6
T/F: LSVT BIG program can be done for all H&Y stages, even 4 and 5?
YES! Program can be done in supine, sitting, standing
- Can occur at any time, but more often when initiating a movement
- Walking through doorways, turning, stepping from one type of surface to another
- Stress
- Crowds
- Off times of medications
Freezing of gait
- 4 basic moves
- Motor control/developmental skills
- Impairments targeted: posture, weight shifting, spinal mobility, stepping
- Performed in multiple positions and progressed
- Able to tailor to specific patient impairments
- Increasing degrees of freedom as the patient progressed throughout the program
PWR!MOVES
- Improvements in gait speed
- No difference in step or stride length
- Improved motor symptoms (measured with the Unified Parkinson's Disease Rating Scale)
- Improved balance
Dual task training
T/F: Pivot turns are better than U-turns?
FALSE.. U-turns are better than pivot turns
- Stages I and II
- Carrying out another task while performing a motor task
- Types: listening to music, carrying items, verbal cognitive task, memory or counting tasks, virtual reality
- For PD, results in decreased gait speed, decreased step length, and increased step variability
Dual task training
Intensive program: 4x/week for 4 weeks with a LSVT BIG certified clinician
- Promotes neuroplasticity
Daily homework practice
Daily carryover activities
Main focus: increased size of movements
Standard protocol that is customized to the patient
LSVT BIG
- Highly recommended to reduce freezing and improve gait
- External temporal or spatial stimuli, including rhythmic auditory cueing, visual cues, verbal cues, or attentional cues
- Attention: LSVT BIG, Counting, Visualize the movement, focusing on each part of the movement
- Works by bypassing the BG pathway to promote normal movement
External cueing
- Bring awareness to triggers
- Imagine a line to step over on the floor
- March in place or shift from one foot to another
- U turns are better than pivot turns
Freezing of gait
- Auditory: use a metronome or keeping time to music
- Beat is slightly faster than normal walking pattern
- Visual: use a mobile laser, tiles or tape on the floor (CON: patient is looking at the floor)
External cues
Walker in which you squeeze the breaks to make the walker move and let go to make the walker stop; very heavy; very stable; can add a metronome and laser to the walker
U-step walker **
PNF is beneficial in PD because...?
Breaking up axial rigidity
Festinating gait is most common in which type of atypical Parkinson's?
- Cervical rotations
- Shoulder flexion
- Lower trunk rotation
- Single knee to chest
- Bridges
Stretching program for PD
- Add weight anteriorly to AD
- Practice reaching in a split stance
- Sit to/from stand
- Common in PSP Parkinson's
Retropulsion
What is the pharmacological treatment for orthostatic hypotension?
Midodrine
- Motivational interviewing
- Identify barriers and facilitators
- Implement strategies to overcome barriers
- Establish realistic, attainable goals
- Patient preference
- Schedule regular follow up visits (6 months to a year later)
How to promote physical activity
- Reduced motor disease severity
- Improved depression, cognition, anxiety, sleep
- Improved function (walking, balance, mobility, fall risk, ADLs)
- Examples: tango, tai chi, power training, dance, qigong
Community based exercise
- Aquatic therapy
- Yoga
- Pilates
- Tai Chi
- Dance
- Boxing
Patient preference/alternative exercise
- Low BP that occurs when you stand from a sitting or lying position
- Pharmacological treatments
- Non-pharmacological: proper hydration, compression garments, gradual position changes, counter maneuvers (ankle pumps, marching, LAQ)
Orthostatic hypotension
- Canes, walking sticks
- Walkers
- WC
- Chair lift for stairs
- Bed rails
- Swivel seat for car
- Medical alert
- Tub bench or shower chair
- Hospital bed
- Weighted utensils
- Rocker knife
- Scoop bowl
- Sock aid
- Reacher's
- Electric razor
- electric toothbrush
- bedside commode
Equipment recommendations
- Use a mirror to assist with apraxia, symmetry
- Stand to the side the patient is neglecting
- Encourage ROM to prevent contractures
- Simplify tasks
CBD
- Anticipate retropulsion
- Lower traditional walker to bring COM forwards
- Add weights to walker or WC
- 24 hr supervision
- Daily ROM for severe rigidity
- Aspiration precautions
- Recommend daily walking with close supervision and assistive device
PSP
- Consider referral to home health (for cognition purposes)
- Help caregiver establish a schedule
- Recommend caregiver to post safety reminders around home
- Promote successful activities in the community
- Identify triggers for behavioral disturbances
- Support caregiver
- Support groups
- Respite care
- Cognition of patient is going to be the biggest barrier
LBD
Monitor vitals throughout session
- Anticipate hypotension
- Adequate hydration
- Possibly recommend salty snacks
Mirror feedback for Pisa syndrome
Adapt program as needed: exercises in sitting vs. standing
MSA