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PHTY3140 > L31: Physiotherapy Management of Parkinson's Disease > Flashcards

L31: Physiotherapy Management of Parkinson's Disease Flashcards

1
Q

What are 8 purposes of physiotherapy in PD?

A
  1. Delay and minimise the effects of PD
  2. Improve or maintain flexibility and muscle strength
  3. Improve or maintain balance
  4. Improve or maintain respiratory function and cardiovascular fitness
  5. Maximise residual movement ability and function
  6. Train movement strategies
  7. Educate clients and carers on the disease, your approach & their role
  8. Maximise QoL
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2
Q

What are the 3 stages of PD?

A
  1. Early stage
  2. Mid stage
  3. End stage
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3
Q

What is the main approach for stage of PD?

A

Program must be tailored to changing needs

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4
Q

What are 3 management approaches in the early stage of PD?

A
  1. Checking for other issues
  2. Preserve or improve physical capacity: Aerobic capacity, strength, joint mobility exercises
  3. Prevent inactivity
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5
Q

What are 3 management approaches in the mid stage of PD?

A
  1. Referral
  2. Strategies to improve function, particularly gait, balance and upper limb tasks
  3. Maintain physical capacity, including posture
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6
Q

What are 2 management approaches in the end stage of PD?

A
  1. RACF
  2. Preserve vital function and prevent complications (e.g. respiratory)
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7
Q

What are 7 evidences for physiotherapy in PD?

A
  1. Improvement in gait, balance, reducing freezing of gait, improving function/PD symptoms
  2. Conventional physiotherapy, exercise (level 1)
    • Dance
    • Treadmill
    • Tai Chi
  3. External cues/strategies (level 1)
  4. Balance training (level 1)
  5. Dual task training (level 2)
  6. Breakdown sequences (level 2)
  7. Progressive resistance training (level 2)
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8
Q

What are 7 strategies for movement dysfunctions (training strategy different for each impairment) for PD?

A
  1. Hypokinesia: Strategy training
  2. Akinesia: Strategy training
  3. Dystonia: Prolonged stretch, botox + exercise
  4. Tremor: Mainly drugs treatment, physio for stabilisation
  5. Rigidity: Rotational exercise
  6. Postural instability: Balance retraining
  7. Dyskinesia: Mainly drugs treatment
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9
Q

What is the strategy for hypokinesia for PD?

A

Hypokinesia: Strategy training

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10
Q

What is the strategy for akinesia for PD?

A

Akinesia: Strategy training

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11
Q

What is the strategy for dystonia for PD?

A

Dystonia: Prolonged stretch, botox + exercise

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12
Q

What is the strategy for tremor for PD?

A

Tremor: Mainly drugs treatment, physio for stabilisation

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13
Q

What is the strategy for rigidity for PD?

A

Rigidity: Rotational exercise

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14
Q

What is the strategy for postural instability for PD?

A

Postural instability: Balance retraining

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15
Q

What is the strategy for dyskinesia for PD?

A

Dyskinesia: Mainly drugs treatment

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16
Q

What are the 4 strategies for motor performance for PD?

A
  1. Reduction of rigidity, increase ROM, flexibility
  2. Improve balance, posture
  3. Increase strength, endurance
  4. Environmental modification
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17
Q

What should you use to improve motor performance for PD?

A

Use cues to improve motor performance

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18
Q

PD has trouble with _____ generated, _____, _____ movements

A

internally; automatic; sequential

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19
Q

What are 5 cognitive cues for motor performance for PD?

A

Use cognitive cues to consciously control movement that is usually automatic

  1. Start with external + internal cues
  2. Then remove external cues
  3. Over time, the internal cues will become more automatic (using basal ganglia), thus less effective
  4. Modify cues to become novel again (using cortex)
  5. Over time may be less able to use internal cues
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20
Q

What are 3 things that the choice of cue depends on for motor performance for PD?

A
  1. Deficit
  2. Stage of disease
  3. Often combine different cues
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21
Q

What are 3 external cues for PD?

A
  1. Visual
  2. Auditory
  3. Proprioception
22
Q

What are 4 features of visual external cues for motor performance in PD?

A
  1. Taped lines on floor (50-70 cm apart) and step over the lines - to normalise step length (hypokinesia)
  2. Mark foot placement for turning in a confined space - to improve step length and freezing
  3. Single strips where freezing occurs - to prevent/overcome freezing
  4. Cue cards: Simple step by step instructions in large print - to break down movements
23
Q

What are 3 features of auditory external cues for motor performance in PD?

A
  1. Verbal cues: Say “big steps” to improve step length •
  2. Exercise to music - to improve rhythm of movement
  3. Metronome to improve gait initiation, cadence & speed
24
Q

What are 2 features of proprioception external cues for motor performance in PD?

A

To help initiating movement

  1. Rhythmical sensory cues: Rocking side to side to initiate walking or rolling
  2. Taking a step back before starting to walk
25
Q

What are 3 internal cues for PD?

A
  1. Focus attention
  2. Prepare in advance
  3. Single task
26
Q

What are 5 features of focus attention internal cues for motor performance in PD?

A
  1. Train to think consciously about each step of the movement
  2. Can be sufficient to initiate and sustain movement
  3. Cognitive cues to emphasise a component of movement (e.g. think “big steps”) • Practice: Repetition enhances movement execution
  4. • Ensure skills are generalised to all environments
27
Q

What are 3 features of prepare in advance internal cues for motor performance in PD?

A
  1. Visualise the movement (e.g. appropriate step length)
  2. Use written instructions on cards
  3. Mentally rehearse each step of a movement
28
Q

What are 2 features of single task internal cues for motor performance in PD?

A
  1. Can dual task during gait with cues in early PD
  2. Avoid dual task in later PD because too dangerous
29
Q

What are 2 characteristics of end-stage PD with cognitive impairments?

A
  1. Cognitive strategies become less effective
  2. May benefit more from
    • External cues
    • Environment restructuring ○ Demonstration
30
Q

What are 7 management of rigidity for PD?

A
  1. Slow, rhythmic rotational movements of trunk and limbs
    • Usually rigid in the morning
  2. Combined with relaxed deep breathing
  3. May incorporate Yoga or Feldenkrais
  4. Muscle stretching: Shoulder abd + ER + thoracic E + hip E
  5. Postural awareness using visual feedback
  6. Lying supine or prone 30 minutes/day
    • Prone is better for early PD
    • Supine is better for later PD
  7. Evidence: 10 week spinal flexibility program improved axial mobility and functional performance
31
Q

What are 7 managements for balance training for PD?

A

Facilitation of balance reactions

  1. Both internally and externally-generated
  2. Aiming to increase speed of reactions
  3. Balance reactions can first be practised cognitively > progress to automatic reactions
  4. Train in various positions
  5. Find the most appropriate balance strategy for the patient
  6. Compensatory stepping: ↑ step length, ↓ initiation time
  7. Evidence: Balance training under altered visual and somatosensory conditions 3x/week improved balance on SOT
32
Q

What are 7 managements for increasing active movements for PD?

A
  1. Large amplitude movements
  2. Start with bilateral symmetrical patterns > progress to reciprocal movements
  3. Emphasise exercises to achieve mobility throughout the spine
  4. Rhythm and music can facilitate movement
33
Q

What are 3 managements for treadmill training for PD?

A
  1. Treadmill is better for early-mid PD
  2. May help with walking training
  3. Varying evidence
    • No difference between treadmill and overground
    • Training treadmill better
    • Positive findings
34
Q

What is a management for strength training for PD?

A

Progressive resisted exercises for trunk, UL & LL

35
Q

What are 3 managements for tai chi training for PD?

A
  1. Controlled movement of COM over BOS, attention, awareness of movement
  2. 6 months + longer term follow up
  3. Tai chi reduces falling in PD
36
Q

What are 2 managements for upper limb training for PD?

A
  1. Cues to increase size of movement, speed
  2. Handwriting training: Write between 2 lines to guide for writing size
37
Q

What are 4 managements for virtual reality games training for PD?

A
  1. Multidirectional COM movements
  2. Alternating steps
  3. Stationary control of COM
  4. Cognitive demand: Attention, real-time, use visual feedback, planning, dual task
38
Q

What are 7 managements for partnered dancing training for PD?

A
  1. Both partnered and non-partnered dancing improved performance on the BBS and quiet stance measures, but there was no difference between the two dancing programs
  2. Dancing (tango) found a significant improvement in miniBESTest results when tested 3, 6 and 12 months
  3. Auditory cues: Music
  4. Visual cues: Partner demo, mirrors
  5. Stability: Holding partner
  6. Dancing involves big steps, turning, crowds
  7. Social benefits
39
Q

What are 4 managements for cardiovascular fitness training for PD?

A
  1. May alleviate depression, fatigue, loss of self-esteem and insomnia
  2. Mild to moderate PD can maintain exercise capacity with regular aerobic exercise
  3. Structured aerobics classes are beneficial
  4. Any aerobic exercise that encourages whole body movement
40
Q

What are 2 managements for falls for PD?

A
  1. Ask about falls, falls circumstances
  2. Modify activities/factors associated with falls
41
Q

What are 7 managements for environmental restructuring for PD?

A
  1. Educate client and carer
  2. Movement strategies identified for the home can be incorporated into treatment
  3. Reduce clutter, rehang doors, rearrange furniture
  4. Reduce need for turns
  5. Tape in difficult areas
  6. Lighting
  7. Cue cards
42
Q

What are 6 cognitive strategies for PD?

A

Use cognitive strategies especially for late PD

  1. Avoid simultaneous tasks
  2. Write instructions down
  3. Speak slowly
  4. Allow for bradyphrenia (slowness of thought)
  5. Use cues
  6. Mental rehearsal
43
Q

What are 2 types of walking aids in the prescription of equipment of equipment?

A
  1. Walking aids with a laser line - help freezers to walk over the line
  2. Does not work if the line just stays on
44
Q

What are 3 types of equipment for bed mobility in the prescription of equipment of equipment?

A
  1. Bed poles
  2. Bed cradles
  3. Satin sheets
45
Q

What are 3 new technologies for PD?

A
  1. Non-invasive brain stimulation (rTMS, tDCS) to facilitate plasticity or extracellular dopamine levels
    • Unclear parameters & usage
    • Some evidence for positive effects, some evidence for no effects
  2. Accelerometry on wrist to monitor symptoms, upload data to clouds, then clinician can use the data for assessment and management
    • Measure, detect gait, movements
  3. Exergaming (e.g. kinect)
46
Q

What are 8 models of service delivery for PD?

A
  1. Physiotherapy is one component of MDT
  2. Combination of 1:1 therapy, group therapy and independent practice
  3. Review clients regularly
  4. Provide top-up programs as required
  5. Home programs to improve functions
  6. Lee Silverman Voice Treatment Big (LSVT BIG): Intensive exercise of high-amplitude movements to overcome bradykinesia and hypokinesia in PD.
  7. PD Warrior: No evidence but good
    • Expensive for physio and patient
  8. Boxing classes: Trunk rotation, unilateral movements, stepping
47
Q

What is the main treatment approach to PD?

A

Drug is the main treatment approach to PD.

  • Drug therapy is more difficult to manage late PD
48
Q

What is the on-off effect in the Pharmacological Management of PD?

A

Effect of on/off medication on movements

  • Do assessment during on period and off period for comparison
  • Know what medication they are on, what effects, when they have it
49
Q

What are 8 side effects of PD drugs?

A
  1. Dyskinesia: Involuntary movements which occur when dopamine level is highest
  2. Nausea
  3. Constipation
  4. Postural hypotension
  5. Depression
  6. Confusion and hallucinations
  7. Compulsive behaviours
  8. Hypersexuality
50
Q

What are 7 characteristics of Deep Brain Stimulation (DBS)?

A
  1. Electrodes implanted in STN or GPi
    1. Thalamus for essential tremor
    2. Pedunculopontine nucleus (PPN)
  2. High frequency impulses that block electrical signals from target regions
  3. Potential to affect many pathways
  4. Use DBS when drugs are no longer controls symptoms, or if severe side effects of drugs
  5. DBS is good for tremor-dominant PD, less good for PIGD
  6. Used in combination with dopamine replacement therapy
    • Reduced dosage
    • Improvement in side effects
  7. Improved gait and posture
  8. Speech unchanged

PHTY3140 (28 decks)

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