severe tremor
DESCRIPTION
Jose MirallesTRANSCRIPT
Physiotherapy in severe tremor. A case study
#HandFun13
What´s tremor?
• Part of ataxia…or not
Res6ng tremor │ Postural tremor │ Cine6c tremor
inac6vity Essen6al tremor Movement
& target
│ │
Sensi6ve Ataxia → Inten6onal & Postural tremor
Del Val, 2004
What do we know about tremor?
Neurons of these structures are capable of genera?ng osc i l l a?ng & rhy thmic ac?vity
MacAuley, 2000
Cor6cospinal via?
Treatment in Tremor • Botulinum toxin (e. Ia)(Demetrios,2013)
• Drugs (Propranolol, Topiramate, Atenolol, Alprazolam, Gabapen6ne) (Zesiewic, 2013)
• Deep Brain s6mula6on
• Physical Therapy: • Resistance training (Sequeira, 2012) • Weight proximal / distal (mcGruder, 2003)
• robo6c exoskeleton/ wearable orthosis (Rocon, 2007) • Differents physical therapies methods.
LOW EVIDENCE
Case • MS progressive 2004 • Sensi6ve Ataxia & severe Tremor in le` arm. • Last interven6on for tremor was botulinum Toxin. • EDSS:6 • Fa6gue
• MSQoL • WHIGET Tremor Ra6ng Scale • Tremor ac6vi6es of ADL ques6onnaire • Assessment of tremor related hándicap ques6onnaire. • Ataxia Scale
Case • Mingazzini
• Finger-‐nose • 9 Hole Peg Test
Pre-‐treatment
Unilateral Bilateral
Physiotherapy…..ideas? • Teaching illnes • Sensi6ve S6mula6on • Mirror Therapy • Bilateral Movement
Hipothesys & objec?ves • Normal movement imaging for a bad cor6cal image
• Posterior spinal cord symptoms need sensi6ve & propiocep6ve treatment • Short Term objec6ves: how is my tremor? • Medium Term objec6ves: I´m moving with less tremor. • Long Term objec6ves: My ADL with less tremor
Teaching illnes (same strategy of
Packer,T)
• How does my tremor work? Let´s ROCK! • Posturology & tremor • Strategies • Benefits if i work my tremor • ADL & tremor • Changing behavior • Biofeedback
Sensi?ve treatment
• Textures • Propiocep6ve mobiliza6ons • Objec6ve: Generate new sensi6ve inputs in somatosensorial cortex
• NO ROCK & ROLL
Mirror Therapy
• Create new movement cortex input • No Rock&Roll
Bilateral/Unilateral/Coordina?on movement • Sensi6ve & Motor control therapy • No rock as posible • Repe66ve & short movements • Without func6on. Just feel & move
and… fine movement?
Conclusions & objec?ves…
-‐ Only qualita6ve improvements. -‐ This protocol not improve ADL & func6on, only movement. -‐ Short & medium term objec6ves: move with tremor.
-‐ Need more pa6ents with tremor! -‐ Inclusion criteria:
-‐ Tremor (Medium & Severe) -‐ Exclusion criteria
-‐ Not Parkinson tremor & ¿Rubral tremor?
