WEEK 2 - PRINCIPLES OF MANAGEMENT FOR PD

Question 1

physiotherapy in chronic progressive disorders (4)

Answer 1

• Maintain function / prevent decline for as long as possible (exercise)
• Maintain functional independence with compensatory approaches where required (aids &
  equipment)
• Access and train support people (family carers / ACAT)
• Short term improvement in function where possible (exercise)

Question 2

Principles of management in relation to the Hoehn & Yahr stage of PD - stage 1

Answer 2

Hoehn & Yahr stage 1
- Unilateral involvement only usually with minimal or no functional disability

physio goals
- self management support
- prevent inactivity
- prevent fear to move or fall
- improve functional capacity
- reduce pain
- delay onset activity limitations

Question 3

Principles of management in relation to the Hoehn & Yahr stage of PD - stage 2-4

Answer 3

Hoehn & Yahr stage 2-4
- Bilateral or midline involvement without impairment of balance -> severely disabling disease, still able to walk or stand unassisted

physio goals:
- maintain or improve activities especially:
- transfers
- balance
- manual activities
- gait

Question 4

Principles of management in relation to the Hoehn & Yahr stage of PD - stage 5

Answer 4

Confinement to bed or wheelchair unless aided

physio goals:
- maintain vital functions
- prevent pressure sores
- prevent contractures
- support carers/nurses

Question 5

mechanisms for effectiveness of exercise in Parkinson’s disease (as you would explain to a patient) - PRINCIPLES OF TREATMENT IN PD (4)

Answer 5

• Intensive exercise
• Maintenance of PROM / strength / balance / endurance
• Compensatory strategies
  
  • Segmentation
  • Mental practice / attention / planning
  • Movement cues (verbal, tactile, auditory, visual)
• Carer training

Question 6

mechanisms for effectiveness of exercise in Parkinson’s disease (as you would explain to a patient) - Evidence based exercise in PD (5)

Answer 6

All the following have well evidenced positive effects on the motor signs of Parkinson’s disease :

• High intensity exercise – cycling, treadmill
  
  • Cycling – suggested parameters 3 x week, 45 mins, 80 – 90RPM
• PRET (progressive resistance exercise training)
• Balance training programmes
• Martial arts and dance
  
  • Tai chi
  • Partnered dance classes and irish dancing
• Boxing subject of much research interest currently & emerging positive findings
  
  • high intensity
  • fast, large whole body movements with targets
  • PEOM (trunk rotation + ext)
  • dynamic movement and balance

Question 7

mechanisms for effectiveness of exercise in Parkinson’s disease (as you would explain to a patient) - multitasking -early vs late PD

Answer 7

• Early PD – evidence for the ability to learn new movements
  
  • Multiple task gait training
    
    • Walking with cognitive tasks
    • Walking with manual activity
    • Leads to improvements in walking (early PD)
• Learning new skills requires intensity & duration of practice
  
  • 3xper week; 6-8weeks; 2-3x per year
• Later PD – discourage multi tasking - patient likely has no autonomic movements and must concentrate on a singular movement pattern