Neuro Knowledge deficits Flashcards
(93 cards)
1
Q
With a deficit of Perception, what are the impairments for Apraxia?
A
- Ideamotor (inability to motorically execute use of an object)
- Ideational (more severe, you comletely lose the idea of of how to use an object or do the task at all)
2
Q
What is the difference between Sensory and Perceptual deficits?
A
- Our sensory deficits, or visual impairments are typically due because there has been damage to the visual pathway
- A true perceptual deficit is damaged more in the temporal occipital association cortex. Agnosia has visual agnosia, this is damage to typically the temporal parietal occipital association cortex that is interpreting visual information. But the sensory system of vision is intact
3
Q
What is the difference between Cognitive and Perceptual Deficits?
A
- For cognition, we are looking at the Frontal Lobe, specifically the Prefrontal cortex
- Perception is an area that dominates on the right hemisphere of our brian, specifically the temporal parietal association area
PT dont assess or treat cognitive and perceptual deficits
4
Q
With MS, what is the Goal Cognitive-Behavioral Training (CBT)?
A
The goal is to change the way an individual thinks or feels about a particular impairment
5
Q
What are the Treatment approaches for Cognitive and Perception deficits?
A
- The Remedial Approach
-Retraining
-Recovery of underlying skills
-Recovery and reorganization of the CNS
-Bottom-up approach - The Adaptive/Compensatory approach
-Direct training of functional skills
-Top-down approach
These are typically used together
6
Q
With the UE, what are some examples of ADLs that deal with Gross Motor UE?
A
- Donning/doffing shirts/coats
- Brushing teeth
- Stabilization on edge of surface
- Hand to mouth/feeding
7
Q
With the UE, what are some examples of ADLs that deal with Fine Motor UE?
A
- Prehension for finger feeding
- Prehension for dressing (buttoning a shirt, tying shoes)
8
Q
With the UE, what are some examples of ADLs that deal with Bilateral Integration UE?
A
- Preparing food
- UE sports
- Caregiving
9
Q
When assessing the UE during therapy, we must recognize S/S of shoulder pain with the neurologic population. What are 2 common causes of shoulder pain and how do they arise?
A
GH Impingment
- May occur with trauma to the joint
- Improper handling
- Poor positioning
Immobility
- Learned non-use
- Atrophy
10
Q
To protect the Hypotonic Shoulder, what shoue be avoided?
A
- Lifting under axilla
- Traction of UE
- Avoid repositioning a patient by placing hands under the axilla
- Simple slings (causes IR and Add)
- Painful ROM
11
Q
To protect the Hypotonic Shoulder, what shoue be employed?
A
- Giv-Mohr Sling
- Pain free ROM
- Perform shoulder flexion and Abd with proper ER
- Bilateral movements with the arms
12
Q
With those with a Hypotonic UE, what should we consider with Positioning?
A
- Proper alignment of the body is necessary regardless of the positioning (supine, sitting, etc). When sitting in a wheelchair, devices such as lap trays, or arm troughs or arm troughs may be used to correctly position the arm.
- Use of Lap Traps, these allow for functional mobility
- Use of Arm Trough, good for positioning in a neutral position, however may decrease functional mobility
13
Q
What are the benefits of Active weight bearing in the upper extremity? What are the 2 types?
A
Benefits
- Improves cortical excitability
- Support weight of upper trunk and body
- Lift or more the body mass during transitional movements
- Stabilize objects against a work surface for task performance
Types
- Forearm WB
- Extended arm WB
14
Q
With Forearm Weight Bearing, what does this promote?
A
- Trunk weight shifting with support of the flaccid/spastic arm
- Proprioception activation for GH joint approximation
- WB to activate shoulder, elbow and wrist muscles
- Scapular stability/mobility
- Normalization of tonal abnormabilty
- Decreased degrees of freedom for improved success
- Increased ease when inhibiting a fisted hand
15
Q
With Extended Arm Weight Bearing, what does this promote?
A
- Increased UE stability
- Functional transitions (bed mobility, transfers, etc.)
- Thoracic extension
- Strength in scapular muscles
- Challenge from forearm WB
16
Q
With Extended Arm Weight Bearing, what are the 3 seated positions that may be utilized?
A
- Hands anterior to hips (This position allows for increased weightbearing to the upper extremities to promote a variety of functions with decreased reliance on trunk stability)
- Hands in line with hips (requires more trunk control and facilitates a more neutral position)
- Hands posterior to hips (requires increased structural stability of the glenohumeral joint)
17
Q
With Extended Arm WB, what are the handeling strategies we can use with the Hands Anterior to Hip position?
A
- The therapist may use one hand to promote neutral alignment of the GH joint while the other promotes active extension of the triceps. The facilitation technique for the triceps includes pressure downward and inward with careful avoidance of locking into full extension
- It is important with this technique to assure that facilitation of muscles is occurring without tactile input to the olecranon or other bony structures.
18
Q
With Extended Arm WB, what are the handeling strategies we can use with the Hands In line with the Hip position?
A
- Stabilize the glenohumeral joint while providing active facilitation of the triceps
- Where the hand is stabilized with additional downward pressure for facilitation of the triceps
19
Q
With Extended Arm WB, what are the handeling strategies we can use with the Hands Posterior Hip position?
A
- Requires more integrity of the glenohumeral joint to avoid impingement
same as other positions - Direction of facilitation in line with triceps, down and in
- Avoid locking into complete extension
20
Q
With Extended Arm WB, what are the handeling strategies we can use with the Standing/Modified Plantargrade?
A
- Stabilize GH
- Facilitate tricep, down and in and avoid locking elbows
21
Q
What are the General UE Guidelines?
A
- Assess ROM at fingers and/or wrist
-a ball or half foam roll may preserve natural arches of the hand
-avoid painful movements
-mobilize as needed if impingement is suspected - Align the trunk, shoulder, forearm, wrist to neutral
- Positioning the hand on the surface
-ulnar side first then roll to thenar eminence
-perserve arches of the hand
22
Q
What are the Benefits of Physical Activity and Exercise?
A
- Improved motor performance
-BDNF and neuroplasticity - Improved functional mobility
-Fall reduction - Improved fitness
-Fatigue reduction - Improved cognition and mood
-Reduced depression - Improved QOL
- Reduced risk of chronic disease
-CVD, metabolic syndrome, stroke, osteoporosis
23
Q
What is Brain Derived Neurotrophic Factor (BDNF)?
What is BDNF involved in?
A
- This is a key mediator or motor learning and “priming the brain” for neuroplasticity
- Its secreted by 2 mechanisms: Constructive and activity dependent pathways
- Evidence that 30 min at 60% maxHR is effective for increasing BDNF in pts with chronic disorders
Its involved in:
- Neuroprotection
- Neurogenesis
- Neuroplasticity
24
Q
What is the importance of screening neurological patients to exercise?
A
CDC recommends 150 min of Mod. intensity exercise
- With this, we must take a complete medial hx to ensure it is safe for the patient
- We assess strength, balance, cognition, behavior, and communication as well
- Assessment of vitals before, during and after must be done
-consider the position of the patient (Supine, sitting, standing)
- Submax testing may need to be performed to ensure proper prescription intensity
25
What are the different modes of submax ETT?
- Treadmill
- Recumbent leg cycle ergometer
- Recumbent stepper
- Upper extremity cycle ergometer
26
What are 3 different Graded ETT protocals with ecg?
- Bruce Protocal: Treadmill
- YMCA Protocal: Cycle Ergometer
- Total-body recumbent stepper protocol
27
What is a non-graded ETT?
6 minute walk test
28
How do we Examine Strength in Neurologic Populations?
With UMN Dx (Stroke, TBI, MS)
- MMT are not valid due to abnormal synergistic movement patterns. MMT are not valid in the absence of isolated movements
Strength Assessment
- Observation of strength though functional task (task analysis)
- Describe abnormal synergy
- MMT of isolated muslces only
- Self-report
With PD patients
- MMT
- Dynamometry
- Functional strength assessment (Task analysis of bed mobility, STS, stair climbing, etc)
29
How do we Examine Aerobic Capacity and Endurance in Neurologic populations?
| Impairment based measures, activity based measures, RPE with exercise
**Impairment based measures**
- HR
- RR
- BP
- SpO2
- VO2 peak
- Ventilation parameters
**Activity based measures**
- 2 min walk test
- 6 min walk test
- 12 min walk test
**RPE with exercise and/or functional activities**
- BORG: 6-20
- Modified BORG: 0-10
30
# Exercise Principles: Strength Specific
What is the Overload Principle?
- Muscles are to be progressively challenged to promote neuromuscular adaptation and gains in strength generation capabilities
- Intensity is needed to increase muscle capacity
31
# Exercise Principles: Strength Specific
What is Cross-Training?
When exercise challenge range of muscle performance with varying speed, contraction type, endurance
32
# Exercise Principles: Strength Specific
What is Reversibility?
- Don't use it, you lose it
- Strength is not sustained unless activity leveles use the new gains and are continuously challenged
- Establish HEP and community fitness programs
33
What is the CDC Guideline for Strength: Older Adults Unsupervised and Special Populations?
- Minimum of 2 days/week
- At least 1 set of 8-12 reps (more benefit with 2-3 sets)
-rest 2-3 min between sets
- Begin with no weight and re-assess bi-weekly
-If you can lift the weight > 12 times with good form, time to increase weight
-If you cant do ≤ 8 reps, reduce the weight
- Work all major muscle groups
-Legs, hips, back, chest, abs, shoulder, arms
- W/u 5-10 min
- Cood down with stretching (30-60 secs for older adults)
34
What is the ACSM Guideline for Strength: Sedentary OIder Adult and Special Populations?
- 1 set of 10-15 reps of each major muscle group
-40-50% of 1RM
-2-3 days/week
- Rest ≥ 48 hours
- Gradual progression to:
-2-4 sets; with rest 2-3 min in between
-60-70% of 1RM novice to intermediate (moderate)
-70-90% (moderate to hard)
-≥80% of 1Rm for experienced (hard)
-< 50% 1Rm and 15-20 reps for endurance
35
How is 1RM calculated?
1RM = Weight / Coefficient Reps
36
Ex. If a patient performed 5 good reps at 35 lbs for paretic leg press, what is their 1RM?
- What is 50% of their 1RM?
*5 Reps has a coefficient of .856*
35 / .856 = ~ 41lb (1RM)
- 41x50%= ~ 20lbs (50% of 1RM)
37
For those patients that are very weak (< 3/5), what type of strengthening should they do?
Isometrically and Eccentrically biased exercise may result in better gains.
- Eccentric strength is relatively more preserved than concentric, epecially those post-stroke
38
Who benefits from Cross-education training?
Cross education has been found to be successful in those with stroke and MS, this capatalizes on eccentric training of the less affected side to improve strength on the more affected side
39
What are General Precautions and Risk with Strength Training?
- MSK pain
- DOMS
- Falls
- Valsalva/Transient Hypertension
40
What are the Strengthening Considerations specific to Stroke?
- Strong evidence supports positive outcomes with progressive resistance training
- **Strengthening does not exacerbate spasticity**
- There is improved function as a result of strengthening programs, but results vary based on specificity and intensity of training
41
What are the Strengthening Considerations specific to TBI?
- Target improving force-production
- Limited evidence of direct benefits in this population - translate and apply evidence from other non-progressive dx such as stroke
42
What are the Strengthening Considerations specific to MS?
- **Fatigue is a critical consideration in MS: Circuit training can improve work capacity**
- 8 weeks of individualized PRE program can improve strength
- Consider closed chain activities to promote strength in the presence of ataxia
## Footnote
Overwork can cause a pseudo-exacerbation
43
What are the Strengthening Considerations specific to PD?
- Target antigravity extensor muscles as these contribute to poor posture, functional activity limitations, postural instability and falls
- Strength training improves muscle force, reduce bradykinesia, improves functional mobility, balance, gait, falls and QOL
- Not recommended to perform stength specific exercise program during "off" phase of medication
## Footnote
Isometric training is generally **contraindicated** and due to reduce torque production at all speeds power training should be considered for Parkinson's, especially due to its correlation with falls
44
What are the benefits of working towards fatigue:
- Promotion of adaptaiton and gains
- Safely applies to TBI, Stroke, PD
- Caution when using with MS (Can be contraindicated)
- Can accomplish low-moderate intensity in multiple short bouts of exercise
45
What are the ACSM and CDC Guidelines of Aerobic Training for Older Adults and Special Populations?
- 30 min minimum per session of Moderate intensity, 5 days/week (150min/week)
OR
- 20 min minimum per session of vigorous intensity, 3 days/week (60min/week)
- Multiple shorter sessions are also acceptable (at least 10 min bouts)
46
Using the FITT Principle, what is recommended for Aerobic Training?
**Frequency**
- 3-5 days/week
**Intensities**
- 40-70% HRR
- 55-80% HRmax
- 60-84% or 77-93% HRR and HR max for high-vigorous aerobic training
**Time** (per session)
- 20 min, 30 min, 60 min (pending intensity)
- Muliple 10 min bouts (for prior sedentary, greater fatigability)
**Type**
- Steady state versus interval training (Consider the mode of delivery)
47
What is the AHA/ASA Cardiovascular Guidelines for Stroke?
**Frequency**
- 3-5 day/week
**Intensity**
- 40-70% HRR pr 55-80% HRmax (11-14 or 14-16 RPE)
**Time**
- 20-60 min per session (or multiple 10 min sessions) (additional 5-10 min warm-up and coo down)
**Type**
- TM walking with BWS, recumbernt leg and/or arm ergometry
## Footnote
- Recumbent stepper is often the safest choice for those patients who may not be able to tolerate walking on a TM without support.
- Use of a harness for protection while on a TM is recommended, and this is functional as it relates to training for task specificity
- Recent protocal has been supporting HIITprotocals for chronic phase of stroke
48
What are the Precautions with Cardiovascular Training with Stroke patients?
- Blunted vital signs response due to medications
- Palpitations and irregular heart beats
- Sudden SOB
- Angina
- Fatigue and exhaustion
- Lightheaded or dizziness
- Imbalance and modification for motor performance
## Footnote
When any of these symptoms present become uncontrollable, or do not diminish with appropriate rest, then there will be a need to cease exercise and possibly call 911
49
What are the Intervention Guidelines for Cardiovascular Training for TBI patients?
**Frequency**
- 3-5 days/week
**Intensity**
- 60-90% age predicted HR max (208 - (.7 x age))
-This is in the vigorous zone
**Time**
- 20-40 min per session, depending on intensity
-Inverse relationship: higher the intensity, the less time needed
**Type**
- Traditional: walking, jogging, elliptical, cycling
- Circuit training
50
What are the Precautions with Cardiovascular Training with TBI patients?
- Fatigue
- Primary impairments of imbalance, ataxia, voluntary motor control
- Vital response must be monitored
- Cognitive function (Rancho Los Amigos)
## Footnote
When wanting to prescribe aerobic training at a vigorous intensity, you must properly screen and perform submax exercise tolerance testing for proper clearance. Patients with TBI are at risk for experiencing dysautonomia
51
What are the Intervention Guidelines for Cardiovascular Training for MS patients?
**Frequency**
- 3-5 days/week alternating days
**Intensity**
- 60-85% HRmax or 50-70% peak VO2
**Time**
- 30 consecutive min or three 10 min bouts
**Type**
- Cycling, walking, swimming, water aerobics, circuit training
52
What are the Precautions with Cardiovascular Training with MS patients?
- Signs of overwork
- Fatigue
-Contraindicted to "work to fatigue"
- Type of MS
-RRMS vs PPMS
- Core body temp
- Incoordination, spasticity, and imbalance
- Sensory impairment
- Cognitive and memory deficit
- CV dysautonomia
-HR and BP may be blunted
## Footnote
Cooling vest and fans are recommended
53
What are the Precautions with Cardiovascular Training with PD patients?
- Monitor vital signs and exertion:
-HR, BP, RR
-SpO2
-RPE
-Fatigue levels
- Hypotensive responses
- Dyspnea
- Fall Risk
54
What are the Contraindications to Begin a Cardiovascular Exercise Program?
- Medical Instability of diabetes, angina, arrythmias
-Consult physician to establish stability
- Uncontrolled HRrest > 100bpm or < 50 bpm
- Resting Systolic BP > 200mmHG or < 90mmHG
- Resting Diastolic BP > 110mmHG
- Oxygen Saturation < 90%
*You should recommend formal submax ETT when indicated by patient factors.*
55
What are the Indications to **STOP** Aerobic Exercise Training
- Lightheadedness or dizziness
- Chest heaviness, pain, or tightnes; angina
- Palpitations or irregular heartbeat
- Sudden SOB not due to increased activity
- Volitional fatigue and exhaution
- Abnormal response in BP values
- Chills, headaches, nausea, blurred vision
- Pain that does not improve
- Muscle burning
56
With Exercise Intensity, for HRR% and %PHR max, what is considered Low Intensity?
**%HHR**
- < 40%
**%PHRMax**
- < 64%
57
With Exercise Intensity, for HRR% and %PHR max, what is considered Moderate Intensity?
**%HHR**
- 40-59%
**%PHRMax**
- 64-76%
58
With Exercise Intensity, for HRR% and %PHR max, what is considered Vigorous Intensity?
**%HHR**
- 60-84%
**%PHRMax**
- 77-93%
59
What is the equation to get the Predicted HR max?
How about with patients that take Beta-Blockers?
Normal
- 207 - (0.7 x age)
Beta Blockers
- 164 - (0.7 x age)
60
What is the equation to find the Target Heart Rate (THR)?
HR @ rest + (%Intensity) x (HRR) = THR
61
# Types of Exercise
With Exercise, what is the purpose for Strengthening Exercise?
- UMN: Challenge activity of descending
motor pathway
- UMN: Challenge antagonist of a
hypertonic muscle
## Footnote
We must OVERLOAD!!!!!
62
# Types of Exercise
With Exercise, how are strengthening exercises measured?
- %RM
- Reps in Reserve
63
# Types of Exercise
With Exercise, what is the purpose fo Cardiovascular Exercise?
Challenge release of BDNF
64
# Types of Exercise
With Exercise, how are Cardiovascular exercises measured?
- %HR Max
- % HRR Max
- % PRE
65
# Types of Exercise
With Exercise, what is the purpose fo Balance Exercise?
Challenge posture control with motor learning principles
66
With Exercise, what is the purpose fo Coordination Exercise?
Challenge composition of movement with motor learning principles
67
What is the Treatment focus with the Early/Mild stages (H&Y 1-2)?
**Restoration**
- The interventions should be **focused on strength, execution, task-specific training, preventing inactivity, improving flexibility and preventing possible deformities by working on postural endurance and postural training**
- Additionally you want to address any asymmetries in gait, such as arm swing, and also address any impairments that you know at this time
- **Fall prevention and disease progression education is ideally started at this stage**
68
What is the Treatment focus with the Moderate/Middle stages (H&Y 3-4)?
**Compensation, while also training restoration**
- This is the stage where **sensory cueing becomes very important and the importance of assistive devices may be warranted**
- There is typically **more difficulty with dual tasking**
- Creating a fall log might also be benefical at this stage to give you an idea of how falls are affecting their ADLs and how you can help to prevent them
69
What is the Treatment focus with the Severe/Late stages (H&Y 5)?
**Compensation**
- We will be providing **a lot of caregiver education for transfer safety and skin integrity awareness**
- It can take a long time to reach this stage, however its important to prevent things such as contractures, pressure sores, and pneumonia (unfortunately, people with PD die with aspiration pneumonia)
- Emphasis on providing family education especially with transfer training can help improve patient care at home
- This may also be an appropriate time to educate the family and the patient about the possibility of moving to a skilled nursing facility
70
What is important to consider when prescribing Aerobic Training for PD patients?
- Gradual progression is recommended to avoid MSK injury
- Mode should be determined based on safe participation
71
With Aerobic Training, what is the goal of intensity (based on the ACSM guidelines)? What is typically encouraged for PD patients to complete in terms of time and intensity?
How can this be beneficial?
**Goal of at least 150 min/week at moderate intensity (30min 5x/week)**
- **It typically encouraged for PD patients to engage in at least 20 min of High-intensity exercise**
- It can help with:
- Deconditioning, its also been shown to decrease or slow the disease process and help stimulate neuroplastic changes (this will increase nutrition and growth factors to stimulate neuroplasticity and help preserve the dopamine-producing neurons
72
With PD patients, what are some parameters for Resistance Training?
- Programs **should be progressive**
- **Resistance training with instability (RTI)** > than resistance training alone to improve strength/power
--Complete resistance training on balance pad, dyna disc, balance disc, BOSU and SB
- Resistance training can be implemented alone or as part of a multimodal intervention
--Power yoga, low intensity exercise, turning-based training, conventional PT
73
# Balance Interventions
When training for reactive balance, what are some exercises that can be done?
- Lateral and Anterior/Posterior perturbation training
- Rebounder
- Abrupt stops and starts
- Ball catch
74
What are the Characteristics of Stooped Posture?
**Most common**
- Flexion of neck and trunk
- Shoulders rounded with IR
- Flexion of hips and knees
75
What are the Characteristics of Camptocormia Posture?
- Extreme involuntary forward flexion of thoracolumbar spine in standing and walking
- Subsides in recumbent positions
76
What are the Characteristics of Pisa Syndrome Posture?
- Increased lateral flexion
- Subsides with passive correction in recumbent positions
77
What are some intervention strategies we can help improve posture?
- Extensor and Core strengthening (Follow 10rep max rule)
--Back, quads, repeated STS, PNF bilateral UE D2 flexion pattern in sitting, Rowing, contralateral UE/LE lifts in quadruped over a ball
- Flexor stretchning, Pec stretching, Trunk Rotation, chin tucks
--Active and passive stretching, large amplitudes
- Manual Therapy to spine and shoulders
- Positioning
--Lye flat, minimize pillows under head and knees, prone and prone on elbows
- Devices
--rollator with platform attachments (careful with patients who festinate)
--Bilateral nordic walking poles to promote upright posture
- Medication adjustment (refer to MD)
## Footnote
**This should be initiated AS SOON AS POSSIBLE**
78
# Gait Characteristics
What is Festination Anteropulsion? What Triggers this?
- The COM gets too far ANTERIOR, "run away train" (leads to falls)
- **TRIGGERS**: Wheeled walkers without hand breaks, forcing through a freeze, being pulled on during a freeze
79
# Gait Characteristics
What is Festination Retropulsion? What Triggers this?
- The COM get too far POSTERIOR, under scaled balance reaction, small steps to recover (leads to falls)
- **TRIGGERS**: Backing up, Reaching overhead, opening door, carrying items too close to body
80
What Triggers Freezing of Gait (Akinesia)?
**Triggers**: Tight/narrow spaces (doorways, elevators), cluttered areas, crowds, anxiety/stress/rushing, turning/pivoting, changes in floor pattern
81
What type of External Cueing is used most commonly for gait training? What can this cue be beneficial for?
Visual Cueing is the most common
- Improve Stride Length
--**150% longer than current**
--Target = 40% of patient height (24-28in)
- Improves turning
- Improves initiation of Gait
82
What is Auditory Cueing? How can it help patients with PD?
Rhythmic cueing with use of metronome, music, clapping or snapping
- This can be used as a mode to improve speed of gait or cadence, as well as speed of any movement or intervention
--**With Stepping, it can help 25% faster than baseline**
--**100-125 bpm can be used for higher functioning patients**
Rhythmic cueing can be used with interventions, such as PNF patterns to improve axial rotation, resistance training or boxing
83
With Freezing of Gait, What are the 4 S's?
If you find that your patient is stuck in a freezing episode,
- You first teach them to **STOP**. Its important to not try to force or push your patient out of their freezing. this will only result in frustration.
- Once they stop, remind them to relax and correct their posture by **STANDING TALL** to get their COM over their BOS
- Next, they will **SWAY** laterally from side to side
- Once they have initiated movement from side to side a few times, they can **STEP LONG/BIG** and begin to initiate their gait again
## Footnote
If a caregiver is with the patient when they are having an episode, they can also aid the patient by placing their foot perpendicular to the patients and giving them a visual cue of something to step over, so that they can help to break the freezing episode
84
With Festination of Gait, what are the 3 S's?
Similar to Freezing of Gait, except there is only:
- Stop, Stand Tall, and Step Long/Big
- As soon as they recognize their steps quickening, they need to **STOP** so that they can reset their COM over their BOS. Some patient do not recognize when they do this, its important to educate them about the signs so they can train themselves to stop as soon as they can.
85
When can Extrenal Cueing not be effective?
With Advanced disease, Severe reductions in step length, Dementia
## Footnote
This may or may not have short-term carryover when cueing is removed
86
With Task-Specific Training, what stage of PD is Sit to Stand/Stand to Sit beneficial? What will PTs typically notice during this stage?
During H&Y Stage 2 progressing to Stage 3
- Their problems with postural instability will start to progress, this will be evident in their execution of a sit to stand
- We will notice the patient will start to fall back into their chair as a result of poor dynamic postural control
- Also bradykinesia will slow their movements which will not allow them to translate their weight far enough anteriorly at a quick enough pace to be able to stand up
87
What are the benefits of Community-based Exercises?
Improvements in:
- Motor and nonmotor Sx
- Functional outcomes (gait, balance, mobility, ADLs, walking capacity and velocity, walking measures, turning and falls/fears of falling)
- QOL
88
What is LSVT BIG? What are its 4 principles?
A training program specific for PD patients
- **1.** Amplitude
-Max effort (8/10 on modified Borg scale)
-Speed increases with large movements
-"THINK BIG"
- **2.** Sensory Re-calibration
-What feels like normal movement to patient is actually hypokinetic
- **3.** Mode
- Intensive standardized exercise program
- Intensive and High Effort
- 16 one hour sessions, 4x/week, 4 weeks
- **4.** Empowerment: "You dont look like you have PD"
## Footnote
This is organized into 60 treatment sessiosn with 4, 60 min training sessions per week
89
With Cardiovascular Training, what is recommended?
**Increased Intensity = Increased Neuroplsticity**
**Recommended**: (Make sure to know this!!!!)
- 30 min / 5x per week (Mod intensity)
- 20 min / 5x per week (high intensity)
- 50 min / 5x per week (low intensity)
90
With LSVT Methods, In Week 1, How long is the Max Daily
Exercises, FunctionalComponent Tasks and how long is the Big Walking, Hierarchy Tasks?
Max Daily Exercises, FunctionalComponent Tasks:
- 45 min
Big Walking, Hierarchy Tasks
- 15 min
91
With LSVT Methods, In Week 2, How long is the Max Daily
Exercises, FunctionalComponent Tasks and how long is the Big Walking, Hierarchy Tasks?
Max Daily Exercises, FunctionalComponent Tasks:
- 40 min
Big Walking, Hierarchy Tasks
- 20 min
92
With LSVT Methods, In Week 3, How long is the Max Daily
Exercises, FunctionalComponent Tasks and how long is the Big Walking, Hierarchy Tasks?
Max Daily Exercises, FunctionalComponent Tasks:
- 35 min
Big Walking, Hierarchy Tasks
- 25 min
93
With LSVT Methods, In Week 4, How long is the Max Daily
Exercises, FunctionalComponent Tasks and how long is the Big Walking, Hierarchy Tasks?
Max Daily Exercises, FunctionalComponent Tasks:
- 30 min
Big Walking, Hierarchy Tasks
- 30 min
