Parkinson's Disease Interventions Flashcards
what are the general intervention goals for early stages of PD (H&Y 1-2)?
- Promotion of active lifestyle
- encouragement of continued engagement in home, work, and leisure activities
- initiation and monitoring of exercise program
- CV training
- strengthening
- balance stretching
- Dual-task activities, complex motor tasks
what are the general intervention goals for middle stages of PD (H&Y 3-4)?
- Promotion of active lifestyle
- continued engagement in home, work, and leisure activities
- mod of tasks and/or environment when appropriate to optimize participation
- continued monitoring of exercise program
- encourage participation in activities and exercises during “ON” times
- Initiate strategy training/cueing strategies w/increased focus on cog movement strategies
- Fall reduction interventions and edu
what are the general intervention goals for late stages of PD (H&Y 5)?
- Caregiver edu and training
- Assistance training
- cuing training
- optimize sitting posture and tolerance
- skin breakdown prevention and edu
- risk reduction for postural abnormalities and contractures
- Implementation of exercise program w/caregiver involvement (PROM and AROM)
- main focus = prevent contractures
- secondary focus = strengthening
T/F: the OFF times for PD get longer as the disease progresses
TRUE
how does cueing with PD pts work?
use of attentional cues
- can we override the loss of BG input to the SMA/PMC by using other systems in our brain?
- Frontal-Cortical control via premotor cortex
describe when the cardinal symptom of bradykinesia is seen in PD pts
- seen with initiation, execution and stoppage of tasks
- Common presentations in gait (temporal):
- gait speed
- arm swing
- step duration
- DLS duration
- Focus on increasing speed with these pts
describe when hypokinesia is seen in PD pts
- seen with initation, execution, and stoppage of tasks
- Common presentations in gait (spatial)
- arm swing
- trunk rotation
- step length
- step height
- weight shifting
- base of support
- Focus on
how is edu important relating to increasing gait speed and amplitude of movements in PD pts?
increasing speed and/or amplitude may feel TOO big to the pt, when in fact the now correted speed and amplitude is appropriate. They need to learn this
T/F: STM will help reduce rigidity in PD pts
FALSE
similar to spasitcity, there is nothing PT can do to fix rigidity
medications like levadopa may be given and surgical procedure such as DBS may help some
describe secondary managment of rigidity in PD pts
- Contracture prevention and management
- sig more at risk than w/spasticity
- stretching program crucial
- positioning crucial
- sig more at risk than w/spasticity
- Joint integrity maintenance
- joint mobilizations
- Skin integrity considerations
how is each aspect of postural stability impacted by PD?
- Acheiving balance
- difficulties with self-initated movements
- reduced anticipatory postural adjustments and control
- Maintaining balance
- smaller functional limits of stability
- midline disorientation
- Restoring balance
- abnormal and inflexible postural responses
- abnormal patterns of coactivation
which aspect of postural stability is most impacted by PD?
restoring balance
how can we help remediate midline disorientation in PD pts?
- encouragement of forward weight shift over balls of feet/toes
- activities on wedges
- rocker board activities
- forward displacement of COG over BOS (ex reaching)
- walking on tip toes
- encourage flexor moment at hips, knees, ankles
what are some compensation strategies for midline disorientation in PD pts?
- heel wedges
- activity modifications
- ex → stand to side of kitchen appliances when opening, intead of directly in front
- ex → “power stance” when opening a door
- AD considerations/modifications
when is breakdown in complex motor tasks in PD pts most noticable?
- sequential movements
- transitioning between movements
List some complex motor interventions
- Dual Task
- +cognitive task
- +motor task
- Multi-step activities
- Obstacle course
Give an example of a dual task outcome measure
- TUG - Cognitive
- TUG while counting backwards in 3s from random start time
- TUG - Motor
- TUG while holding a glass of water
what are the steps to deal with freezing of gait?
- ID common trigers
- Internal Cues
- External Cues
Give some examples of common triggers for freezing
- competing stimuli in environment
- small spaces
- changes in flooring type or pattern
- doorways
- thresholds
- approaching people, furniture, objects
- weight displacement on feet
- stress/anxiety/fear
- anticipatory FOG
- turning around/changing direction
- cog tasks, attention-splitting tasks
- crowds
Why do we see festinating gait and what does it lead to?
- why we see it
- gait kinematics
- initiation problems
- disequilibrium problems
- what does it lead to
- COG ant to BOS → LOB
- FOG
- sig reduced economy of walking
during the early stages of PD (H&Y 1-2) what does gait and functional training look like?
- primary focus → amplitude and symmetry
- neuroprotective strategies
- add dual-task w/cognitive and motor loads
- vary environment and task
- these pts can be pushed!!
during the mid stages of PD (H&Y 3) what does gait and functional training look like?
- primary focus → festination, retropulsion, LOBs
- continue to address amplitude
- strategies for “on” and “off” times
during the mid-late stage of PD (H&Y 3-4) what does gait and functional training look like?
- primary focus → FOG, fall risk management
- more involvement of family training/caregiver assistance
- increase in “off” times, strategies crucial
Describe PD checklist you could go through when performing a task analysis
- Initiation issues?
- Execution issues?
- Bradykinesia or hypokinesia?
- Postural instabilities?
- Additional S/S?
- tremor or rigidity?
- weakness?
- festinating gait?
- freezing?
- turning issues?
- complex motor task breakdown?
- Stoppage issues
why is aerobic conditioning important in PD pts?
decreased economy of movement is common, even in early stages of PD
aerobic conditioning shown to improve VO2 max in individuals with PD
Describe some methods for aerobic conditioning, recommendations, and outcome measures
- methods
- treadmill walking, overground ambulation, cycling
- recommendations
- 5x/week for at least 30 min (150 min/week)
- outcome measures
- 2 MWT
- 6 MWT
- RPE/mRPE
why is strengthening important for PD pts?
PD-related weakness has been tied to balance deficts, falls, and overall functional decline
caused by → altered descending central drive, deconditioning, aging or as secondary effects of postural abnormalities and changes in muscle length tension
list some guidelines and outcomes measures for strengthening in PD pts
- Guidelines
- 2-3x/week; 8-12 reps x 1-3 sets for general strengthening
- Outcome measures
- MDS-UPDRS
- 5x STS
- No current evidence on use of hand dynamometry in PD
why is stretching important for PD pts? what areas are most impacted?
- Most impacted:
- common ROM deficits at neck, trunk due to altered posture (forward trunk flexion, lack of spinal extension and rotation)
- Important b/c:
- increasing flexibility has been shown to improve balance, gait and ADLs
how should stretching be focused in PD pts? What are some guidelines
- Focus:
- spinal extension and rotation
- Iliopsoas
- hamstrings
- gastrocnemius
- pec major
- Guidelines:
- 3x/week (easy HEP to incoorporate)
List some possible secondary orthopedic sequale to PD
- Orthopedic considerations
- forward head, rounded shoulders, kyphosis lead to sig postural changes
- shadow pillow → supine postures
- CV considerations
- reduced CV function leads to reductions in activity tolerance
- Pulmonary considerations
- due to kyphotic posture, lung compliance often reduced
