment of upper airway disorders remains a focus and passion for her.
Elizabeth Peterson M.A., CCC-SLP
Ms. Peterson received her master’s degree in Speech, Language and Hearing Sciences from the University of Colorado-Boulder. She began working with Dr. Lorraine Ramig’s research team while completing her master’s thesis. She has worked as a research associate at the National Center for Voice and Speech-Denver and the University of Texas Health Science Center, San Antonio and primarily delivers LSVT LOUD in a research setting. Ms. Peterson is currently involved in Dr. Ramig’s research investigating the short and long-term impact of LSVT LOUD on neural underpinnings of speech in Parkinson disease.
LSVT BIG Faculty
Patricia S Brown PT, DPT, NCS
Dr. Brown received her Bachelor of Science in Physical Therapy from California State University Long Beach and her Doctor of Physical Therapy from Western University in Pomona. She is certified by the American Board of Physical Therapy Clinical Specialists in Neurology since 1999. She has been certified in LSVT BIG since 2009 and is a graduate of the National Parkinson Foundation’s (NPF) Allied Team Training (ATTP) for PD. She has worked many years clinically as a neurologic clinical specialist in physical therapy. Currently, she is a Clinical Assistant Professor in the Physical Therapy Program at Chapman University in California and an instructor and steering committee member at a local non-profit gym for persons with Parkinson disease.
Erica Vitek MOT, OTR, BCB-PMD, PRPC
Ms. Vitek received her Master’s in Occupational Therapy from Concordia University in Wisconsin. She is employed by Aurora Sinai Medical Center in Milwaukee, WI, where she is the LSVT program lead and runs LSVT BIG and LSVT LOUD skills classes for LSVT graduates. Ms. Vitek is a graduate of the NPF’s Allied Team Training for PD and has been certified in LSVT BIG since 2009. Ms. Vitek is Board Certified in Biofeedback for Pelvic Muscle Dysfunction and a Certified Pelvic Rehabilitation Practitioner allowing her to address bladder, bowel and sexual dysfunction in her patients with PD. Additionally, she is a faculty instructor with Herman & Wallace Pelvic Rehabilitation Institute and authored the course Neurologic Conditions and Pelvic Floor Rehab. She regularly presents and authors articles for the Wisconsin Parkinson Association.
Julia Wood, MOT, OTR/L
Ms. Wood received her Bachelor of Science in Exercise Science and Wellness from Ball State University and Master’s in Occupational Therapy from the University of Minnesota. She specializes in treating neurological movement disorders at the Dan Aaron Parkinson’s Rehabilitation Center at the University of Pennsylvania Parkinson’s disease and Movement Disorder Center of Excellence at Pennsylvania Hospital. She also serves in interdisciplinary clinics for patients with atypical Parkinsonism, Huntington’s disease, ALS and those considering Deep Brain Stimulation. Ms. Wood serves as occupational therapy faculty for the Parkinson Foundation’s Allied Team Training for Parkinson’s program, educating clinicians in interdisciplinary focused, evidence-based evaluation and treatment of individuals with Parkinson’s disease. She is a certified facilitator for PD SELF, educating newly diagnosed individuals with PD and care partners in self-efficacy to promote quality of life. She serves as an ambassador for the Davis Phinney Foundation, providing support to the PD community through connection to resources and education.
Kathleen Salik PT, DPT, NCS, MSCS, CCCE
Dr. Salik received her Bachelor’s degree in Physical Therapy from Ithaca College in New York in 1985 and her Doctorate in Physical Therapy from the University of Montana. She is certified by the American Board of Physical Therapy Clinical Specialists in Neurology. Dr. Salik is a Multiple Sclerosis Certified Specialist. Dr. Salik is the Clinical Coordinator for Education for Banner Thunderbird Rehabilitation Services in the outpatient department at Banner Thunderbird Medical Center in Glendale, AZ. Ms. Salik has advanced training in Vestibular Rehabilitation and is LSVT BIG certified. Her clinical experience focuses on neurological rehabilitation primarily for adults with Parkinson’s disease, MS, stroke and vestibular impairments.
Tamara Hefferon PT, DPT, CSCS, OCS
Dr. Hefferon received her Bachelor of Science in Physical Therapy from the University of Arizona and her Doctorate in Physical Therapy from A.T. Still University. She has been certified in LSVT BIG® since 2009, and received her Orthopedic Clinical Specialist Certification in 2017. Dr. Hefferon is an Assistant Professor and Orthopedic Specialist at Franklin Pierce University. She also owns her own cash based practice with her husband called Impact Physical Therapy. She has a passion for treating persons with Parkinson disease with emphasis on early onset and young onset patients.
Jenny Tuccitto, MPT, GCS
Ms. Tuccitto received her Master’s Degree in Physical Therapy from the College of St. Catherine in Minnesota in 2001 & received her Geriatric Clinical Specialist Certification in 2015. As a physical therapist, she has over 20 years of experience in treating a wide variety of clients with neurological diagnoses with a focus in Parkinson Disease. Ms. Tuccitto has been certified in LSVT BIG since 2009 and part of the LSVT BIG Training and Certification Faculty with LSVT Global since 2011. She now serves as the Director of Innovation and Communications for LSVT Global as well as the LSVT BIG Clinical Expert. She has assisted with the development of many LSVT BIG treatment tools & courses including the LSVT BIG Homework Helper videos, BIG for LIFE training, webinars & LSVT for LIFE. She has presented for the National Parkinson Foundation, the Minnesota Physical Therapy Association, Combined Sections for the American Physical Therapy Association and at the American Speech and Hearing Association on LSVT BIG & Parkinson Disease.
Laura Gusé, MPT
Ms. Gusé received her Master’s Degree in Physical Therapy from the University of North Dakota. She has over 15 years of experience working with adults with neurological disorders with a special focus on Parkinson disease and Multiple Sclerosis. She has been certified in LSVT BIG® since 2009, and is a Multiple Sclerosis Certified Specialist. She is an LSVT BIG faculty member and Clinical Expert, and has helped to develop many of the current LSVT BIG treatment tools and videos, webinars and curriculum. She now serves as the Chief Clinical Officer of LSVT BIG.
Cynthia Fox Ph.D., CCC-SLP
Dr. Fox received her doctorate degree in Speech and Hearing Sciences from the University of Arizona, Tucson. Her training included a focus in the areas of neuroscience and motor control. She is an expert on rehabilitation and neuroplasticity and the role of exercise in the improvement of function consequent to neural injury and disease. Dr. Fox is a world leader in administration of LSVT LOUD speech treatment for people with Parkinson disease. Dr. Fox began working with Dr. Ramig over 20 years ago conducting efficacy research on LSVT in people with Parkinson disease. She was the first to apply this treatment to disorders other than Parkinson disease (e.g., multiple sclerosis) and pioneered the application to pediatric populations including children with cerebral palsy and Down syndrome. Dr. Fox worked closely on the development of a physical therapy program, LSVT BIG, that was modeled after the speech treatment protocol. Dr. Fox also serves as faculty for LSVT LOUD and LSVT BIG training and certification courses. She has numerous publications in these areas of research and has presented extensively nationally and internationally. Dr. Fox is a Co-Founder and Vice President of Operations of LSVT Global, Inc.; a Research Associate at the National Center for Voice and Speech in Denver, CO. Recently, Dr. Fox was appointed Chief Executive Officer of LSVT Gobal.
Heather Cianci, PT, MS, GCS
Ms. Cianci is the Geriatric Team Leader and founding therapist of the Dan Aaron Parkinson’s Rehab Center at Pennsylvania Hospital in Philadelphia, PA. She received her Bachelor of Science in Physical Therapy from the University of Scranton, and her MS in gerontology from Saint Joseph’s University, both in Pennsylvania. Heather received her Geriatric Clinical Specialist Certification in 1999 and was certified in LSVT BIG in 2007. She is a 2004 graduate of the Parkinson’s Foundation’s (formerly the NPF and PDF) Allied Team Training for PD, and became a faculty member for the program in 2017. Ms. Cianci has written and lectured for several national PD organizations, on-line CEU providers, and PT programs at Philadelphia area universities. Her research is on falls and bed mobility in PD, and she is also a former board member for CurePSP.
Bernadette Kosir OTR/L, CAPS
Ms. Kosir is a graduate of University of Michigan in Ann Arbor and Wayne State University in Detroit and has been a practicing Occupational Therapist for over 35 years. She specializes in home health clinical leadership, quality process development, and innovative clinical education. She is currently Branch Manager at Henry Ford Home Health, part of a large non-profit health system serving Detroiters with an established LSVT BIG and LSVT LOUD continuum of care. As a therapy director, she developed and managed successful LSVT BIG and LSVT LOUD clinical programs that brought this evidence-based treatment approach to homebound patients with advanced Parkinson’s Disease throughout Michigan. Ms. Kosir has been LSVT BIG Certified since 2008 and joined LSVT Global as faculty in 2011. She is a certified trainer in Integrated Care Management for coordinated care of patients with chronic diseases including Parkinson disease and is an NAHB Certified Aging in Place Specialist.
Clinical Officers
Jenny Tuccitto, MPT, GCS
Ms. Tuccitto received her Master’s Degree in Physical Therapy from the College of St. Catherine in Minnesota in 2001 & received her Geriatric Clinical Specialist Certification in 2015. As a physical therapist, she has over 20 years of experience in treating a wide variety of clients with neurological diagnoses with a focus in Parkinson Disease. Ms. Tuccitto has been certified in LSVT BIG since 2009 and part of the LSVT BIG Training and Certification Faculty with LSVT Global since 2011. She now serves as the Director of Innovation and Communications for LSVT Global as well as the LSVT BIG Clinical Expert. She has assisted with the development of many LSVT BIG treatment tools & courses including the LSVT BIG Homework Helper videos, BIG for LIFE training, webinars & LSVT for LIFE. She has presented for the National Parkinson Foundation, the Minnesota Physical Therapy Association, Combined Sections for the American Physical Therapy Association and at the American Speech and Hearing Association on LSVT BIG & Parkinson Disease.
Angela Halpern M.S., CCC-SLP
Ms. Halpern is in charge of facilitating national and international training and certification courses for LSVT LOUD and LSVT BIG. She assists the team in the research and development of new courses and products, and she has worked to develop and advance LOUD for LIFE exercise maintenance classes for LSVT LOUD graduates. Ms. Halpern serves as national and international faculty for LSVT LOUD training and certification courses. She has been a part of Dr. Ramig’s research team at the National Center for Voice and Speech in Denver since 2000, where she has played an integral role in the randomized control trial research for LSVT LOUD. Ms. Halpern received her Masters degree in Communication Disorders and Sciences from the University of Pittsburgh, PA. Ms. Halpern was born and raised in Kansas and currently resides in Golden, Colorado.
Laura Gusé, MPT
Ms. Gusé received her Master’s Degree in Physical Therapy from the University of North Dakota. She has over 15 years of experience working with adults with neurological disorders with a special focus on Parkinson disease and Multiple Sclerosis. She has been certified in LSVT BIG® since 2009, and is a Multiple Sclerosis Certified Specialist. She is an LSVT BIG faculty member and Clinical Expert, and has helped to develop many of the current LSVT BIG treatment tools and videos, webinars and curriculum. She now serves as the Chief Clinical Officer of LSVT BIG.
Management
Joni Wing
Joni is the People and Projects Manager at LSVT Global. She joined the organization in September of 2022 and manages the product support and marketing teams as well as operational projects. Joni holds a Bachelor of Arts Degree in Education from Arizona State University and has worked in the education technology industry for more than 30 years. She grew up in Scottsdale and currently resides in Oro Valley, AZ.
April DalleNogare
April is the Finance Manager for LSVT Global, Inc. She joined LSVT Global, Inc. in March of 2015. She manages the Accounting Department, Human Resources, Payroll and Benefits. April is an Arizona native and currently resides in Oro Valley.
Administration
Remington Trewern
Remington is the Marketing Specialist at the Tucson office. He joined LSVT Global in May 2021. He helps coordinate LSVT’s marketing efforts. Remington has a Bachelor of Arts Degree in Communications from University of Arizona, and has experience in a wide range of marketing activities. He grew up in Arizona and loves the outdoors! He currently resides in Tucson.
Michael Siddons Villalobos
Michael is the LMS Specialist and Salesforce Administrator for the Tucson office and joined LSVT Global in July of 2021. He is primarily responsible for providing customer support to email, chat and phone inquiries with an expertise in technical support. Michael also supports the maintenance and functionality of LSVT Global’s LMS and Salesforce tools. He was born and raised in Tucson, AZ. and attended the University of Arizona.
Jenifer Bannon
Jenifer is the Event, Online LOUD & BIG Group, and Continuing Education Coordinator for LSVT Global, Inc. and joined the team in January of 2016.
She is in charge of all trade shows both foreign and domestic, to include: CSM (Combined Sections Meeting), AOTA (American Occupational Therapy Association), ASHA (American Speech and Hearing Association), WPC (World Parkinson’s Congress), and Unity Walk in Central Park, New York
Jenifer also coordinates with both LSVT Chief Clinical Officers, Mrs. Angela Halpern (LOUD) and Mrs. Laura Guse (BIG), on University and Corporate Online Groups. She has been instrumental in seeking approval in the required 19 states for Continuing Education Credits for all LSVT BIG Courses both live and online.
Jenifer proudly served in the United States Navy for over 10 years where she received exceptional training and certification in the field of Oral Maxillofacial Surgery assisting along with General Dentistry assisting and team leadership/management.
She currently lives in Vail, Arizona with her husband, (Ret. MSgt.) Trevor, daughter Kylie, son Jackson, and 13 year old Cairn Terrier, Roxy-Roo. She enjoys spending time with her family and taking long hikes in the beautiful Arizona mountains.
Pete Vasquez
Pete is part of the administrative staff. He handles all LSVT LOUD and LSVT BIG online completers, renewals, and supplementary courses. Pete is in charge of all shipping, receiving and inventory. He was also prior service and served in US Army for 6 years and is a Tucson native.
Shannon Townsend
Shannon is part of the administrative staff. She joined LSVT Global, Inc. in July of 2017. She assists in processing payments, helping clinicians and patients that call or email the company asking for help with our website, finding a clinician or processing an order.
Olivia Vinson
Olivia Vinson is part of the administrative staff at LSVT Global. She prepares materials and documents needed for both clinicians and the training staff during the live LSVT BIG and LSVT LOUD Training and Certification Courses and handles post-workshop administrative paperwork. She has been part of the LSVT Global team since 2013. Olivia received her B.S. and MA in Speech, Language, and Hearing Sciences from the University of Arizona, Tucson in 2016 and University of Colorado Boulder in 2018. She is a Maryland native and currently resides in Tucson.
International
Stephanie Grömminger, Ergotherapeutin
Stephanie Grömminger ist Ergotherapeutin und seit über 10 Jahren in ihrer eigenen interdisziplinären Praxis selbständig. Sie ist seit mehr als 15 Jahren in der Neurologie tätig und seit 2012 zertifizierte LSVT BIG Therapeutin. Schwerpunkt ihrer Arbeit ist die häusliche Rehabilitation im direkten Umfeld des Patienten. Ihre persönliche Freude und Begeisterung an Sport und Bewegung (Crossfit, Yoga) lässt sie in die Therapie mit einfließen. Frau Grömminger ist aktiv in der Ulmer Selbsthilfegruppe für Parkinson. Sie hat dabei eine beratende und unterstützende Funktion, hält Vorträge und trainiert die Gruppe. Sie hat zudem Lehrerfahrung in der Ausbildung von Ergotherapeuten.
Annette Sprock, Physiotherapeutin
Annette Sprock ist Physiotherapeutin und arbeitet seit 2001 im “Neurologischen Fachkrankenhaus für Bewegungsstörungen und Parkinson” in Beelitz-Heilstätten. Sie referierte häufig in Rahmen von Workshops und Fortbildungsveranstaltungen zum Thema Physiotherapie in der Parkinsontherapie, mit dem Schwerpunkt PSP und LSVT®-BIG. Frau Sprock ist unter anderem PNF-Therapeutin und seit 2008 LSVT®-BIG Trainerin. Sie war 2007-2009 maßgeblich beteiligt an der Durchführung einer Studie zur Fallneigung bei PSP.
Frauke Elisabeth Schroeteler, Physiotherapeutin, Manualtherapeutin
Frauke Elisabeth Schroeteler ist staatlich anerkannte Physiotherapeutin,
Manualtherapeutin und zertifizierte LSVT/ BIG Therapeutin. Sie arbeitet seit 15 Jahren
in der Neurologie und ist seit 2007 Mitglied der wissenschaftlichen Arbeitsgruppe zu
aktivierenden Therapien bei Parkinson und Bewegungsstörungen (Leitung Prof.
Ceballos-Baumann) in der Schön Klinik München-Schwabing. Sie hat langjährige
Lehrerfahrung, ist Autorin wissenschaftlicher Publikationen und leitet Workshops im
Bereich der evidenzbasierten Physiotherapie.
Kerstin Ziegler, Physiotherapeutin
Kerstin Ziegler ist Physiotherapeutin und seit 17 Jahren in der Neurologie tätig. Der wissenschaftlichen Arbeitsgruppe zu aktivierenden Therapien bei idiopathischem Parkinsonsyndrom und Bewegungsstörungen (Leitung: Prof. Ceballos-Baumann) an der Schön Klinik München Schwabing gehört sie seit 2007 an. Im gleichen Jahr zertifizierte sie sich als LSVT®BIG Trainerin. Sie unterrichtet seit vielen Jahren Physiotherapie in der Neurologie, hält Vorträge und gibt Seminare zur Anwendung evidenzbasierter Methoden in der Neurorehabilitation.
Thomas Brauer
Thomas Brauer is head of the school for logopedics at Johannes Gutenberg-University in Mainz, Germany, since 1985. For 27 years he has been a member of the board of Deutscher Bundesverband fuer Logopaedie (the German professional organization of SLTs). Since 2007 Thomas is organizing LSVT LOUD and BIG workshops in Germany. He translated the LSVT Companion into German and supports clinicians and patients in handling the companion. He also produced the German version of the DVD “LSVT BIG Homeworkhelper!”.
2013 LSVT Global appointed him “LSVT Global Representative – Germany”.
Thomas Brauer is SLT, teacher for speech and language disorders caused by neurological disorders and dementia. He grew up in North-West Germany and resides in Mainz (close to Frankfurt), Germany since 1975.
Other
Geralyn Schulz – LSVT Global – Grants Coordinator
Dr. Schulz is the Grant Coordinator for LSVT Global; she oversees all aspects of the LSVT Small Student Grant program for graduate students in Speech Pathology, Physical Therapy, and Occupational Therapy from preparing submission guidelines, soliciting submissions, through soliciting reviewers and the awarding of grants. She also is involved in an LSVT research project investigating the speech intelligibility of individuals with Parkinson’s disease in noise following voice or articulation treatment. Dr. Schulz received her PhD from the University of MD in 1994. She worked at the National Institutes of Health as a research speech pathologist for 13 years, taught at the University of FL for 5 years and then returned to the DC area to chair the department of Speech, Language, & Hearing Sciences at the George Washington University (2000-2007). She was Associate Dean for Research at GW (2007-2014) where among other duties she administered several yearly internal grant competitions, and is now back in her home department where she has resumed teaching both at the undergraduate and graduate level. Her research has concentrated on the neurophysiology of the speech, voice and language problems in Parkinson’s Disease and the effect of various surgical interventions for PD voice, speech, & language. Her current research focus investigates the efficacy of providing SLP services remotely (TeleRehabilitation) vs traditionally (face-to-face). She is also serving as the Perspectives Editor for the ASHA Special Interest Group on TelePractice.
Dr. Carol Boliek, LSVT Global Pediatric Expert
Professor
Department of Communication Sciences and Disorders
Faculty of Rehabilitation Medicine
University of Alberta
Dr. Boliek is a full professor in the Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine and the Neuroscience and Mental Health Institute at the University of Alberta. She completed her PhD in Psychology with an emphasis in Developmental Neuropsychology from the University of Northern Colorado. She did a postdoctoral fellowship in developmental neuropsychology at Southern Illinois University and a second postdoctoral fellowship in pediatric speech motor control at the University of Arizona. Dr. Boliek became a research scientist at the University of Arizona focusing on speech physiology in typically developing infants and young children as well as children with cerebral palsy. Dr. Boliek joined the staff at the University of Alberta in 2002. Her research program involves both basic speech physiology studies across the lifespan and applied studies involving treatment–dependent neuroplasticity following LSVT LOUD with children who have motor speech disorders and cerebral palsy.