W14: Interventions for Patients with Parkinson’s Disease Flashcards
What are the CARDINAL SIGNS of PD ?
- Postural instability
- Tremor
- Bradykinesia
- Rigidity
What are some interventions you can use to address Postural Instability with PD patients ?
- Balance
- Righting reactions
- Teaching strategies
- Capitalizing on reflexes
- Prescribing AD’s
- Home modifications for safety.
What are some things you should know in regard to TREMORS ?
-The t TYPE of tremor is very important.
What is something that may help can suggest to help with TREMORS ?
-Gets better when you move in a focused way
Weighting may help
What is BRADYKINESIA ?
- Moving smaller amplitude
-Small and slow movement
-The Inability to perceive intrinsic deviations from the norm with movement
What is the main goal of Neuroplasticity ?
Main goal of PD intervention is to drive amplitude of movement.
In other words, make movement bigger.
What are the main goals of the principles of Neuroplasticity ?
-Intensity matters
-Repetition matters
-Salience
-Use it or lose it
-Use it and improve it
Principle 1:
Intensity matters :
-To drive amplitude.
-You need to train your patients at HIGH intensity (8/10 effort)
[MAX EFFORT]
Principle 2:
Repetition matters:
-Patients should be doing as many reps as possible daily to drive neuroplastic change.
Principle 3:
Salience:
-You are training tasks that matter to the patient. Pick relevant interventions.
-No 3 sets of 10 of a non-functional exercise like hamstring curls.
Principle 4:
Use it or lose it:
-In a progressive disease this is even more pronounced.
Principle 5:
Use it and improve it:
- Patients with PD can functionally improve, treat them like they can
What does an ideal LSVT BIG dosage look like ?
LSVT BIG is dosed:
- 4x/week
-1 hr. for 4 weeks straight.
Daily homework of about - 1 hour on treatment days.
- 2x/day on non-treatment days.
-SO MANY REPS!!!
What are some TOOLS used for BRADYKINESIA ?
Need to recalibrate them to normal.
How can you recalibrate BRADYKINESIA this in someone who cannot tell that they have bradykinesia?
Drive amplitude by:
SHOW THEM :
- You must use your own body to show them what big amplitude movement is.
- They will mirror you.
SHAPE THEM :
- Use your tactile cues position they body in bigger movements
TELL THEM:
Use your voice to drive intensity and motivation, exaggerate.
Art Of Calibration:
Changes are not _____ or ________ unless you achieve calibration.
Changes are not lasting or meaningful unless you achieve calibration.
Art Of Calibration:
Calibration would be transitioning the patient from requiring ______ cues to move with normal amplitude to depending on _________ feedback for what is normal.
Calibration would be transitioning the patient from requiring external cues to move with normal amplitude to depending on their own intrinsic feedback for what is normal.
Art Of Calibration:
We must retrain their normal to be _______ than they think it should be and then make that automatic.
We must retrain their normal to be LARGER than they think it should be and then make that automatic
Art Of Calibration:
The more a patient cues themselves, even when you are not there watching, the more you know they are getting ________.
The more a patient cues themselves, even when you are not there watching, the more you know they are getting CALIBRATED.
Art Of Calibration:
If their presentation is very different when they are working with you in clinic to when they walk back to their car, they are NOT calibrated.
[TRUE OR FALSE]
TRUE :
If their presentation is very different when they are working with you in clinic to when they walk back to their car, they are NOT calibrated.
Rigidity is a form of _____.
Rigidity is a form of HYPERTONIA.
Is Rigidity spasticity ?
Why or Why not ?
IT IS NOT SPASTICITY.
B/C IT IS NOT VELOCITY DEPENDENT
_________ complications of rigidity are what we treat.
SECONDARY COMPLICATIONS of rigidity are what we treat.
What are some secondary complications of Rigidity ?
Think of chronic high tone in the thoracic region.
What would that effect?
What about at other joints that may be affected by Rigidity ?
Hips - Pelvic Tilt
Cervical Region - FHP
Knees
How would you treat joints that are affected by rigidity for a patient with PD ?
*Use your MSK Knowledge !!!
- Thoracic Mobility
- Rotational Mobility
- AROM, PROM
- Breathing exercises
- Postural strengthening
- Motion (is lotion)
- Keep them moving
- Strengthen
Ask yourself ?
+ What is lengthened and lengthened ?
+ What is short ?
-Work on joint restrictions
-Endurance
-Training/cardio
- Relaxation techniques
- Stress management
Cuing is KEY in PD , especially with _____ cues , but must train them to transition these to _____ so there is CARRY OVER.
Especially EXTERNAL cues, but must train them to transition these to INTERNAL so there is CARRY OVER.
What are some examples of EXTERNAL CUES that can be utilized ?
External Cues. :
- Metronome
- Verbal cues to move.
-Higher amplitude.
- Tactile cues to move with higher amplitude
-Visually watching you move with higher amplitude.
You have a patient who is exhibiting a , “FREEZING GAIT” Pattern during therapy what are some interventions you can use to correct this ?
Freezing Gait Interventions:
- WEIGHT SHIFTS.
- VISUAL TARGET that is past the freezing point
-METRONOME
What are some non-motor impairments that you may see with PD , and how would you treat ?
Social interaction may help with :
-Depression
-Self efficacy
-Feelings of isolation
- Feeling understood
How can we assist with facilitating environments that work both on the motor and non-motor symptoms?
**Give [3] Examples.
Group intervention:
1. Tai Chi
2. Dance
3. Kick-Boxing
4. Cycling
5. Pilates
6. Doing group PWR ! or LSVT BIG or LOUD.
7. BIG for Life
8. Hippotherapy
———————————-
TAI CHI
Works on:
+ Balance (key outcome in systematic review)
+ Mobility
+ Relaxation
+ Motor Control
+ Flexibility
+ Social setting
+ Emotional regulation
DANCE :
Works on:
+ Social interaction
+ Balance
+ Mobility
+ Motor control
+ Auditory stimulus
+ Tactile stimulus
+ Visual stimulus
+Flexibility
+Etc.
KICK-BOXING :
Works on:
+ Strength
+ Coordination
+ Rotational mobility
+ Balance
+ Social interaction
+ Flexibility
+ Limited high-quality
+Studies on this:
but one found correlation to decreased self reported falls
What does a , “Parkinsonian Gait” look like? *
- Festinating gait pattern
- Short rapid steps
- Difficulty initiating movement
- Once movement initiated, able to carry out the task
- High fall risk
What is Parkinson ? *
Progressive degenerative disease of the nervous system that affects movement.
What is the diagnosis of PD ? *
Cause by degeneration of basal ganglia and deficiency of dopamine.
What is the PROGNOSIS of PD ? *
Is a progressive disease, with a reduced life expectancy.
What are some other PT interventions you can perform ? *
INTERVENTIONS :
- Repetitive auditory stimulation
- PNF
- Rhythmic initiation
- Gait training Relaxation techniques
What are some A&P benefits behind PT Intervention ? *
- Decrease muscle tension
- Decrease contracture
- Muscle strengthening
- PNF enhance trunk mobility/improve motor performance
What are some GOALS of PT interventions ? *
- IMPROVE Impairments
- IMPROVE Functional Limitations
- IMPROVE Disabilities
What are some SIDE EFFECTS of PT Interventions ? *
Avoid Excessive Exercise and Stretching.
