Parkinson's Treatment Flashcards
Neuro II Parkinson's Treatment Approaches
What are some relaxation exercises?
Slow rocking/rotational exercises, rhythmic initiation (no research evidence to support, only clinician suggested if pt is very rigid)
Slow rocking/rotational exercises
supine, slow sided to side head rotation
hooklying lower trunk rotations
sidelying upper and lower trunk rotations
sidelying trunk rotations combined c scapular patterns
Rhythmic initiation
-progress from passive to resisted movements
used to reduce problems of immobility
once patterns are learned, teach as HEP
Which muscle groups should receive special attention in flexibility exercises?
trunk flexibility
Approach to specific training in mobility
Part-to-whole training of complex movements
What to do with “sticking point?”
practice it as an exercise and then put it into a functional movement. Also try movement “backwards” like with SCI patients
Sit to stand: hypokinesia
pt mental rehersal and self verbal cueing
Sit to stand: akinesia
proprioceptive cues and self verbal cueing
Two major problems with turning over and getting out of bed
complexity of the task
done at night - low Levodopa levels, dark
Getting out of bed tips
Slow-acting Levodopa meds
night-light
lightweight quilt and satin or silk sheets and nightwear
mental rehearsal
conscious attending to individual subtasks
consider bed height
commode near bed
Getting out of bed subtasks
throw back covers shifting pelvis toward center of bed turning head bringing arm across body swing legs over edge pushing up adjusting postural alignment - sit upright
Example of “augmented feedback”
self-cueing
keep cues simple and functionally relevant
Can persons with PD increase strength?
Lower extremity strength can increase substantially with resistance training
Early PD - aerobic conditioning and trunk exercises can increase trunk flex/ext torque production
Examples of balance activities
weight shifting
reaching for objects in ranges that challenge balance
movement transition practice
perturbations
grid on floor
obstacle courses
+alter lighting, close pt eyes, busy environment, increase noise level
A fall diary can help determine if falls are due to…
pt should include when and what they were doing
PD movement disorders cognitive impairment way in which task is performed environmental factors medications factors outside of PD (weakness, loss of ROM, vestibular)
Primary problems with gait training c PD
bradykinesia, hypokinesia
Primary approaches to gait training with hypokinesia
Visual - eg. lines on floor
Attentional - “big step” self-cue
Auditory - eg. walking to music
Primary approaches to gait training with dystonic plantarflexors
Teach pt standing stretches to reduce tone;
attentional cues to attend to heel-strike and push-off
PD pt likes to dual task?
teach pt to avoid dual-tasking
Normal amount of steps for elder pt 360 degree turn
6 steps
What does a PD pt with motor instability exhibit with 360 degree turn?
20+ steps, freezing, progressively smaller steps, little head/trunk movement
Approach to train patient turning around
more of an “arc” motion than rapid directional change
Turning attentional tip in tight spaces
clock turn - consciously step with one foot then the other to numbers on the “clock”
For pts unable to sit up in bed
raise HOB
provide a knotted rope to end of bed or overhead trapeze
Additional adaptations if necessary
firm mattress
satin sheets/pajamas
firm chair c armrests at appropriate height
leather or hard composition soles for sliding
lowered heel or toe wedge - festinating gait
FWW…UNLESS pt has poor balance
UE dexterity “homework”
buttoning handwriting reaching, grasping objects pouring water opening/closing jars lifting jars and boxes picking up grains of rice picking up a staw don/doff clothing dialing on telephone paper folding ORIGAMI
PD pts should not be pushed to extremes due to…
increased risk of fatigue
Things to check for – pt and family education
effects of immobility and deconditioning problem solving training skin breakdown and positioning (reduce contractures) how to transfer community support groups
Considerations for aerobic conditioning
peak aerobic capacity occurs at lower work levels
use submaximal intensities 3-5 days/week
use shorter periods several times/day if low capacity
