PHYSICAL THERAPY FOR PARKINSON S DISEASE. Ann Zylstra PT

Transcription

1 PHYSICAL THERAPY FOR PARKINSON S DISEASE Ann Zylstra PT

2 PARKINSON S TEAM Nrsg/ MA Psych Family Support MD PT Social/ SW And much more Support Group s I&R Centers Friends/ family Church Other Person w PD ST OT

3 SYMPTOMS OF PARKINSON'S DISEASE *Not all people with PD develop all these symptoms Motor Symptoms that Occupational and Speech Therapy can help with ADL s Micrographia Driving / community safety Home management / safety Medication management UE function Vision / oculomotor function Masked face Hypophonia Difficulty swallowing Cognitive changes More..

4 SYMPTOMS OF PARKINSON'S DISEASE / PT * Not limited to but most common *Not all people with PD develop all these symptoms Motor Symptoms (Physical Therapy can help) Difficulty turning / moving in bed Difficulty arising from a chair Stooped, forward - flexed posture Difficulty walking / walking changes Rigidity and freezing in place Postural instability / Falls / Imbalance

5 Non Motor Symptoms Diminished sense of smell Low voice volume Pain Painful foot cramps (dystonia) Constipation Urinary frequency/urgency Cardiac blunting Seborrhea and psoriasis Sleep disturbance Visual / perception changes Fatigue Difficulty swallowing Autonomic dysfunction Hypotension Orthostatic hypotension Drooling Thermal paresthesia Increased sweating Sexual dysfunction Cognitive changes Impulsivity Depression Anxiety

6 Non Motor Symptoms /ST Diminished sense of smell Low voice volume Pain Painful foot cramps (dystonia) Constipation Urinary frequency/urgency Cardiac blunting Seborrhea and psoriasis Sleep disturbance Visual / perception changes Fatigue Difficulty swallowing Autonomic dysfunction Hypotension Orthostatic hypotension Drooling Thermal paresthesia Increased sweating Sexual dysfunction Cognitive changes Impulsivity Depression Anxiety

7 Non Motor Symptoms /OT Diminished sense of smell Low voice volume Pain Painful foot cramps (dystonia) Constipation Urinary frequency/urgency Cardiac blunting Seborrhea and psoriasis Sleep disturbance Visual / perception changes Fatigue Autonomic dysfunction Hypotension Orthostatic hypotension Drooling Thermal paresthesia Increased sweating Sexual dysfunction Cognitive changes Impulsivity Depression Anxiety

8 Non Motor Symptoms PT Diminished sense of smell Low voice volume Pain Painful foot cramps (dystonia) Constipation Urinary frequency/urgency Cardiac blunting Seborrhea and psoriasis Sleep disturbance Visual / perception changes Fatigue Autonomic dysfunction Hypotension Orthostatic hypotension Drooling Thermal paresthesia Increased sweating Sexual dysfunction Cognitive changes Impulsivity Depression Anxiety

9 DIFFICULTY MOVING IN BED

10 Bed Mobility: Break into smaller tasks Sit to side Roll Scoot (caterpillar crawl)

11 Bed Mobility Sit where you want your bottom to be Inside arm in lap Outside arm reaches over and helps lower ear to bed/ pillow Legs up when trunk goes down A bed handle may be helpful

12 Bed Mobility/ Rolling Bend knees Reach and Roll (look in direction you want to go head will help to roll) Shoulders hips and knees all go in same direction

13 Bed Mobility/Supine to Sit Bend Knees Roll to side As legs go off: Push up with arms (bed handle gives leverage) Top shoulder in front of bottom shoulder

14 Bed Mobility/ Scooting; caterpillar crawl Break into sections: Move 1 section at a time Head and Shoulders Hips (Bridge) Feet Repeat

15 BED MOBILITY: HELPFUL HINTS How to make things easier: Sit where you want your hips to be Keep knees bent until you are where you want to end up Silk PJ s versus silk sheet (bottom no top yes) Light comforters/ cotton high thread count sheets Practice log roll Bed handle

16 BED HANDLES

17 Sit to Stand: (getting out of chair) Sit to stand is shifting weight from 1 base of support to another

18 SIT TO STAND: (GETTING OUT OF CHAIR) Break Into Smaller Tasks Scoot: Hips to edge of chair Feet back: Under hips Lean forward: Nose over knees Push (with arms) allow 3 tries before getting help, OK to rock to rise

19 Sit to Stand: (getting out of chair)

20 SIT TO STAND: HELPFUL HINTS Try to sit in firm chairs with armrests Silky fabric on chair can help with sliding to the edge ( avoid thick pile fabric) A strip of tape takes the think out of where to place feet, then look at the tape Allow time to succeed (Fail 3x then get help)

21 PUSH: DON T PULL UP Wrong muscles: Pusher muscles more effective Wrong direction of Movement; pulling brings weight back into chair, pushing brings body over base of support Leads to posterior falls

22 STAND TO SIT Feel chair with backs of both legs Find chair with both hands

23 Anatomic review: Designed to climb vines

24 Big Muscles win Stretch the big muscles: Those effecting posture Sit to stand Step length

25 Stretch the Big Stretch the big muscles Calf stretch Hamstring stretch Chest stretch Hip stretches Stretches should be done slowly (20-30 second hold) and repeated 2-3 times (1 minute per muscle) Stretches should be done daily

26 Target the little muscles Strengthening the small

27 Conditioning / Strength over time Repetitive Rhythmic Sustained (Goal is minutes) Walk, bike, equipment Benefits: Fatigue Depression Lung Capacity Sleep pattern Endurance Improves bowel habits Improves cognitive skills

28 FORWARD FLEXED POSTURE Posture!

29 WITH PARKINSON S DISEASE THE CENTER OF MASS IS IN FRONT OF THE BASE Smaller BOS; COG forward of base Bigger BOS Center of mass is central over BOS

30 Base of Support Normal gait BOS Parkinson's gait BOS Forward posture BOS

31 ADDRESS POSTURE Stretching the big Strengthen trunk and hip extensors Strengthen hip abductors Strengthen posterior shoulder girdle Cervical mobilization Spinomed Brace (Study upcoming in 2014)

32 GAIT CHANGES Changes in Gait can be defined numerous ways

33 NOT ALL WALKERS ARE THE SAME Adaptive Equipment: Walking aids:

34 Not all walkers are the same Avoid SPC in the later stage (tripping hazard) FWW are for orthopedic problems (though cheap and easily accessible) 2 most common wheeled walkers for PD Dolomite Legacy U step made by in step mobility, (available with laser light and laser light with SPC)

35 FREEZING: MORE QUESTIONS THAN ANSWERS Why? What is happening that is changing the way a person walks? Why do some people freeze and others don t? Predictably Unpredictable

36 Strategies to Facilitate Movement Sensory Cues (& Postural Cues) Visual

37 FREEZING WITH TURNS

38 FALL PREVENTION

39 What is Balance? Keeping your Center of Gravity over Base of support

40 Center of gravity is outside the base of support Loss of balance

41 ADDRESSING BALANCE Improve step width and length Proper shoe wear Slow down! Allow ample time for task Strengthen hips Stretch hamstrings and calves Improve posture Review medications with your MD / Pharmacist Avoid getting on stools or ladders!

42 CARDIOVASCULAR / AUTONOMIC DYSFUNCTION Orthostatic Hypotension >50% occurrence Symptoms include; Dizziness Impaired vision Impaired thought process Fatigue Coat hanger pain Postprandial Hypotension: increased BP drop after meals

43 ORTHOSTATIC HYPOTENSION: TREATMENT Medications Conservative therapy: Fluids If approved by physician sodium Exercise Support stockings Abdominal binders Slow down 10 second rule

44 COMMON BLADDER SYMPTOMS Unstable or irritable bladder that contracts with small amounts of urine Urinary urgency Inability to delay urination Urge incontinence Bladder does not empty all of the way because of weak bladder contraction or spastic sphincter Difficulty emptying, dribbling Leakage with increased pressure Stress incontinence

45 BLADDER DYSFUNCTION Studies state 38-71% reported bladder dysfunction. Newer studies 30-40% Urinary Problems Frequency> Urgency, Spastic Bladder Nacturia Incontinence Urgency and fall risk Often treated with antispasmodics which can cause confusion Can contribute to decreased volume intake worsening orthostatic symptoms Bladder training may be effective

46 WHAT IS NORMAL?? Urinate every 2-4 hours Urinary stream last at least 8 seconds No night-time urination <65 years old Up 1x after age 65 ok Able to delay urge to urinate at least 30 minutes No loss of urine with cough, sneeze, laugh, jump, run No Just In Case Peeing JICing

47 BLADDER TIPS Take your time and relax your muscles when emptying your bladder deep breathes for relaxation Empty bladder fully each time you urinate Try to urinate when your bladder is full, not just when you feel the urge. Try waiting 2-3 hours between urinations. Use urge delay techniques Urgency and frequency can be improved by spacing out your fluid intake

48 BLADDER TIPS CONT. Maintain good fluid intake of 6-8 cups (8oz) of liquid Limit bladder irritants Maintain good intake of dietary fiber Avoid smoking

49 Bladder Irritants Alcohol Tomato products Vinegar Coffee/tea incl. decaf Spicy foods Citrus, cranberry Caffeinated drinks Carbonated drinks Food colorings Some food flavorings Artificial sweeteners Chocolate

50 TREATMENT OF STRESS INCONTINENCE PHYSICAL THERAPY Teach proper use of pelvic floor muscles i.e. proper performance of Kegel exercise Biofeedback helps isolate the muscles and shows improvement Training in proper breathing and isolation of pelvic floor from abdominal muscles

51 Most common side effect of any Constipation medication Recommend: Fluids Fibers Exercise

52 BOWEL DYSFUNCTION Bowel Bradykinesia Decreased frequency and decreased ability to defecate Problem with relaxation of internal and eternal sphincters and muscle coordination

53 BOWEL TIPS: EFFECTIVE EMPTYING Wait until you have the urge before trying to have a bowel movement Never force or strain to empty Try to get to the bathroom within the first 1-2 minutes after getting the urge Get in a routine for eating/emptying Most people empty in the morning or after meals: Start the day with a big glass of warm water Eat a hot cereal like oatmeal to stimulate the gut

54 Bowel Tips How you sit on the toilet makes a difference in how easily you will empty Make sure your legs are well supported Experiment with leaning different directions

55 PT FOR PD SUMMARY Physical Therapy Can help! Mobility Flexibility Strength Posture Walking Balance Orthostatic Hypotension Bowel and Bladder dysfunction HOME EXERCISE PROGRAM!!!

56 THANK YOU!

57 QUESTIONS?