Neuromuscular 2 Unit 3 Parkinsons Flashcards
(56 cards)
When treating PD patients, what would happen if the patient has depression, anxiety, apathy and/or cognition issues? What can we (the PTs) do?
They will be low energy, they may have impaired learning and low compliance
- We may need to have simple commands and give them reminders
When treating PD patients, what would happen if the patient has postural hypotension (drop of 20 SBP or 10 DBP and 10% increase in HR) and/or have bladder urgency/infrequency? What can we (the PTs) do?
They may have dizziness, falls with blackouts, and/or injury
- They may need compression stockings, salt on food, hydration, pause with STS
- They may need pelvic floor exercises, MD referral
When treating PD patients, what would happen if they have sleep disturbances or psychosis? What can we (the PTs) do?
- They may have fatigue
- May require referral for sleep study, medication adjustment for psychosis
PD across the continuum of care
What is considered the Early/Mild stages of the Hoehn and Yahr Scale?
Stage 1 - 2
What is considered the Moderate/Middle stages of the Hoehn and Yahr Scale?
Stage 3 - 4
What is considered the Severe/Late of the Hoehn and Yahr Scale?
Stage 5
With the Hoehn and Yahr Classification of Disability, what is Stage 1?
Minimal disability, unilateral symptoms
With the Hoehn and Yahr Classification of Disability, what is Stage 2?
Bilateral, or midline involvement (no balance impairment)
With the Hoehn and Yahr Classification of Disability, what is Stage 3?
Postural instability present but can still live independently
With the Hoehn and Yahr Classification of Disability, what is Stage 4?
All symptoms present, standing/walking only possible with assistance
With the Hoehn and Yahr Classification of Disability, what is Stage 5?
Wheelchair or bed bound
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
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
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
What should be the intensity for Aerobic exercise? What are the Benefits of Aerobic Training for PD patients?
PTs should implement moderate - to high intensity aerobic exercise
There are improvements in:
- Oxygen consuption
- Motor and nonmotor impairments
- Functional activities (ex., gait, balance, ADLs)
- QOL
No one form of aerobic exercise is superior to another, however the emphasis should be placed in intensity
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
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
What are some examples of Aerobic Training a PD patient can do?
Bike (cycling)
- Consider 3-wheels for stability
- “Forced” Tandem biking/cycling has shown to be beneficial. If the patient can recruit a family member or friend, it would be more enjoyable but it would also increase their intensity by way of “forced” use.
–89-90RPMs, with a trainer
Walking
- This can be done on ground or by using a treadmill. With a treadmill, the patient can choose to do it with or without bodyweight support, they can do it flat, at an incline, and they can also choose to use UE support (or do it without support)
Swimming
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)
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
With Balance and Fall Interventions, when are Fall outcomes most reduced? And when are they less effective?
- Fall outcomes most reduced in patients with Mild PD; and Less effective in patients with Severe PD
Dopamine replacement medication does not improve reactive responses
Wiith falls, what are some contributors to falls for PD patients?
- Sensory, reactive, proactive issues
- Static/dynamic balance, mobility, turning, STS
- Orthrostatic Hypotension (may be medication)
- Urinary incontinence
- Home environment
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
Balance Interventions
When training for Anticipatroy balance (self initiated movements), what are some exercises that can be done?
- Consider Wii balance board
- Gait with head turns
- Reach for objects on the floor
- Weight shifting
