Occupational Therapy For Parkinsons Disease
Occupational therapy for Parkinsons Disease incorporates the use of functional activities as part of the therapy process, including:
ADL training: dressing, feeding, bathing, grooming, hygiene, toileting
IADL training: leisure activities, social participation, caring for pets, participating in daily activities and routines
Balance training to improve participation in tasks
Training to manage tremors in the hands and upper extremities
Safety and fall prevention including fall proofing of home environments
Modification of tasks including recommendation of equipment, technology and adaptive strategies to improve independence
Transfer training to improve ability to get up from a chair or toilet seat as well as in and out of bed or a car.
An occupational therapy program can help a client with Parkinsons Disease to:
Prevent falls and improve safety at home
Improve coordination with tasks including buttoning, feeding and handwriting
Manage tremors during functional tasks
Continue to participate in social activities with modifications
Maintain independence at home with improved safety
Light Therapy And Parkinsons
NIr therapy works by using infrared illumination to treat brain tissue affected by a lack of oxygen, toxic environments, and mitochondrial dysfunction. Mitochondria help to produce energy in cells and play a role in regulating cell function when working properly. NIr attempts to reduce cell damage and death by protecting the dopamine-producing neurons.2 NIr has been shown to reduce tissue inflammation and improve mitochondrial function.
It is not a targeted therapy because it works on the neural symptoms of many conditions by reducing the neurodegenerative process. Light therapy targets the brain and therefore it is likely to impact multiple facets of neural functioning. Studies have yielded results that show improvement in cognitive, emotional, and executive function.
Photobiomodulation is the ability of light to modulate biological processes at a cellular level.4 The use of controlled exposure of red to infrared wavelengths of light have successfully improved healing, reduced inflammation and pain. It has done this by improving mitochondrial function and stimulating antioxidant pathways in the brain. Photobiomodualtion has been therapeutically effective to improve the recovery rate for other medical conditions, and has shown promise in the lab for people and animals with PD.
Strategic use of specific light applied at a targeted time of day for a specific length of time should be able to attack melatonin, and reduce it, thus restoring dopamine balance.5
Why Big Is Better
BIG has one primary focus: amplitude. It asks those following the program to move big, encouraging a vigorous range of movement and pushing participants to use all parts of the body, from the feet to the hands and fingers. In a BIG session, the patient mimics or mirrors the therapist through a series of large stepping or rocking movements with their arms moving in various directions.
In recent studies, the principles of LSVT BIG were applied to limb movement in people with Parkinsons disease. The documented results demonstrated improvements in amplitude that generalized to improve speed , balance, and quality of life. In addition, people were able to maintain these improvements when challenged with a dual task.
At Progressive Physical Therapy, our programs are designed to meet the individual needs of the patient and their ability in a safe and fun manner. This, combined with doing a home exercise program one to two times a day helps clients with Parkinsons Disease improve their skills. The goal is for patients to use their bigger movements automatically in everyday living and for long-term carryover of increased amplitude. The therapy can be used in a walking, standing or sitting position.
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Promoting Physical Activity And Preventing Falls
Because PD is a chronic progressive disorder, it is probable that sustained exercise is necessary to maintain benefits. Indeed, follow-up data from a number of human exercise interventions have demonstrated a gradual return to baseline abilities after the supervised intervention is finished.7,25,38
Because weekly intervention with a physical therapist, throughout the entire course of PD, is neither realistic nor desirable, patients need to take responsibility for their physical activity and exercises. Methods have been developed, based on theories of behavior, for improving exercise habits. Strategies include exploration of the patient’s beliefs about exercise and barriers to regular exercise and discussing the possibility of looking at things differently to change beliefs and overcome barriers.4345 Together, the clinician and patient then establish reasonable goals that the patient thinks are attainable they build on those goals as exercise habits improve. Regular follow-up appointments also are important to monitor progression and provide support to the patient.
Parkinson’s Disease And Movement Disorders Center
Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.
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How To Start Exercising If Youre Living With Parkinsons
Safety is key. The first thing you need to do is talk with your neurologist and primary care doctor to make sure that the exercise regimen that you embark upon is safe for you.
Next, ask for a referral for physical therapy. A physical therapist will be able to figure out what movement challenges you may have and design a program to help you improve. There are certain physical therapists with additional training in Parkinsons. Your physical therapist will work with you for your allotted sessions, and then can help you plan your ongoing exercise regimen that is tailored to you. You can contact the APDA National Rehabilitation Resource Center for Parkinsons Disease for help finding resources in your area.
Additionally, physical therapy can help counteract the tendency for people with PD to reduce the size of their movements. The Lee Silverman Voice Technique has designed a program called LSVT-BIG which trains participants to make big movements. You can search for an LSVT-trained professional near you.
Anyone starting out on an exercise program could benefit from APDAs Be Active & Beyond exercise guide which includes clear photos with simple instructions that are easy to follow, with exercises that address all levels of fitness.
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Types Of Physical Therapy For Parkinson’s Disease
Parkinson’s disease is a nervous system disorder that affects over 1 million Americans. This disease involves the part of the brain that controls movement. The main symptoms include tremors, muscle rigidity and difficulty with coordination, balance and walking.
Although there is no cure for Parkinson’s disease, various treatments can relieve symptoms and help patients maintain their quality of life. Physical therapy is one form of treatment known to help individuals with Parkinson’s disease increase mobility, strengthen their muscles, improve coordination and balance, and ultimately, remain independent. This post explores the different types of physical therapy and how to make the most of a rehabilitation program.
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Physical Therapy Strategies For Parkinsons Disease
PT can improve daily functioning for people living with PD by:4
- Improving gait, or the way a person walks
- Improving transfers, like going from stillness to activity
- Improving balance
- Strengthening joints and muscles to improve physical capacity
One of the ways physical therapists help improve gait is through the use of cues. Cues are stimuli from the environment or generated by the person that they can use to facilitate repetitive movements, like walking. Cues can be:4
- Auditory, like using a metronome or music
- Visual, such as stepping over stripes on the floor
- Tactile, like tapping on the hip or leg
- Cognitive, like using a mental image of the length of a step
Make It To Your Appointments
The number of physical therapy appointments you need depends on your condition and goals. Generally, your first appointment will include an evaluation and exercise recommendations. In following appointments, your physical therapist will check your progress and add or modify exercises according to your needs. Make sure you attend all of your appointments to stay on track.
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Infrared Light And Parkinsons Disease: Is There A Connection
Parkinsons Disease is a progressive nervous system disorder that affects neurons in the brain and their ability to regulate dopamine. This can cause difficulties with muscle rigidity, speech, mobility, tremors, and many other areas of functioning. While there are medications that can help, there is currently no cure for Parkinsons.
The disease usually progresses as mobility and speech become further impaired.
However, there has been some interesting research into treating Parkinsons with infrared light. Multiple researchers have found beneficial effects of Near Infrared light for the treatment of Parkinsons .
These studies found that NIR is neuroprotective . However, many of these studies involved intercranial NIR, meaning that surgery was performed to allow NIR to penetrate the cranium or skull. However, a recent study by Stone et al found that even using light on the body and excluding the head produced neuroprotective factors , leading them to believe that the immune system is also involved in the benefits of NIR for Parkinsons. Researchers also found that there were no side effects for patients receiving the NIR.
Stone, J, Johnstone, D, Mitrofanis, J. 2013. The helmet experiment in Parkinsons disease: An observation of the mechanism of neuroprotection by near infra-red light. Proceedings of the 9th World Association for Laser Therapy Congress, WALT 2012
Can Physical Therapist Intervention Help This Patient
Mr Jennings, a 54-year-old financial planner currently in H& Y stage 2, had been diagnosed with PD 4 years earlier. His symptoms had begun 7 years earlier with weakness and tremor on his left side. He had not received physical therapist for PD. Medications and supplements included pramipexole, selegiline, amantadine, coenzyme Q10, a multivitamin, and fish oil containing omega-3 fatty acids. He had no significant comorbid conditions. His goal was to engage in a therapeutic exercise program to prevent decline related to aging and PD. Mr Jennings did not report any falls but reported feeling stiff, moving slowly, and being concerned about balance and walking, particularly in crowded environments.
The physical therapist evaluation included measures of function and an assessment of underlying impairments that could limit current or future abilities with balance and gait. Several of these measures, including the TUG, the FRT, and the 6-minute walk test, were reported in the Cochrane review. Additional measures of balance and gait included the Five-Times Sit-to-Stand Test and the Functional Gait Assessment . His score of 25 of 30 on the FGA indicated a mild fall risk . He was able to ascend and descend a full flight of stairs without the use of a railing, indicating good lower extremity strength. This finding was further confirmed by his ability to perform the FTSST in 10 seconds and without the use of hands.
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How Physical Therapy Can Help With Parkinson’s Disease Symptoms:
People with Parkinsons often have trouble with balance, with initiating walking, feel stiff in their trunk, and have difficulty moving quickly. Physical therapists can help with all of that and more. Below are some examples of common treatments that someone with Parkinsons can have if they come into CBPT:
Good Days And Bad Days
Parkinsons symptoms fluctuate. Some days, the patient will be able to move quickly, smoothly, and confidently, like their old self has returned. Other days, they will hardly be able to move, eat, or talk. It is a seesaw and the only way to cope is to approach each day as its own. Determine where you are and make it work as best you can. If it is a bad day, focus on rest and recovery, knowing you will be ready to take advantage of good days when they come.
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How To Find A Speech Therapist
Tell your doctor if you are experiencing any changes in your speech, voice or swallowing. Ask for a referral to a speech language pathologist to evaluate and address these symptoms. If you have not noticed changes in your speech, but a spouse, care partner or friend has, pay attention to their comments. The sooner you get a speech evaluation and start speech therapy, the better.
Speech therapists work in many settings, including hospitals, outpatient rehabilitation centers and private practice offices. To locate one in your area:
Ideally, you should see a speech therapist face-to-face for a complete voice and speech evaluation and treatment. However, if a speech therapist is not available in your area, LSVT LOUD the most researched voice treatment for people with PD is virtually offered in select states. The speech therapist interacts with you in your home or office live through your computer screen.
How Do I Find A Physiotherapist
As Parkinsons is complex to manage, it is important to be seen by a physiotherapist who has experience of the condition. If you cannot find a physiotherapist with Parkinsons experience, you may want to share with the physiotherapist the European Physiotherapy Guideline for Parkinsons Disease and Pre-Assessment Information Form .
Referral procedures depend on the country in which you live in some countries physiotherapy is prescribed by a doctor but in others you can contact a physiotherapist direct. Depending on where you live, treatment may or may not be accessible through your countrys national health system. In some countries you need to be referred by your neurologist in order to get the cost of physiotherapy reimbursed.
Training and accreditation varies throughout Europe so you should always check the experience of anyone you consult and the likely costs before treatment starts.
Your national Parkinsons organisation may be able to provide information based on members experiences. See also, Other Parkinsons organisations.
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Focus Of Pt For Parkinsons
After collecting information about your current functional abilities and impairments, your physical therapist can start to formulate a treatment plan. Your plan of care will likely involve other healthcare professionals since PD affects so many different body systems. It is also important to include family members or friends in your treatment so that they can provide assistance if needed.
The main focus of your physical therapy should be on maintaining functional mobility and control. Specific strategies to help improve the smoothness of movement may also be necessary to maintain optimal functional mobility.
Since PD can cause many motor planning changes and mobility problems, exercise should be a primary component of treatment. The focus of exercise for PD should be to improve walking and balance, improve strength and range of motion, increase postural awareness and improve breathing and endurance. Be sure to speak with your healthcare provider and physical therapist before starting an exercise program to be sure that it is safe for your specific condition. Your healthcare provider and physical therapist can also work together to help you decide which exercises would be best suited for you.
- Carr, J. H. . Neurological rehabilitation: optimizing motor performance. Oxford: Butterworth Heinemann
- Umphred, D. A. . Neurological rehabilitation. . St. Louis: Mosby.
How Often Should A Person Visit A Physical Therapist
The number of PT sessions a person needs can vary. Depending on the facility and an individuals requirements, sessions are usually between 30 minutes and 1 hour.
During the first few sessions, a physical therapist will assess a persons needs and map out a customized exercise plan. A therapist will give a person exercises to do at home and schedule regular PT sessions as necessary.
The European Parkinsons Disease Association recommends that a person tries to exercise for at least 150 minutes each week. They can break this down into five 30-minute sessions, ten 15-minute sessions, or three bursts of 10 minutes each.
The EPDA describes the LSVT Big program, which involves 16 sessions over a month, or 4 hourly sessions each week. This intensive treatment focuses on improving fine motor and gross motor movements, making daily tasks easier for people with Parkinsons disease.
A person can ask a physical therapist about the duration and frequency of their PT sessions.
According to the World Confederation for Physical Therapy, apart from performing PT treatments and interventions, a licensed physical therapist can:
- give a clinical diagnosis and prognosis
- determine outcomes of a clinical intervention
- conduct a physical evaluation of a persons movement and flexibility
- map out short and long-term goals
- give self-management recommendations to manage conditions across multiple specialties
- refer a person to other healthcare professionals
- stooping or hunched posture
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How Many Physical Therapy Visits Will I Need
Treatments in physical therapy often can be completed in one to three office visits. The first appointment includes an evaluation and recommendations for exercises. The following appointments check your progress and review and expand your home program. Most hospitals can provide additional sessions of outpatient therapy if needed.
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Despite disease-relevant treatments, Parkinsons patients experience declines in physical functioning and their capacity to participate in daily activities as their disease progresses.
Adding physical therapy to medication regimens is a common approach to help slow these declines. Physical therapy can encompass a range of activities, with most programs involving Parkinsons-relevant exercises to build muscle strength, improve balance, and restore or retain a more normal posture and gait, all with the goal of improving or maintaining functional abilities.
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Physical Therapy And Pd
Exercise and staying active play important roles in living well with Parkinson’s disease , from diagnosis throughout the course of disease. Physical therapy helps people with PD keep moving. In fact, recent research suggests that physical therapy including gait and balance training, resistance training and regular exercise may help improve or maintain PD symptoms.