Evidence Based Practice - Parkinson's Disease

Question 1

Why should large-amplitude, whole-body movements be performed?

Answer 1

Makes patients perform bigger, faster and more precise movements

Improves proprioception due to patients mentally focusing on the amplitude of the movement

Helps to restore normal movement patterns if performed intensively - by reversing hypokinesia

Question 2

What areas of education should be highlighted in Parkinson’s Disease

Answer 2

Self-management strategies

Prevention of inactivity

Prevention/fear of falling

Disease-specific education

Question 3

Why does education improve treatment outcomes?

Answer 3

Empowers patients to take a role in their care

Improves engagement and self-efficacy

Question 4

What is the goal of exercise in early-stage Parkinson’s?

Answer 4

Improve stability

Improve activity levels

Question 5

What is the goal of exercise in late-stage Parkinson’s?

Answer 5

Improve Transfers
Improve mobility
Improve postural control

Question 6

What type of exercises should be implemented?

Answer 6

Endurance training
Resistance training
Balance training (e.g. tai chi, dancing)

Question 7

Why does exercise improve treatment outcomes?

Answer 7

Maximises functional activity
Limits deconditioning
Reduces risk of secondary complications

Question 8

What type of endurance training is required and why?

Answer 8

Intensive, complex and powerful endurance training - i.e. high repetitions of difficult movements

Important as has a neuroprotective effect if initiated soon after diagnosis

Question 9

Why is balance re-training important?

Answer 9

Helps to prevent falls which will improve QoL and reduce risk of secondary complications

Question 10

How many repetitions and why?

Answer 10

As high as possible (100s of reps) - as it improves the fluency of the motor skill via motor learning

Question 11

Why should exercises be context/task-specific?

Answer 11

Improves engagement and therefore improves motor leaning

Question 12

why are dual tasks important?

Answer 12

increased complexity of the task –> increased cognitive engagement –> improves motor learning

Question 13

what is an example of dual-task in Parkinson’s?

Answer 13

walking and talking

Question 14

how does mental imagery help with tasks?

Answer 14

Utilises the visual cortex to access the motor pathway - therefore reducing the reliance on basal ganglia

Question 15

how is whole-part-whole effective for Parkinson’s disease?

Answer 15

Breaking the task down into individual segments requires cognitive problem-solving. The patient is then given a defined sequence to complete the task - under conscious control - reduces the automaticness of movements

Question 16

what type of cues can be given?

Answer 16

visual (e.g. a strip on the floor)
auditory (e.g. metronome to step to)
tactile (e.g. rocking from side to side before taking a step)

Question 17

How to cues help with movement in Parkinson’s disease?

Answer 17

Compensation for the lack of internal generation of movement - use of the premotor & parietal cortex and the cerebellum to generate movement

Question 18

what is an attentional strategy?

Answer 18

asking the patient to actively focus on the task (e.g. think about taking a bigger step, or think about making a wider arc as you turn)

Question 19

what is the benefit of attentional strategies?

Answer 19

Compensation - the movement is generated by the executive process - using the frontal and prefrontal pathways

Question 20

Why is group exercise beneficial?

Answer 20

1. Improves social interaction between patients who may be withdrawn due to their illness
2. Allows patients to discuss and ask questions about their symptoms & management strategies with their peers
3. Shows newly diagnosed patients the importance of exercise

Question 21

what type of strength training should be employed?

Answer 21

Strength training against an external resistance (cycle ergometer, weight machines, therapeutic putty, elastic band, weight cuffs)

Question 22

How should posture be improved?

Answer 22

Encourage upright standing by strengthening the back and hip extensors

Question 23

why should posture be trained?

Answer 23

Stooped posture increases the risk of falls - by improving posture we can reduce the risk of falls