Alternate Therapies (2) - PD

Question 1

when are attentional cues useful

Answer 1

during transfer training and other fxnal activities

Question 2

attentional cues

Answer 2

break difficult movements into parts

give concise instruction

mentally rehearse

perform in sequence

Question 3

auditory cues

Answer 3

counting out loud

clapping hands/snapping fingers

metronome

rhythmic auditory stimulation

Question 4

parameters to consider –> visual cues

Answer 4

orientation of lines

amount of space b/w lines

contrast b/w lines and the background

where to apply the lines

static v. dynamic

Question 5

ideas for visual cues

Answer 5

tapes lines in doorway

“X’ in front of sink/counter or in front of chair

dycem handprints or foot prints

“step over” wand

Question 6

tactile cues

Answer 6

pts can tap their own foot w/ cane

caretaker can touch/tap pt’s knees

use of companion dog

Question 7

use of RAS in PD

Answer 7

match baseline walking velocity w/ a specific tempo

then increase by 10-20% until it has improved

Question 8

RAS –> what should we walk w/

Answer 8

deliberate (exaggerated) arm swing

big steps, landing on your heel

to the beat of music

Question 9

what ADs are not generally recommended

Answer 9

SW and quad cane

secondary to complex sequencing

Question 10

what ADs are recommended

Answer 10

SC or RW

for increased stability

Question 11

what AD is good for festination

Answer 11

rollators w/ brake systems

seat is beneficial for “off” periods

Question 12

postural education/positioning

Answer 12

reduced activity levels

loss of ability to automatically and independently change positions

potential skin cahnges

Question 13

what is more prominent –> postural education/positioning

Answer 13

axial rigidity than extreme rigidity

increase backward lean

Question 14

what else do PD pts have –> postural education/positioning

Answer 14

poor eye contact

decreased breath support

dysphagia

Question 15

seating and positioning

Answer 15

optimal seating for pressure relief and postural support

correction/accommodation for asymmetries

Question 16

seating and positioning –> W/C

Answer 16

reclining w/c backwards to compensate for excessive forward trunk flexion/rounded shoulders

Question 17

pain

Answer 17

MSK

dystonic

neuropathic

central

akathisia

Question 18

MSK pain

Answer 18

related to rigidity, postural changes and comorbidities

Question 19

dystonic pain

Answer 19

likely during “off” period

Question 20

neuropathic pain

Answer 20

radicular pain from compressive nerve root lesions

focal/peripheral neuropathy

Question 21

central pain

Answer 21

unusual burning

unrelated to motor phenomena

not helped w/ peripheral blocks

Question 22

akathisia

Answer 22

inner more restlessness

Question 23

cognitive changes

Answer 23

bradyphrenia

dementia

hallucinations

Question 24

bradyphrenia –> CC

Answer 24

slow processing

impaired memory

executive fxn

judgement

Question 25

dementia --> CC

Answer 25

almost 60% of pts

Question 26

hallucinations --> CC

Answer 26

mostly visual

Question 27

alternative therapies

Answer 27

animal assisted therapy therapeutic horticulture

Question 28

what should we do for training the family and fall prevention

Answer 28

teaching good body mechanics and injury prevention strategies

Question 29

if necessary what should we do --> training the family and fall prevention

Answer 29

environmental modification

Question 30

what should we use training the family and fall prevention

Answer 30

visual cues wearing good footwear do not walk/talk simultaneously