PD Interventions Outside the CPG Flashcards
what are the benefits of cycling in PD?
neuroplastic and neuroprotective effects
enables individuals with significant motor impairment and FOG to safely engage in CV training
improve motor fxn
reduce tremors, rigidity, and freezing
improve mental health and QoL
what motor fxns are enhanced by cycling?
balance, walking capacity, and walking speed
t/f: intensity levels and cadence in cycling didn’t significantly affect outcomes
true
t/f: there is a limited focus on FoG in cycling
true
are cycling benefits more pronounced when applied as a long term regimen or as a single session intervention?
when applied as a long term regimen
what is high cadence cycling?
cycling with the motor maintained at 75-85 rpm
t/f: high cadence cycling showed significant improvements in UPDRS motor 3 and TUG times in a study
true
how often is high cadence cycling done?
40 min sessions 3-5x/week
what are the aerobic recommendations for how often it should be done?
3x/wk for 30-40 minutes
what is the recommended HR range for aerobic exercise?
70-85% of HRmax
what is the recommended RPE for aerobic exercise?
5-8/10
t/f: use of RPE scale may be more helpful than HR in determining exercise intensity if HR response is blunted
true
is pedaling for parkinson’s better for long or short term care that is motivating and sustainable?
long term care
how long is a session in pedaling for parkinson’s
1 hour w/40 minutes of high cadence cycling with a warm up and cool down
what is PWR! (Parkinson’s wellness recovery)?
a community wellness program that started as a gym in AZ that now uses PTs/OTs coordinating with fitness professionals with whole body movts to improve PD specific changes in posture, weight shifting, trunk rotation, and transitional movts
who can be trained in PWR!?
PT/OT
PTs/OTs coordinate with who to follow PWPD along a continuum of care?
fitness professionals
the whole body movts included in PWR! target what changes in PD?
posture
weight shifting
trunk rotation
transitional movts
what is the prepare portion of PWR! targeting?
rigidity
what is the activate portion of PWR! targeting?
bradykinesia
what is the flow portion of PWR! targeting?
incoordination
what positions are included in PWR!?
low floor
high floor
sitting
standing
what fxns are targeted in PWR!?
bed mobility
getting off the floor
getting in/out of the car
posture/balance
is certification required for LSVT BIG and LOUD?
yes
is certification required to provide large amplitude, high velocity interventions in clinical practice to address the impairments of a person with PD?
nope
t/f: LSVT started as a speech program
true
t/f: LSVT BIG is based on the principle of LSVT LOUD
true
what are the principles of LSVT?
intense amplitude based program
what is the focus of LSVT?
high intensity and amplitude exaggerated movts
what is the goal of LSVT?
to make bigger moves more automatic
to improve posture, flexibility, and balance
recalibrate the system to make normal movts
what are the fundamentals of LSVT?
amplitude
sensory calibration
intensity
what is often the biggest limiter to using LSVT programs?
pt and caregiver buy in
what is the fundamental principle of amplitude used in LSVT?
the largest ROM that can be performed, with highest effort and most biomechanical efficiency
what is the fundamental principle of sensory calibration in LSVT?
teaching the pt to self monitor
pt must accept that what feels too big is actually normal and create new motor memories
what is the protocol for LSVT?
4 sessions (1 hour each) per week for 4 weeks (total of 16 sessions)
t/f: LSVT has a long hx of national funding
true
pre-treatment in LSVT, what is the cycle creating decreased movt in PD?
pts don’t recognize their movts are small–> they continue scaling reduced amplitude of movt patterns in self cueing–> reduced amplitude of motor output–> produce slow, small movts
what is the cycle in treatment with LSVT?
improve pt’s self-perception of amplitude required to produce normal movt–>improve self-cueing to habitually scale increased amplitude of movt patterns–>increase amplitude of motor output–>produce larger movt
t/f: LSVT tries to bring awareness to PD pts’ off calibration
true
the amount of effort needed for an individual with PD to reach normal movt feels similar to what for a healthy individual?
the effort to perform big movts
what a pt with PD perceives as ____ movt is actually _____ movt
big, normal
what are the maximal daily exercises included in LSVT?
floor to ceiling - 8 reps
side to side - 8 reps
forward step - 8 reps
sideways step - 8 reps
backward step - 8 reps
forward rock and lean - 10 each side (working up to 20)
sideways rock and lean - 10 each (working up to 20)
what are the functional tasks included in LSVT?
5 everyday tasks (ie STS, pulling keys out of pocket, buttoning shirt) - 5 reps
t/f: STS are usually included in most pts in the functional tasks of LSVT
true
what are the hierarchy tasks in LSVT?
pt identified tasks (ie. getting out of bed, playing golf, getting in/out of car) that involve multiple steps
t/f: hierarchy tasks in LSVT should build in complexity across the 4 weeks to work towards long term goals
true
LSVT can be modified to ___, ___, or ____ according to ability
supported standing
seated
supine
the get ready signal in PD is _____
too weak
what is the consequence of the get ready signal in PD being too weak?
inadequate set for movt
what is the clinical result of weak get ready signal?
bradykinesia/hypokinesia
the go signal in PD is ____
too weak
what is the consequence of the go signal in PD being too weak?
inadequate selection/initiation of movt
what is the clinical result of a weak go signal in PD?
freezing/hesitation
the no-go signal in PD is ____
too weak
what is the consequence of a weak no-go signal in PD?
inadequate completion of a movt
what is the clinical result of weak no-go signal in PD?
festination
movts run together
what are the teaching techniques used in LSVT?
model
shape
drive
stabilize
calibrate
what does the teaching technique “model” mean?
show, don’t tell
“do what I do”
what is the purpose of modeling in LSVT?
to minimize cognitive overload
what does the teaching technique “shape” mean?
create the largest amplitude movt with optimal alignment
what cues can be used to shape movt in LSVT?
visual, auditory, and propriceptive cues
what does the teaching technique “drive” mean?
give big effort to increase motor output
what does the teaching technique “stabilize” mean?
repetitions of practice are needed to reinforce and motivate
what does the teaching technique “calibrate” mean?
retrain sensory perception to make movt look normal
t/f: LSVT should be errorless learning
true
should we correct mistakes in LSVT?
yes!
what are the strengths of LSVT?
certification is affordable
it is a marketable program for clinics
it provides quick results
it is customizable and salient to the pt
it can help slow disease progression and drive neuroplastic change
what are the weaknesses of LSVT?
pt time commitment
it is dependent on compliance
it must be done by a certified therapist
it is inflexible to modification
there is a potential insurance limitation
it is not effective in late stage PD
t/f: there is no single mode of exercise or program that fits all PD pts
true
beware of programs with _____ mentality
all or nothing
t/f: caregiver and family education is key
true
should we incorporate community exercise programming into our POC for PD?
yes!
