1
The CPG for Parkinsons are mostly for which Hoehn and Yahr stages?
Stages 1-3
People with PD can learn new tasks and improve functional performance through focused practice of tasks. How is this done?
Bypass the basal ganglia pathway
Creative PT sessions
- Vary your exercises regularly
- Preserve hobbies if possible
- Work simplification strategies
Moderate to high intensity
- agility training
- boxing
- Kayaking
- Zumba
Dual tasks
- Physical
- Cognitive
H&Y Stage I and II
- Highly recommended to improve task-specific impairments and functional outcomes
- Mental imagery paired with actively performing task
- UE: gross and fine motor tasks
- Turning
- Incontinence
Task-specific training
- Buttoning
- Handwriting
- Reaching, grasping, drinking from cups
- Pouring water from one cup to another
- opening and closing a range of jars
- Lifting jars and boxes of different weight
- Elements of dressing
- Dialing telephone numbers
- Paper folding
Instrumentals ADLs (IADLs)
- Increase synapses formed
- Increased blood vessels in brain = improved cognition
- Improves efficacy of dopamine replacement medications and better use of remaining dopamine
- Lowers risk of PD for those with genetic and environmental risk factors
- Improves scores reported on quality of life measures
- Reduces stress and fatigue
- Decreases rigidity and bradykinesia
Benefits of exercise in PD
- Achieving the patients goals
- Maintaining or increasing activity level
- Decreasing rigidity or bradykinesia
- Optimizing gait
- Improving balance and motor coordination
- Improving independence in functional tasks
- Creating a community based exercise program
Goals of outpatient therapy in PD
What levels on RPE scale are we promoting neuroplasticity in PD?
5-8
What can PD patients do before writing to increase the size of writing?
Micrographia
What is the default for getting into the car?
Typically the modified single leg car transfer
- Timing of medications
- Hydration -- For orthostatic hypotension
- Diet and how it impacts medications
- Exercise is essential
- Fall prevention
- Home modifications
- Behavioral modification
- Proper footwear
Education for patients with PD
- Treat ADLs, gait, balance, and postural deficits that are being impacted
- Teach compensatory strategies to maintain QOL
- Start to minimize dual tasking
- Assistive device training
H&Y Stage III
- Provide recommendations for appropriate equipment
- Home evaluation
- Simplify tasks
- Break down movements
- Lots of repetition
- Educate caregiver
- Body mechanics to assist with transfers
- Floor transfers
- Caregiver burnout
H&Y Stage IV and V
Bed mobility: rolling, supine to/from sitting
- PNF
- Apply manual resistance
- Break down movements
- Teach caregiver how to cue
Sit to/from stand
- Watch for retropulsion
- Sequencing
- Different height surfaces
- Sitting at a chair at a table
ADLs
What is the recommendation when doing a car transfer?
Sit first, then swing legs into car (requires large amplitude movements)
- Difficulty swinging legs out
- Retropulsion for sit to stand
- Freezing upon standing up
- Loss of balance when trying to close door
Issues with getting out of the car
Dosing: 2-3x/week for 5-10 weeks
- Additional research:
- Reducing fall rates
- Type of intervention
- Methods of delivery: individual, group, home
Balance training
- Progressive
- Add instability: balance pad, dyna discs, balance discs, BOSU, swiss ball
- Frequency and duration: 1-2 days per week for 30-60 minutes while applying 80% of the repetition maximum (specific for persons with movement disorders)
- 3-4 days/week
Resistance training
What are the (2) types of corrective strategies for balance?
1. Ankle strategy
2. Hip strategy
- Moderate to high intensity
- Rating of perceived exertion vs. target HR
- Type: no single form is better than another
- Additional research:
- Moderate vs. high intensity
- Modifying symptoms or slowing disease progression
- Optimal frequency and duration
- 30 mins/day -- 150 mins/week
Aerobic exercise
What is the (1) protective strategy for balance?
Stepping strategy
- Backwards
- Side stepping
- Braiding (crossover step)
- On command: stopping, starting
- Direction changes (turns, diagonals)
- Obstacle courses
Dynamic gait training
- Weight shifting
- Perturbation training
- Sensory integration
- Anticipatory postural adjustments
- Compensatory postural adjustments
- Multidirectional stepping
- Technology
- Make it functional
balance training
What is the prescription for the LSVT BIG program?
Intensive: 4x/week for 4 weeks with a LSVT BIG certified clinician
- High amplitude movement training (if not LSVTBig certified)
- Locomotor training (treadmill)
- Tactile cueing with poles
- inside vs. outside
- environment: quiet vs. crowded
- Dual task
Gait training