Gait & Balance Abnormalities
Parkinsons Disease Exam
Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.
Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.
We have three tests for this part of the PD exam:
1) Standing up from a chair
2) Free walking
3) Provoked pull test maneuver for balance
Study Aims And Objective
This protocol study aims to evaluate an innovative rehabilitation treatment based on robotics, for the older patients with Parkinsons disease, designed to improve the gait and to reduce the risk of falling. The treatment involves the use of two robotic devices: Tymo system , a wirelesss static and dynamic platform, for evaluating and rehabilitating posture, and Walker View , a treadmill equipped with a sensorised belt with eight load cells and a 3D camera.
The primary aim is the evaluation of the effect of the rehabilitation treatment on the balance and gait of the older PD patient, as a result of the use of the Tymo system or Walker View, at the end of the treatment and at a 6months, 1 and 2years follow-up using POMA scale.
The secondary aims are:
the evaluation of the effect of the rehabilitation treatment on the gait speed of the older PD patients, as a result of the use of the Tymo system or Walker View, at the end of the treatment and at a 6months, 1 and 2years follow-up using instrumental gait analysis
the evaluation of the effect of the rehabilitation treatment on the fear of falling of the older PD patients, as a result of the use of the Tymo system or Walker View, at the end of the treatment and at a 6months, 1 and 2years follow-up using FES-I short form scale.
In addition, the study design will include use a standardized questionnaires and instrumental gait analysis, in order to collect data on the improvements with a mix-method approach.
Physical Therapy Guide To Parkinson Disease
Parkinson disease is the second most common degenerative brain disorder affecting adults. People of all ethnic groups can develop PD, but it occurs less among African American and Asian populations. Parkinson disease was first defined as only a “motor” disease, but research has shown that it also causes nonmotor symptoms in other systems of the body. People with PD are at risk of falling and sustaining other injuries due to their movement and balance challenges. Treatment includes a combination of medication and physical therapyand in some cases surgery. Physical therapists partner with people with PD and their families to manage their symptoms, maintain their fitness levels, and help them stay as active as possible.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
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Pathophysiology Of Parkinsons Disease
The progressive death of dopaminergic neurons in the Substantia Nigra pars compacta located in the midbrain, more precisely in the Basal Ganglia , promotes a significant decrease in the levels of the neurotransmitter dopamine, and as a consequence the functional impairment of the neural circuits . The chronic reduction in dopamine levels gives rise to the manifestation of the motor symptoms that characterize this disease. However, the pathophysiology of PD is not limited to the dopaminergic system, that is, neuronal degeneration of other areas of the brain such as the brainstem and cortex competes and even precedes neuronal death in BG. Thus, other neurotransmitter systems are compromised, thus making PD a multisystemic pathology manifested by a series of motor and non-motor symptoms .
Examples of experimental tests showing a high and a low data dispersion.
The cardinal motor signs of PD are: resting tremor, plastic-type muscular rigidity, bradykinesia , and postural instability. This set of symptoms associated or not, forges characteristic clinical signs in patients with the disease such as gait and balance disorders, mask facies and dysarthria. In addition to these symptoms, a set of sensory autonomic and cognitive-behavioral symptoms may manifest during the course of the disease .
Continuous Monitoring In Daily Activities
Monitoring motor function of PD patients during real life activities could provide physicians with an assessment of specific motor symptoms, predict fall risk, evaluate medication compliance and provide information for early diagnosis.
Unlike guided and standardized motor tasks, motor assessment in unsupervised environment allows subjects to moving in daily activities, which means that two subjects can walk with different motion parameters not because of disease itself but due to individual differences . A fully charged measuring device such as portable gait rhythmogram could achieve 40 consecutive hours of recording . With this PGR attached to the limbs, different motor fluctuations were observed according to the alterations in gait rhythm: if a subject was noted with a shift to a faster gait cycle, he/she may suffer from short-step walking, festination or freezing of gait on the other hand, if a subject was found to exhibited a shift to a slower gait cycle, there was high possibility that he/she had bradykinesia or instability . On the other hand, some researchers thought that parameters regarding the gait performance were not representative enough and the utilization of alternative measures like entropy or the measure of the arm swing might be a better choice . In presenting variation in ON and OFF states, arm swing and entropy showed better performance compared to step frequency, stride length and speed .
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How To Find Your Expert Physical Therapist For Parkinsons Disease
It is important to find a physical therapist who has specialty training and experience working with PD. You may find experienced physical therapists working in hospital outpatient departments, home health agencies, nursing homes or within the community close to your home. Ask your neurologist for a referral at your next appointment.
The Parkinsons Foundation Helpline at 1-800- 4PD-INFO can help you locate an experienced physical therapist near you who is trained to work with people with PD, and provide questions to ask a potential physical therapist to assess their experience.
How Is It Diagnosed
Because there is not one definitive test for PD, it can be difficult to diagnose. A diagnosis is usually made based on a persons medical history and a neurological examination. If your physical therapist suspects that you have symptoms of PD, you may be referred to a neurologist for further examination.
A diagnosis of PD may be made if a person is found to have:
- Slowing of motion and tremor when resting, or muscle rigidity
- A significant improvement in symptoms when taking a medication to treat PD.
- Initial symptoms on 1 side of the body only.
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Trunk Stiffness/ Slowness Of Movement:
- Big and large movements to retrain the muscles and slow down the progression of slowness of movements
- Trunk rotation movements to reduce stiffness
- Strength and flexibility training
This isnt an exclusive list of what type of physical therapy treatments there are for people with Parkinsons Disease. Each physical therapy treatment is tailored to the specific individuals needs, goals, and wants. And while physical therapy isnt a cure for Parkinsons Disease it can help reduce symptoms and improve quality of life.
If you have Parkinsons Disease or know someone that does, please come in for a FREE ASSESSMENT to see how physical therapy at Coury & Buehler Physical Therapy can help you! Contact us at 714-256-5074 for a free consultation or fill out the form below! A representative will contact you shortly.
Focus Of Pt For Parkinson’s
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.
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How Can Physical Therapy Help Parkinsons Disease
Parkinsons disease is a neurological disorder that causes problems with movement and coordination. Physical therapy can offer significant benefits for people living with the condition.
Parkinsons disease is a progressive condition of the central nervous system due to low dopamine levels in the brain.
Symptoms may include slow movement, rigid muscles, freezing episodes, tremors, and unsteady balance.
Physical therapy improves a persons range of movement, prevents further injury or disability, and improves the quality of a persons life.
This article explores the benefits of PT for people with Parkinsons disease. It also provides tips for finding a physical therapist and explains when to contact a doctor.
According to the Parkinsons Outcomes Project, PT can improve the quality of life for people with Parkinsons disease.
Research from indicates that regular PT treatment and exercise can have positive, long lasting outcomes for those with the condition.
Parkinsons UK notes that PT can help people with Parkinsons disease by:
- keeping joints and muscles flexible
- building strength
- improving mobility, movement, and bodily functions
- maintaining daily independence
- maintaining and improving effective breathing
- helping to prevent falls
- managing stress
- boosting mood
Also, because PT encompasses self-management patient education, hands-on care, and exercise prescription, the Parkinsons Foundation notes that a physical therapist can:
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:
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Setting Movement Goals With Your Therapist
Every client works with their physical therapist to set individualized movement goals. Physical therapists can help you optimize your exercise routine based on the latest research, re-learn challenging tasks or stay safe and independent in the home. Some of the most common movement goals for people with Parkinsons include:
- Learning about exercises
- Improving walking, balance or posture
- Addressing fall risk
- Treating pain
Before your first visit, think about your movement goals and write down your problems and questions. This will help you to organize your thoughts. You can do this for future visits, too.
Getting The Most Out Of Physical Therapy
Physical therapy will teach you the right exercises to target the symptoms you want to make better. Exercise is crucial for improving Parkinson’s disease symptoms and maintaining general health. Even if you do not have mobility or pain issues, start an exercise program as soon as possible to delay the disease’s progression.
Once you start a program, your physical therapist will guide you and help you reach your goals. Still, it is in your power to make the most of your treatment. Here are tips to maximize the benefits of physical therapy:
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How Can Occupational Therapy Help Parkinson’s Disease
For Parkinson’s disease, occupational therapy generally provides assessment, treatment, and recommendations in the following areas:
- Arm and hand therapy
- Driver evaluation and vehicle modification information
- Cooking and homemaking adaptations
- Ways to make the most of your energy
- Computer modifications
- Workplace or work equipment modifications
- Leisure skill development
Write Down Your Goals
Before you meet with a physical therapist, write down all the goals you want to accomplish. Writing your goals can help you organize your thoughts and focus on what is most important to you. When listing your goals, consider the areas you are struggling with and would like to improve most. Your goals will provide direction for your treatment and help you stay motivated. You can adjust your goals or create new ones as needed.
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Objective And Quantitative Assessment Of Motor Function In Parkinsons Diseasefrom The Perspective Of Practical Applications
Ke Yang, Wei-Xi Xiong, Feng-Tao Liu, Yi-Min Sun, Susan Luo, Zheng-Tong Ding, Jian-Jun Wu, Jian Wang
Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
Contributions: Conception and design: J Wang Administrative support: None Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Revision and Final approval of manuscript: All authors.
Abstract: Parkinsons disease is a common neurodegenerative disorder with high morbidity because of the coming aged society. Currently, disease management and the development of new treatment strategies mainly depend on the clinical information derived from rating scales and patients diaries, which have various limitations with regard to validity, inter-rater variability and continuous monitoring. Recently the prevalence of mobile medical equipment has made it possible to develop an objective, accurate, remote monitoring system for motor function assessment, playing an important role in disease diagnosis, home-monitoring, and severity evaluation. This review discusses the recent development in sensor technology, which may be a promising replacement of the current rating scales in the assessment of motor function of PD.
Keywords: Parkinsons disease motor function objective measurement wearable sensors
Submitted Feb 11, 2016. Accepted for publication Feb 26, 2016.
What Is Physical Therapy
Physical therapy is a specialized form of health care that involves evaluating and treating a person with limited mobility. It is used to treat many conditions, including arthritis, amputations, injuries and Parkinson’s disease. Physical therapists are licensed professionals trained to apply individualized techniques to help patients regain mobility.
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Are Unified Parkinson’s Disease Rating Scale Scores A Valid Indicator Of Functional Performance
The UPDRS was originally developed to serve as an assessment of the severity of the disease. The UPDRS consists of 6 sections: IMentation , Behavior, and Mood IIActivities of Daily Living IIIMotor Examination IVComplications of Therapy Vthe Modified Hoehn and Yahr Stage Scale and VIthe Schwab and England Activities of Daily Living Scale. Sections I through III are scored on a 5-point Likert scale from 0 to 4, with 0 representing no impairment and 4 representing marked impairment. These 3 sections can be analyzed independently or combined with each other. The UPDRS total score reflects performance on these 3 sections , with lower scores showing less disability. Sections of the UPDRS are scored and reported separately.
Section II of the UPDRS asks the client to verbally rank his or her perceived ability in many areas, including falling , freezing when walking, and walking. Nine of the 14 items of section III of the UPDRS explore motor activity at the impairment level , rather than performance of functional abilities. The 5 items in section III that measure performance of functional abilities are speech, facial expression, rising from a chair, gait, and postural stability of these items, only the last 3 items are routinely addressed by physical therapists and relate to mobility concerns.
Training Future Physical Therapists In Parkinsons Disease
Did you know the Parkinsons Foundation is working to better educate physical therapy students across the country to ensure better PD care for everyone?
The Parkinsons Foundation Physical Therapy Faculty Program is improving Parkinsons physical therapy care by training faculty leaders across the U.S. so they can, in turn, educate physical therapy students. The intensive course allows physical therapy educators to immerse themselves in learning the latest evidence-based findings in Parkinsons research and care. Physical therapy educators can make a great impact on the lives of people with PD by bringing this knowledge back to their students, our future practitioners.
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How Can A Physical Therapist Help
Because PD affects each person differently, your physical therapist will partner with you to manage your specific situationnow and as your condition changes. You are not alone!
Following a diagnosis of PD, your physical therapist will conduct a comprehensive evaluation, including tests to examine your posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on your test results, your physical therapist will develop an individualized treatment plan to help you stay as active and as independent as possible. Your program will include exercises and techniques to combat the symptoms of PD.
Depending on the nature and severity of your condition, your treatment program may focus on activities and education to help you:
- Improve your fitness level, strength, and flexibility.
- Develop more effective strategies to get in and out of bed, chairs, and cars.
- Turn over in bed more easily.
- Stand and turn to change directions more efficiently.
- Improve the smoothness and coordination of your walking.
- Improve your ability to perform hand movements.
- Improve your ability to climb and descend stairs and curbs.
- Perform more than 1 task at a time more efficiently.
- Participate in activities that are important to you.