Treatment for Parkinson's

Question 1

What are the 3 key elements for treatments?

Answer 1

1. depending on stage - teach the ability to move easily and any posture stability strats
2. seconday problem management (deconditioning, ↓ mobility and comorbidities)
3. physical activities and future fall prevention

Question 2

When decreasing compensations, what are some strategies to bypass a bad basal ganglia?

Answer 2

↑ reliance on cortical control to start the movement

↑ on attention to keep complex movements going

Question 3

How are we able to enhance performance for compensation training?

Answer 3

• breaking big sequences into component parts
• attention (!!!)
• perform task separately and one at a time
• mental practice and visualization

while providing external cues of visual and auditory

Question 4

What are we using in the brain when using external cues?

Answer 4

an intact premotor cortex to bypass bad BG-SMA circuits

Question 5

What are some visual cues used to help with gait?

Answer 5

Theres improvements when visual cues are given like:
- lines on the floor (static)
- inverted cane (dynamic = transportable cues)

these all help ↑ velocity and stride length

Question 6

What are some negative effects of visual cues?

Answer 6

Freezing - when there is an obstacle, change of direction

Distraction - bad for PD patients

Question 7

What are some auditory cues to assist with gait?

Answer 7

when there is a metronone to keep a steady and easy beat to follow

Question 8

What are the benefits of auditory cues for gait?

Answer 8

= ↑ cadence with gait –> long term retention even with decreased use of the beat

Question 9

In early to middle stages, what are we practicing to assist with strategy training?

Answer 9

be able to practice multiple task conditions and have a varying:
- speed
- surfaces
- directions
- sensory input

Question 10

How do we assist with deconditioning (secondary problem)?

Answer 10

• people with PD need more O2 during walking = more aerobic exercise
• Any edurance training
• mild strength but more focused on endurance

Question 11

What are we prioritizing with ↓ mobility and posture?

Answer 11

for the axial structures to have more trunk flexibility

Question 12

What is included in the HEP for PD?

Answer 12

daily exercise 3x per week with focus on felxibility, edurance and some strengthening
- this allows for neuroplasticity
- big part = assistance to prevent future falls

Question 13

What is the reasoning behind PT “check ups”?

Answer 13

• Being able to update HEP
• checking for any functional decline or improvement
• checking for any safety concerns or increasing possible efficiency

Question 14

What are the environmental constraints for freezing?

Answer 14

can nautrally happen out of nowhere and made worse by the task or environment

can possibly have the disorder of the sensory-motor processing

Question 15

What occurs in the brain when there is problems of the sensory-motor processing?

Answer 15

the caudate integrates the sensory information –> ↑ attention to the most relevant stimuli needed for the action

theres a sensory overload if theres too much things going on

Question 16

What are the task constraints for freezing?

Answer 16

happens more likely with long or complex locomotor skills than single isolated movements

to help - breakdown into simple taks with cues to switch

Question 17

What are the emotional contraints for freezing?

Answer 17

due to anxiety and stressfulness like crossing a busy road or panicking to get a ringing telephone

Question 18

What are the medical contraints regarding freezing?

Answer 18

usually happens during “off days” in patients who’s been on meds for a while = advanced/late stage

Question 19

How do we avoid freezing?

Answer 19

• rhythmical sensory cueing
• relaxation techniques
• be able to stop and prepare then restart the task
• keep it simple silly
• cognitive compensation
• avoiding stairs

Question 20

What is the most efficient strategy for PD?

Answer 20

Movement biomechanics - so training with functional context for MAX carryover

Question 21

What does LSVT teach?

Answer 21

An attentional strat that we can use everywhere to ↑ motor output for BIG BAD FAST MOVEMENTS

Question 22

What are some multidirectional sustained movements daily whole body exercises?

Answer 22

floor to ceiling stretch
side to side stretch

Question 23

What are some multidirectional repetitive movements?

Answer 23

Step and reach:
- to the side
- foward
- backward

Rock and reach:
- side to side twist
- foward/backward reach

Question 24

What are some patient driven functional movements?

Answer 24

Rolling
floor to stand
out of bed
sit to stand
chair and reach
stand and reach
walk and reach
walk and turn
stand and turn

Question 25

What are some “real-world” big tasks hierarchy?

Answer 25

in and out of the car
walking and talking
laundry
playing with grandchildren
hiking
gardening
golf
tennis

some tasks but take account patient driving force

Question 26

What is the mantra for sensory re-calibration?

Answer 26

if the patient doesn’t feel like they are moving “too big” - not moving big enough

Question 27

What is the frequency of cueing training?

Answer 27

20-60 minutes
2-5x/wk
3-8 weeks

Question 28

What is visual cueing aimed towards?

Answer 28

aimed to improve function

Question 29

What is auditory cueing aimed towards?

Answer 29

being delievered before and during the movement to initate or keep a motor action