physiotherapy for parkinsons disease

7/31/2019 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

physiotherapy for parkinsons disease

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