Lecture 8: Parkinsons intervention

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side effects dbs

HA’s super intense
* makes sense, they drilled into your brain

Question 4

Therapy for parkinsons is based on the stage of the disease your in

Stages
* Early - working to alleviate symptoms/get them better
* Middle
* Late

Restorative-Improving impairments, activity limitations, and participation restrictions

Preventative-Minimizing potential complications and indirect impairments

Compensatory-Modifying task, activity, or environment to improve function

Question 5

often dont get refferals to pt at this stage - unless coming from parkinsons clinic

Question 6

aerobic ex good for slowing progression of pd
* so thats part of why its important to see them early

Question 7

middle stages pd

can still do things, its just slower
* very important to do aerobic to slow progression
* stopping moving is about the worst thing you can do
* these pts wont want to leave the house as much due to symptoms - dont want them to stay home

Question 8

late stages

more compensatory shit
* think assistie devices etc…
* teaching how to do skin checks

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figure out what dilinates pd pts from others
* cognition
* slow movement
* tremors etc…

Question 11

no evidence that theres a gold standard tx for pd
* some pts will do well w/ big and loud while others wont

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People w/ PD have motor learning difficulties - will learn slower, take many more repeittions
* motor learning deficits
* slower learning rates
* reduced efficiency
* increased context specificity training - could work on sit to stand in a chair but they wont be able to tranfer it to other chairs
* complex movement sequences and movements depdent on internally generated cues more difficult than external cues - can improve performnce but works best in early stages
* early and middle stages- can improve performance through practice and additional sensory information
* amount of persistence of learning variable
* learning lower than healthy age matched people
* advanced stages and pronounced cognitive deficits training will likely be less successful

Question 14

what type of practice is better for people w/ pd, blocked or random?

Answer 14

blocked - this is doing the same task over and over
* however, for most normal people random is better

works best if you use small words and there is less time in between

Question 15

repeatedly practicing a single skill or task before moving on to another, focusing on repetition and building mastery of that specific skill

Answer 15

blocked practice

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motor learning w/ pd
* large # of repetitions to develop procedural skills
* focus full attention on desired movement
* Environment modified to reduce clutter and competing attentional demands that may trigger freezing episodes
* Task modified to minimize competing cognitive demands (they have trouble w/ dual tasking)
* long and complex movement sequences avoided or broken down into component parts - while whole works best you can’t do the whole if you cant do the part
* blocked pratice order reducing effects of contextual interference
* structured instructional sets improve movement speed and consistency
* advanved disease and cognitive deficits-repetitive drill like practice used together with increased focus on caregiver training to ensure safety

Question 18

external cues w/ pd
* facilitate movement utilizing premotor cortex-active in generation of movement in response to visual or auditory stimuli
* bypass supplementsry motor are BG - so basically bypassing where the problem is and relying on other areas
* external cues heighten pt attention through common mode of action to bypass diminished internal cueing of the BG
* focusshifted to less automatic movement using alternative, more conscious motor control pathways

that external cue might be putting something infront of them to reach for to faciliatte that wt shift

or lines of the floor to help w/ gait
* putting them far apart trying to increase stride length

Question 19

external cues:
* effective in triggering sequential movements and improving movement characteristics-mild to mod

visual cues
* stationary floor markings-perpendicular to gait path about one step length apart
* dynamic transportable cues (laser light) mounted on assitive device or clothing

freezing episodes reducd

improved stride length and velocity

rhythmic auditory stimulation-metronome
* improve gait speed, cadence, and stride length
* beat is typically set 25% faster than preferred pace - to get them to walk faster

auditory cues such as “big step” improve gait: 1,2,3 stand, ready set go, big first step

can be self directed auditory cue

cues should be consistent, not rushed and have rhythmical quality

auditory cues greater influence on temporal components of movement (gait cadence, stride synchronization) than spayisl components

multisensory cueing effective

good strategy w/ lines is making them further apart - kind of like an opposite festinating giat

they’re better in closed environment but live in an open one

Question 20

not effective for all pts

works best early/middle

if they progress really quickly its not going to work well
* think starting w/ gait/postural instability

once they have dementa, then external cues dont really work unless they’re lready really well trained w/ it.

Question 21

EX training w/ pd
* amplitude-based behavioral intervention
* “training big”
* concept = repetitive high amplitude movements yield greater improvements in motor performance as possibly have neuroprotective effect
* patient guided by physical therapist to ex at high intensity (8/10 borgs rpe scale) for 1 hour 4 times a week for 4 weeks w/ large amplitude, multiple repeittions, and whole body movements that increase in complexity.

Question 22

big movements should be done multiple times a day for a long time

Question 23

relaxation ex
* gentle rocking to produce generalized relaxation of excessive m tension owing to rigidity - sometimes tell them to tighten first then relax
* rocking chair temporarily relax pt and enhance sit to stand transfers
* slow, rhythmic, rotational movements of extremities and trunk can precede interventions such as rom and stretching, and functional training - this is you helping them move through the motion - helps relax that rigidity
* rhythmic initiation specifically designed to help overcome the ffects of rigidity w/ pd - you start by taking them through the, motion then they start to take over that goes up to resisted movement

Question 24

breathing - can do d2 patterns to promote respiration
* phenominia can be a problem

pt w/ parkinsons only gets so much e = use it efficently - probs mostly due to rigidity - fighting thier own muscles

Question 25

flexibility ex w/ pd * combination od static (PROM), and dynamic (AROM), and facilitated PNF EX * **flexibility ex minimum 2 to 3 days/week ideally 5 to 7 days/wk** * **minimum of 4 reps per stretch for 15-60 sec** * stretching common areas of limitation * stretching can be combined w/ joint mobilizationa to reduce tightness of joint capsule or ligaments around joint * accessory movement to improve rom and decreased pain * stretching more effective if warmed with active ex or external heating modality * HEP-pt and cargiver can use heat * stretch after heat is used think also doing trunk rotational ex not just extremities try and add stretches into irl activitied to make them more functional

Question 26

dont want to do a program thats too hard because they might get frusterated * lots of americans dont do ex programs because they start too hard hold relax/contract relax

Question 27

benefits from additionsl attention and cueing strategies during active strteching ex * they dont know where their body is * just like they dont realize they're whispering dont do ballistics because of increased risk injury more at risk for osteoporosis - wolfs law stretching may cause increased pain for these pts

Question 28

20 - 30 mins want the stretches to be comfrotably uncomfrtable * should be able to tolerate * if body is tighening against the stretch they are no longer strdtching * needs to be relaxed

Question 29

resistance training w/ pd - lots of really goog evidence, especially postural muscles - think strengthening spinal extensors becuase it takes them out of that kyphotic posture. really training every extensor is a good idea because they're in that hunched forward pos. note they dont have great force production. try to deviate between fast and slow movements to grade control (their brain struggles w/ this). note strengthening doesnt necisarily transition to balance - need to work on balance as wll * specific areas if weakness targeted-antigravity extensor muscles * muscles assocated w/ poor posture and functional deficits * postural instability, falls, and fall injury due to weakness * Frality and injuries: cooperative studies of intervention techniques trials benefiy of ex * strength training: improve muscle force, bradykinesia, and qol * greater improvments in balance and strength: combined program of balance training and high intensiy resistance training for knee extensors and flexors and ankle pfs as compared to balance training alone

Question 30

she be doing function in least restrictive pattern (think if they can do sit to stand w/o hands dont use hands) and least restrictive assistive device

Question 31

note w/ their bed mobility they're going to really struggle w/ rotation due to the rigidity * they're going to use straight plane movmeemnts over rot - work on rot work on different surfaces - think mat vs soft bed bridging useful for end stages because it gives them a lot more abilities w/ hygene - helps care givers a lot

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sit to stand * poor timing in controlling COM forward velocity, which tends to be lower * * insufficient upward momentum (LE extension torques) * * level of agonist-antagonist coactivation and rigidity * inital rocking * cueing stratgies (counting, placing one hand between the pts shoulder blades) to assist forward lean * inflated disc/cushion forward weight shift and seat off * improved le muscle strength * raise seat to lower * **avoid blocking flexion/weight shift forward** they have less power, let them rocking forward and dont block them - be on the side for this so they can rock forward

Question 34

backward stepping uses a plaetheria of mucles that are weak * helps w/ upright posture because its hard to do it w/ kyphosis

Question 35

any pt thats a fall risk should be training this hard if trunk rot is lost early

Question 36

work on balance in many surfaces

Question 37

lots of training methods * not much detail here

Question 38

data is undtermined

Question 39

locomotor training * primary gait impairments - body is not telling them to take the right size steps * slowed speed * decreased stride length * lack of heel-toe sequence w/ forward progression * **chacterized by a shuffling (festinating) gait pattern** * diminished contralateral trunk movement and arm swing * overall flexion while walking problem w/ treasmil is if they're holding on it doesnt encourage trunk rotation * arm swing comes from trunk rotation - so if they have decreased trunk rot they'll have decreased arm swing - not vice versa

Question 40

can do pole walking instead of using assitive devices * upright reciprocal pattern * can pace themselves w/ music *

Question 41

may teach them to drag foot over obstcle to tell their brain that they've cleard it * make sure foot is all the way on stair and feel it b4 taking that step

Question 42

when you use a brace, you're not using the muscles under that brace when you use a spinal orthosis they arent using those m to hold themsleves up. at some point this will be needed * however probs dont use this early stgE * USED WHEN COMPESENTORY SHIT IS NEEDED

Answer 42

Question 43

weak m = trouble breathing swallowing impacted = aspiration phenominia

Question 44

aerobic ex = neuroprotective should be 60-80% max hr * however, their hr might skyrocket - might get there walking slows rate of progression parkinsons if doing high intensity

Question 45

can be anything aquatic therapy good because dont have to worry about falling

Question 46

firmer mattress = easier to get up

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