Evidence based treatment- Gait and Mvt disorders (PD)

Question 1

what do current therapies target

Answer 1

motor systems by introducing compensatory behaviours or use cognitive strategies to bypass the deficient basal ganglia function

Also a large amplitude whole body movements to increase both the speed and amplitude of functional tasks – LSVT – BIG

Question 2

Lee Silverman Voice Training

Answer 2

BIG should be conducted by a certified therapists and consists of 16 one hour sessions over four weeks.

Focuses= on movement amplitude to achieve bigger, faster and more precise movements in an attempt to restore normal movement patterns

Movements are designed to alter the person’s perceptions of their movement amplitude and reverse hypokinesia.

Improves proprioception through cognitive involvement by mentally focussing on individual movements. This approach to treatment appears to be affective with mild-moderate PD.

Question 3

what are the 4 main areas of the European guidelines for Parkinson’s

Answer 3

education, exercise, practice and movement strategy training.

Question 4

Education

Answer 4

essential to increase health and empower individuals to take an active role in condition management.

self-management support, prevention of inactivity, prevention of fear of falling / movement and disease specific education.

Question 5

Exercise

Answer 5

key element in the management of PD with the goals of maximizing functional activity and minimizing secondary complications.

Focus= change over the course of the disease.

Early treatment should focus on minimizing postural instability and inactivity, then as the disease progresses the aim maybe to improve transfers, mobility and postural control.

Gait re-education, falls prevention and improving balance is important.

Exercise approaches include endurance training, resistance training and other intensive training modalities including tai chi, dancing, tandem cycling, treadmill training and fast walking.

Question 6

practice

Answer 6

Upgrade’ exercise

Using repetition to improve the fluency of motor skills via motor learning.

Using context specific and repetitions can provide positive feedback.

Progression of complexity as well as dual-tasks, cues and attention to increase the cognitive engagement.

Strategies for complex motor sequences includes breaking down of the task to simple components= performed in a defined sequence with conscious control+ combined with mental imagery.

Strategies appear to use the visual cortex to access the motor pathways and therefore reduces the reliance on the basal ganglia.

Question 7

movement strategy training

Answer 7

Compensate for the lack of internal generation of movement.

Includes cueing, attention and strategies for complex motor sequences.

Cueing strategies= visual, auditory or tactile cues. Attentional strategies can be used to overcome the initiation difficulties.

External cues use more of the premotor and parietal cortex and the cerebellum to overcome the lack of internal control provided by the basal ganglia to time and scale automatic and repetitive movements.

Attentional strategies= generated through executive processes, using prefrontal and frontal pathways.

These cues and attentional strategies= used in combination to initiate movement, or assists in the continuation of movement, or prevent freezing. They can also be used in exercise training to generate optimal movement.

Question 8

Goal of therapy

Answer 8

Optimise function and independence of individuals with PD to enhance their quality of life.

PD= progressive disorder the long term management will alter over time as the patient experiences physical and cognitive decline. Negotiating goals is an essential part of the process

Physiotherapy can have a positive effect on the quality of life for these individuals by using evidence informed interventions and appropriate goals