HISTORY TAKING AND ASSESSMENT TOOLS IN REHABILITATION IN PARKINSON’S DISEASE

Mariella GrazianoPhysiotherapy trainer mariella.graziano@parkinsonnet.lu

24 July 2021

Mariella GRAZIANO

• Gain understanding on the assessment of the person’s problems in the

framework of the European Physiotherapy Guideline for Parkinson’s

• Recognise what needs to be addressed in history taking, referring to members

of the MDT when required.

• Identify Parkinson’s measurement tools in clinical practice in the context of the

European Physiotherapy guideline for Parkinson’s

Overview

Self-management

Partnership

Respectful of the individual preferences, needs and values and According to disease stages

Cooperation with carer

Working on problemsimportant for the person

> A patient centered approachThe assessment process

PT PwP

Specific PT domains facilitate interdisciplinary collaboration

Balance & falls

Physicalcapacity

Gait Transfers

PainRespiratoryproblems

Posture

Dexterity

The assessment process > Domains

• History taking • Physical examination • measurement tools

Assessment

Identification of problems and Goals

what to askwhat to examine

To measure what is treated

Relevant points:• to build a relationship of trust • Therapist observational skills

AREAS TO INCLUDE

Diagnosis:• Impact on the person and family life. • Myths and beliefsPMH co-morbidities pain OA, diabetes, heart conditions, respiratory problemsSocial history and leisure Work/retired and hobbiesHome environment Speech swallowingEmotional status

Medications – name, dosage, timing, and side effects, wearing off, on/off periodsCharacteristics of PD:

Initial side of onsetInitial presentation / symptomsNon-motor symptoms (NMSS) -fatigue, decreased memory, depression etc

> First step to a successful treatmentHistory taking

To lease with MDT when required

History taking

> Quick Reference Card 1History taking

> Quick Reference Card 1History taking

> Tips and tricksHistory taking

Mariella Graziano in cooperation with EPDA Coping Strategies invented by People with PD

Tips and tricks

Promotes an interdependent relationship between PT & PWP.

Identifies problems seeing by PWP and how they manage them.Provides better goal settingMore time • efficient for therapist• to treat relevant problemsContent: -Inside in(near) falls-freezingphysical activitiesTransfersManual activities

16 ITEMS

Accurate MTs for research or the physician e.g. Unified Parkinson's Disease Rating Scale (UPDRS) often are not suitable to capture the specific problem for a PwP in clinical practice.

Barriers• Take time • Difficult to

• Select appropriate tools

• Apply them with accuracy

Meaurement tools (MTs) for clinical practice

5. ↑ Motivation 6. ↑ communication 7. cost effective interventions

1. goal oriented treatment2. better insight in troublesome activities3. monitoring change4. identify of fall risks and fall predictions

BUT to examine and treat the PwP systematically MTs are essential.

Advantages: Investing time in their use results

The choice is based on

• The treatment goal To measure what is treated• The availability of the tool (e.g. concerning language and costs), • The feasibility of carrying out the tests at the PwP’s home, • The clinimetric properties - reliable, valid, responsive to the intervention

The physiotherapy guideline selected 18 measurement tools which are valid, reliable and can be used in physiotherapy practice in term of time and costs when possible they are specific for PD

Meaurement tools (MTs) for clinical practice

Gait

▪ Modified Parkinson Activity Scale (M-PAS-II)

▪ New Freezing of gait questionaire (N-FOQ)

▪ 6 or 10 Meter Walk

▪ Timed Up and Go (TUG)

▪ Rapid turns

▪6 Minute WalkTransfers

▪ M-PAS (I,III)▪ Timed Up and Go (TUG)▪ 5 Times Sit-To-Stand

Physical Capacity

▪ 6 Minute Walk & Borg 6-20

▪ 5 Times Sit-To-Stand

Balance

▪ History of falling

▪ Falls diary

▪ ABC / FES-I

▪ Modified PAS

▪ Push & release test

▪Timed Up and Go (TUG)

▪BBS / DGI&FGA / Mini-BESTest

▪Five time sit to stand

Insight main problemPre-assessment Information Form

Not by PT: QOL: PDQ-39Symptoms: UPDRSCognition

Goal Attainment Scaling - SMARTSpecific, Measurable, Attainable, Relevant and Timely

How to integrate metrics?

> Quick Reference Card 2Physical examination

Diagnosed with PD 12 yrs ago, livesalone with carer support.

Unpredictable on/off periods. Duodopa pump. Difficulty to

regulate optimal pump function. Now predictable motor fluctuations. Progressive cognitive impairements.

When pump is not working well My feet glue to the floor.

I try to walk forward

It is dangerous I could fall

To show me and my carers how to overcome it

When the pump is not working, I try not to move.

Pre-assessment Information Form (PlF)

> Quick Reference Card 1History taking

Only when the pump is not working as expected

New Freezing of Gait> Questionnaire

TURNING

I WAS NOT CONCENTRATING

I HOLD ON TO SOMETHING

History of Falling > Questionnaire

> Quick Reference Card 2Physical examination

Push and Release Test / p.121

Rapid Turns test / p.124

1,1 m/s

Optimal pump function

3 - Step Falls Prediction Model

• SMART• Specific

• Measurable

• Agreed/Attainable

• Relevant

• Timely

Setting & Agreeing Goals

Agreed with PaulTo walk under supervision towards a chair and turn before sitting using cueing without freezing and with the carer prompting in 6 sessions

(three weeks).

Goal planning

• A detailed history taking detects the PwP

specific problems and referral to MDT

• PIF identifies the PwP problems and goals

• Measurement tools are crucial to monitore

change and progress and adjust treatment

Take home messages

Mariella GrazianoPhysiotherapy trainer mariella.graziano@parkinsonnet.lu

THANK YOU