Category Archives: Physical Therapy

Occupational Therapy, Physical Therapy, rehabilitation , , , , Leave a comment

Off to see the wizards, of OT and PT, oh my!

by

And where would we be without Occupational Therapists (OTs) and Physical Therapists (PTs)? Probably still in need of skillful psychiatrists. Which is a short way of saying that physical health and mental health are closely linked. “Fitness for Mind and Body,” as the slogan for Power for Parkinson’s succinctly says it.

I just received, in my full of junk mail inbox, a link to an article that lays out the differences and specific tasks of OT and PT:  Occupational and Physical Therapy – What’s the diff?

The key takeaways are here:

  • Occupational therapy (OT) focuses on helping people with injuries, illnesses, or disabilities learn necessary skills while physical therapy (PT) focuses on improving mobility, strength, and flexibility after illnesses, trauma, or medical procedures.
  • Occupational therapists (OTs) assist patients with a wide range of day-to-day tasks such as eating, bathing, or getting dressed (and much more), regardless of the health condition, injury, or trauma that may have affected their skills.
  • Physical therapists (PTs) treat conditions, injuries, or trauma that cause reduced mobility, pain, and movement problems, helping patients reduce pain, regain strength, and increase flexibility after surgeries, trauma, or neurological conditions such as Parkinson’s disease. (bold emphasis added)

I had the privilege (?!) of receiving services from both OTs and PTs within the past few years, and can attest to the skills they have and how they can improve one’s enjoyment of the tasks Of Daily Living (ODL).

May you never need their services, but if you do… do it!

###

depression, Exercise, Parkinson's, Physical Therapy, prodromal, Research, Reviews, Sleep , , , , Leave a comment

Exercise & Sleep disorders and Parkinson’s – Oh my!

by

My first draft of this got lost in the computer (Thanks, all you coders who think you know how to create intuitive, ease to use interfaces). So here’s another attempt to get stuff from one location to another. We’ll see how it it goes…

A while back I posted a Powerpoint presentation on research on music, dance, and singing, which cited a review in the Movement Disorders Society (2018, I believe), in which the conclusion was that exercise did not affect Parkinson’s Disease (PD) symptoms. Since then, there have been many more studies on the effects of different modalities of exercise. In this first article, a meta review of publications, found that exercise is good for you if have PD.

Yang Y, Wang G, Zhang S, et al. Efficacy and evaluation of therapeutic exercises on adults with Parkinson’s disease: a systematic review and network meta-analysis. BMC Geriatrics. 2022 Oct;22(1):813. DOI: 10.1186/s12877-022-03510-9. PMID: 36271367; PMCID: PMC9587576.

The purpose of the review was to compare and rank the types of exercise that improve PD symptoms by quantifying information from randomised controlled trials.  Out of 10,474 citations, 250 studies were included involving 13,011 participants. The results (drumroll, please):

  • Power training (PT) had the best benefits for motor symptoms
  • Body weight support treadmill training showed the best improvement in balance, gait velocity  and walking distance
  • Robotic assisted gait training had the most benefits for freezing of gait
  • Dance showed the best benefits for depression
  • Only Yoga significantly reduced anxiety symptom compared with controls
  • Only resistance training significantly enhanced sleep quality and cognition
  • Physical Therapy showed the best results for muscle strength
  • Five types of therapy showed improvement in concerns about falling versus control groups.

If interested, the full free text is available at the linked citation above. Other reviews have shown different results. Best recommendation is to find a variety of exercises that you enjoy, and do them as often as you can. But don’t try so hard that you wind up hurting yourself.

The second meta review alluded to in the title has to do with sleep disorders.

Xu Z, Anderson KN, Pavese N. Longitudinal Studies of Sleep Disturbances in Parkinson’s Disease. Current Neurology and Neuroscience Reports. 2022 Oct;22(10):635-655. DOI: 10.1007/s11910-022-01223-5. PMID: 36018498; PMCID: PMC9617954.

Fifty-three longitudinal studies of sleep in PD were identified, which included:

  • Excessive daytime sleepiness,
  • Insomnia,
  • Obstructive sleep apnea,
  • Rapid eye movement sleep behavior disorder (RBD),
  • Restless legs syndrome, and
  • Shift work disorder were studied in addition to other studies that had focused on either multiple sleep disorders or broadly on sleep disorders as a whole.

RBD is now considered an established prodromal feature of PD, but other sleep disorders do not clearly increase risk of subsequent PD.

I’ll throw in one last citation. Not just because it plays on the title to one of Bob Dylan’s songs, but also because it is one of many nutritional supplements prescribed to aid in cleaning out neural cell debris in (where else?) Bob’s Brain:

Kalyanaraman B. NAC, NAC, Knockin’ on Heaven’s door: Interpreting the mechanism of action of N-acetylcysteine in tumor and immune cells. Redox Biology. 2022 Oct;57:102497. DOI: 10.1016/j.redox.2022.102497. PMID: 36242913; PMCID: PMC9563555. 

and that ends this day.

Dance, Dance for Parkinson's, depression, Exercise, Music, Parkinson's, Physical Therapy , , , , Leave a comment

What to do?

by

When it comes to diseases like cancer, the UK medical folks have decided that the “fighting” and “warrior” mentality are counter-productive. For one, this mindset causes people to delay seeking treatment. I don’t have the exact citation at hand, but it is referenced in this blog somewhere, and you’re welcome to search for it. (Thankfully, this is not a dissertation or scholarly article, or I couldn’t have written the previous sentence and gotten away with it).

But when it comes to exercise as a good way to slow, and sometimes reverse the physical or cognitive symptoms of Parkinson’s Disease (PD), there ain’t no doubt in some folks minds that dance is one of the finer things around to combine aerobic exercise, movements, and cognitive challenges to build new connections between neurons in the brain.

From the Digital Commons at Sarah Lawrence College comes this Master’s Thesis:

Rajan, Sneha, “Embodied Medicine: Integrating Dance/Movement Therapy into Physical Medicine & Rehabilitation” (2021). Dance/Movement Therapy Theses. 79. https://digitalcommons.slc.edu/dmt_etd/79

Long story short: “Overall, physiatry and dance/movement therapy have separately helped so many people but developing a synergy between these fields has the potential to transform rehabilitative medicine.”(emphasis added).

Specifically addressing Parkinson’s Disease issues, she writes:

For individuals with Parkinson’s disease, studies have shown that physical rehabilitation is an effective way to manage motor and non-motor symptoms (Mitra et al., 2020). However, maintaining motivation for treatment is difficult because of progressive difficulties with physical disability and co-existing emotional factors, so as a result not many adults engage with enough physical exercise (Mitra et al., 2020). By incorporating cognitive, emotional, and social components, the exercise environment could become more engaging and multidimensional (Mitra et al., 2020). One experimental study examined the effects of dance/movement therapy sessions on the cognition, quality of life, and motor symptoms of patients with Parkinson’s disease (Mitra et al., 2020). They used a variety of techniques such as targeted body exercises, memory games, movement improvisation, guided imagery, rhythm work, contact improvisation, mirroring, body coordination and movement reflexes (Mitra et al., 2020). Music was also used to incorporate rhythm and sensory motor cues (Mitra et al., 2020).

As a result, participants showed a significant increase in cognitive functioning and a decrease in Parkinson’s related health difficulties. Additionally, patients reported improvements in coordination, mood, and memory (Mitra et al., 2020). Another study analyzed the effectiveness of music-based movement therapy on gait related activities in Parkinson’s patients (Dreu et al., 2011). They examined both individual music-based gait training and partnered-dance interventions. The music provides rhythmic cues that help synchronize movements and also facilitates emotional responses in the participants (Dreu et al., 2011). Participants showed improvements in walking velocity and balance (Dreu et al., 2011). (Emphasis added.)

 If I were to judge this Master’s thesis, I would suggest more sources, and more recent ones than the one she used in material about Parkinson’s in the paragraphs before the ones I quoted above. But I’m not on the faculty of Sarah Lawrence College, so that’s their loss.

And the answer to the question posed in the title of this blog entry “What to do?” is simple: Don’t Stop Moving To The Music!

 

###

Parkinson's, Physical Therapy, Research, Reviews , Leave a comment

More physical therapy, more research & guidelines

by

Perhaps it is because one is in rehabilitation, that one’s interest turns towards rehabilitation and Parkinson’s Disease. Sounds like a reasonable explanation.

This article from 2017 looked at rates of utilization of rehabilitative services, looking at several demographics:  Utilization of rehabilitation therapy services in Parkinson disease in the United States    (This article is on PubMed and is open access).

  The authors. …”found that 75% of Medicare beneficiaries diagnosed with PD did not receive rehabilitative therapies over a 36-month period. While it is not clear what the appropriate utilization rate should be, utilization among patients with PD in the Netherlands and the United Kingdom greatly exceeds what we found in the United States: at least 57% and 54%, respectively., In this study, predictors of higher (but still low) rates of therapy utilization included PD care by a neurologist, Asian or Caucasian race, and geographic location. 

The NICE folks in the UK have a link where one may download their entire set of guidelines for treatment of people with Parkinson’s:

Parkinson’s disease in adults

After looking at their recommendations on DBS, I’m not sure I am in total agreement with them there. But other that, they seem to be solid, aimed at the general practitioner, though, not to the Movement Disorders Specialist (my impression).

This article is not available for open access, but here’s the citation:

Rafferty, M.R., Nettnin, E., Goldman, J.G. et al. Frameworks for Parkinson’s Disease Rehabilitation Addressing When, What, and How. Curr Neurol Neurosci Rep 21, 12 (2021). https://doi.org/10.1007/s11910-021-01096-0

There is moderate to strong evidence supporting physical therapy, occupational therapy, and speech-language pathology soon after diagnosis and in response to functional deficits.

We propose a framework of three pathways for rehabilitation care:

(1) consultative proactive rehabilitation soon after diagnosis for assessment, treatment of early deficits, and promotion meaningful activities;

(2) restorative rehabilitation to promote functional improvements; and

(3) skilled maintenance rehabilitation for long-term monitoring of exercise, meaningful activities, safety, contractures, skin integrity, positioning, swallowing, and communication.   (emphasis added).

I would agree with the overall framework – I have had some postural issues since the beginning (pre-PD), and assessment and promotion of meaningful activities would have been helpful. I did receive some physical. therapy to correct posture, which did so, only to reveal spinal stenosis.  Later on, I had bunionectomies which kept me wheelchair bound or with limited mobility for a year, and restorative rehabilitation was provided and needed. Finally, my own hubris regarding my mobility led to several falls in 2019 and 2020, and are now being addressed with both restorative rehabilitation and skilled maintenance rehabilitation which will hopefully correct the problems and provide the the tools to maintain posture, etc. over the (hopefully) years to come.

Parkinson's, Physical Therapy , Leave a comment

It’s PT (Physical Therapy) time again

by

I have described myself as “71 going on 17” frequently enough lately to others that isn’t getting funny anymore. But a couple of things have happened that go beyond a palindromic allusion to the soundtrack from “The Sound Of Music.”

On March 27, 2019, I was reaching over a landscape boulder in my yard, trying to put in place a sun shade umbrella stand that would serve as a solar panel stand for a small water feature, when I lost my balance, fell forward, and broke my fall with my left hand. I was actually in physical therapy at the time for rehabilitation following a couple of bunionectomies on the same foot, so after X-rays confirmed there was no fracture, I continued with both rehabs. This past October, 2020, I managed to step off a different landscape boulder in my yard with no apparent damage while falling on my back. Then later in the month, on the 24th and 31st, while out photographing wildflowers in a preserve, I fell backwards stepping off – again, no apparent damage. On the 31st, I attempted to catch up with the group I was with by taking a shortcut, stepping up on a boulder using my walking stick. I almost made it, but teetered and fell backwards. Fortunately there were no apparent fractures. But it did make the symptoms from the 2019 return. Short story long – my Primary Care Provider referred me to rehab, I was assigned to a PT who had seen me before, and she quickly focused in on the worst pain, and then worked on the other, postural habits and problems that continued to cause problems. And noted that when I step up, I tend to lean back, which probably had something to do with my October 31 fall.

All of which is a roundabout way to lead in to this review article: Physiotherapy in Parkinson’s Disease:A Meta-Analysis of Present Treatment Modalities   

Results:

  •  Conventional physiotherapy significantly improved motor symptoms, gait, and quality of life.
  • Resistance training improved gait.
  • Treadmill training improved gait.
  • Strategy training improved balance and gait.
  • Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.
  • Exergaming improved balance and quality of life.
  • Hydrotherapy improved balance.
  • dual task training did not significantly improve any of the outcomes studied.

citation info: Neurorehabilitation and Neural Repair 2020, Vol. 34(10) 871–880 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1545968320952799 journals.sagepub.com/home/nnr