Download - Physiotherapy for Parkinsons Disease
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PHYSIOTHERAPY INTRVENTION
FOR PARKINSONS DISEASE
Dr. Surender Singh
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Role of the physical therapist:
prescribes therapy based on movement analysis andpatient goals
assesses equipment needs
advise home modifications as needed
help teach caregivers/family ways to assist the personwith PD (cueing as needed)
Physical Therapy (PT)
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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
Goals of PT
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Most PD patients face mobility deficits
Difficulties with transfers
Posture
Balance
Walking
Fear of falls
Loss of independence
Inactivity
Evidence Based Practice: PT and PD
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Benefits of Exercise
Increased VO2Improved BP Control
Increased HDLDecreased Body FatImproved Weight ControlImproved BS ControlImproved StrengthLess FatigueImproved Balance
Heart DiseaseLung Disease
DiabetesNeuromuscular
MusculoskeletalObesity
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Aerobic Safety walking is preferred, but may need to use bike
ergometer, eliptical, arm ergometer or others if symptomswarrant.
Balance devices harness, walking polesStrength
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
Exercise Prescription TipsParkinsons Disease
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PWR! Hands
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PWR! Rock
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Set 1
Exercise 1:
Be seated.
Hold your breath as tightly as possible while pushingdown or pulling up on your chair with both hands for 5sec.
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Set 1
Exercise 2:
Be seated.
Bear down against a chair with only one hand. Produceclear voice simultaneously.
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Set 1
Exercise 3:
Repeat ah 5 times with a hard glottal attack on eachvowel.
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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
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Set 2
The series of exercises should be completed five to tentime per day for five minutes
Each exercise should be repeated 5 times before movingon to the next exercise in the set
The whole series of exercises should be repeated threetimes
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Set 2
The series of exercises should be completed five to tentime per day for five minutes
Each exercise should be repeated 5 times before movingon to the next exercise in the set
The whole series of exercises should be repeated threetimes
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Set 2
Exercise 2:
Begin phonation of ah with a hard glottal attack andsustain phonation with a clear, smooth vocal quality for5-10 seconds
http://images.google.com/imgres?imgurl=http://www.safe-nz.org.nz/Image/speaking.png&imgrefurl=http://www.safe-nz.org.nz/Newsletters/newssixteen.htm&usg=__73YdA1ZT5W0gfqYgb9vgWnw0IfQ=&h=208&w=176&sz=7&hl=en&start=32&um=1&tbnid=e3XI6f6Y-Cu0LM:&tbnh=105&tbnw=89&prev=/images?q=speaking&imgtype=clipart&as_st=y&ndsp=18&hl=en&rlz=1G1ACAWCENUS335&sa=N&start=18&um=1 -
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Set 2
Exercise 3:
Pseudo-supraglottic swallow
Take a breath, hold it, and cough as strongly as possible
http://images.google.com/imgres?imgurl=http://www.adclinic.com/Doctors_Specialties_Maps/Allergy/16015562.jpg&imgrefurl=http://www.adclinic.com/Doctors_Specialties_Maps/Allergy/allergycoughedu.htm&usg=__c3Wfwv35TFZwN7Vk679irPr9Mu4=&h=800&w=532&sz=165&hl=en&start=26&um=1&tbnid=gWbQ3kalwT7XIM:&tbnh=143&tbnw=95&prev=/images?q=cough&ndsp=18&hl=en&rlz=1G1ACAWCENUS335&sa=N&start=18&um=1 -
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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)
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THANK YOU