Parkinson's Treatment

Question 1

What are some relaxation exercises?

Answer 1

Slow rocking/rotational exercises, rhythmic initiation (no research evidence to support, only clinician suggested if pt is very rigid)

Question 2

Slow rocking/rotational exercises

Answer 2

supine, slow sided to side head rotation
hooklying lower trunk rotations
sidelying upper and lower trunk rotations
sidelying trunk rotations combined c scapular patterns

Question 3

Rhythmic initiation

Answer 3

-progress from passive to resisted movements
used to reduce problems of immobility
once patterns are learned, teach as HEP

Question 4

Which muscle groups should receive special attention in flexibility exercises?

Answer 4

trunk flexibility

Question 5

Approach to specific training in mobility

Answer 5

Part-to-whole training of complex movements

Question 6

What to do with “sticking point?”

Answer 6

practice it as an exercise and then put it into a functional movement. Also try movement “backwards” like with SCI patients

Question 7

Sit to stand: hypokinesia

Answer 7

pt mental rehersal and self verbal cueing

Question 8

Sit to stand: akinesia

Answer 8

proprioceptive cues and self verbal cueing

Question 9

Two major problems with turning over and getting out of bed

Answer 9

complexity of the task

done at night - low Levodopa levels, dark

Question 10

Getting out of bed tips

Answer 10

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

Question 11

Getting out of bed subtasks

Answer 11

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

Question 12

Example of “augmented feedback”

Answer 12

self-cueing

keep cues simple and functionally relevant

Question 13

Can persons with PD increase strength?

Answer 13

Lower extremity strength can increase substantially with resistance training
Early PD - aerobic conditioning and trunk exercises can increase trunk flex/ext torque production

Question 14

Examples of balance activities

Answer 14

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

Question 15

A fall diary can help determine if falls are due to…

pt should include when and what they were doing

Answer 15

PD movement disorders
cognitive impairment
way in which task is performed
environmental factors
medications
factors outside of PD (weakness, loss of ROM, vestibular)

Question 16

Primary problems with gait training c PD

Answer 16

bradykinesia, hypokinesia

Question 17

Primary approaches to gait training with hypokinesia

Answer 17

Visual - eg. lines on floor
Attentional - “big step” self-cue
Auditory - eg. walking to music

Question 18

Primary approaches to gait training with dystonic plantarflexors

Answer 18

Teach pt standing stretches to reduce tone;

attentional cues to attend to heel-strike and push-off

Question 19

PD pt likes to dual task?

Answer 19

teach pt to avoid dual-tasking

Question 20

Normal amount of steps for elder pt 360 degree turn

Answer 20

6 steps

Question 21

What does a PD pt with motor instability exhibit with 360 degree turn?

Answer 21

20+ steps, freezing, progressively smaller steps, little head/trunk movement

Question 22

Approach to train patient turning around

Answer 22

more of an “arc” motion than rapid directional change

Question 23

Turning attentional tip in tight spaces

Answer 23

clock turn - consciously step with one foot then the other to numbers on the “clock”

Question 24

For pts unable to sit up in bed

Answer 24

raise HOB

provide a knotted rope to end of bed or overhead trapeze

Question 25

Additional adaptations if necessary

Answer 25

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

Question 26

UE dexterity “homework”

Answer 26

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

Question 27

PD pts should not be pushed to extremes due to…

Answer 27

increased risk of fatigue

Question 28

Things to check for – pt and family education

Answer 28

effects of immobility and deconditioning
problem solving training
skin breakdown and positioning (reduce contractures)
how to transfer
community support groups

Question 29

Considerations for aerobic conditioning

Answer 29

peak aerobic capacity occurs at lower work levels
use submaximal intensities 3-5 days/week
use shorter periods several times/day if low capacity