PD: Interventions

Question 1

treatment strategies to address multiple impairments of PD

Answer 1

external cueing
forced exercise vs voluntart exercise
dual task training
gait training
freezing management
balance training
strength training

Question 2

External cues

Answer 2

visual and auditory cues: shown to improve step length, stride length, gait speed, and UPDRS

cueing ideas: count steps audibly, metronome, lines/visual targets on floor

Question 3

How does cueing work?

Answer 3

allows use of cortical areas to initiate/control movement, bypassing the basal ganglia
self-given auditory cue is most effective

Question 4

benefits of forced exercise vs. voluntary exercise

Answer 4

shown to result in global improvements and neuroplastic changes

Question 5

dual task training

Answer 5

most beneficial for those at H&Y stages 2-3
dual task activities:
-counting, memory tasks
-carrying items/ball toss
-go/no go 
-completing a sequence
-various stepping upon command
-stroop task

Question 6

gait training

Answer 6

Nordic walking with trekking poles

• shown to improve gait speed, TUG, 6MWT, and QoL (PDQ-39) with lasting effects up to 5 months after training
• provide bilateral support for postural stability
• facilitates UE reciprocal motion and trunk rotation
• promotes symmetry

Question 7

Treadmill Training

Answer 7

• 6 weeks of TT w/o MWS increased QoL, motor UPDRS, gait speed
• TT + conventional therapy resulted in greater reduction of freezing episodes compared with just conventional training
• evidence supports TT as another example of forced exercise by having the treadmill pace at a speed > preferred gait speed.
• Goal: training speed of an age-matched normative speed
• BWSTT not beneficial

Question 8

4 “S” strategy for freezing interventions

Answer 8

Stop
Stand tall
Shift weight
Step

FoG prevention strategies:

• count steps
• external cues
• minimize dual task

Question 9

T/F: You should try to power through freezing episodes

Answer 9

false

Question 10

HiBalance training

Answer 10

3x/week for 60min/session
included highly challenging balance exercises including:
-sensory integration
-anticipatory postural adjustments
-motor agility
-stability limits

Provided improvements in mini-BESTest, gait speed, and step length

Question 11

Retropulsion balance training

Answer 11

counterbalance with COG forward
power stance with wide BOS
Side step vs. backing up

Question 12

strength training

Answer 12

power strength training consisting of 13 exercises targeting upper and lower body

• 10-12 reps, 2x/week for 12 weeks
• fast through concentric phase and slow through eccentric phase
• improved UPDRS motor scores, Berg Balance scores, and mini-BESTest, TUG

Eccentric training more effective

important to target back and hip extensors