PHYSIOTHERAPY INTRVENTION FOR PARKINSONS DISEASE

Dr. Surender Singh

Physical Therapy (PT)

Role of the physical therapist:
prescribes therapy based on movement analysis and patient goals assesses equipment needs advise home modifications as needed help teach caregivers/family ways to assist the person with PD (cueing as needed)

Goals of PT
Slow sensorimotor deterioration Prevent falls Establish home exercise program that challenges the person with PD Follow up every 3-6 months Fall prevention Correct deficits Transfers and bed mobility Strengthening of trunk, shoulders, hips Balance and coordination

Evidence Based Practice: PT and PD

Most PD patients face mobility deficits

Difficulties with transfers Posture Balance Walking Fear of falls Loss of independence Inactivity

Benefits of Exercise

Increased VO2 Improved BP Control Increased HDL Decreased Body Fat Improved Weight Control Improved BS Control Improved Strength Less Fatigue Improved Balance

Heart Disease Lung Disease Diabetes Neuromuscular Musculoskeletal Obesity

Exercise Prescription Tips Parkinsons Disease

Aerobic
Safety walking is preferred, but may need to use bike ergometer, eliptical, arm ergometer or others if symptoms warrant. Balance devices harness, walking poles

Strength
Warm up important Focus on exercises that extend the trunk Functional exercises best Auditory cues may be needed to help with timing of repetitions Ensure good posture

PWR! Hands

PWR! Rock

Set 1

Exercise 1: Be seated. Hold your breath as tightly as possible while pushing down or pulling up on your chair with both hands for 5 sec.

Set 1

Exercise 2: Be seated. Bear down against a chair with only one hand. Produce clear voice simultaneously.

Set 1

Exercise 3: Repeat ah 5 times with a hard glottal attack on each vowel.

Set 1
Patients should practice this series every day for one week. A follow-up swallow evaluation should be completed to assess improvements in airway protection from the larynx. The SLP and patient can also monitor improvements in laryngeal function by listening to clarity and vocal quality. If no improvements are noted, the exercises should be changed to those in Set 2. This prevents monotony and introduces exercises in a hierarchy

Set 2
The series of exercises should be completed five to ten time per day for five minutes Each exercise should be repeated 5 times before moving on to the next exercise in the set The whole series of exercises should be repeated three times

Set 2
The series of exercises should be completed five to ten time per day for five minutes Each exercise should be repeated 5 times before moving on to the next exercise in the set The whole series of exercises should be repeated three times

Set 2

Exercise 2: Begin phonation of ah with a hard glottal attack and sustain phonation with a clear, smooth vocal quality for 5-10 seconds

Set 2

Exercise 3: Pseudo-supraglottic swallow Take a breath, hold it, and cough as strongly as possible

Recovery
Improvement should be seen within 2 weeks Occasionally it will take 6-8 months with some patients to attain adequate airway protection or vocal quality
these are often those who have had more serious conditions (i.e. extended supraglottic laryngectomy)

THANK YOU