Tag Archives: Physical Therapy

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

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

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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!

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

More physical therapy, more research & guidelines

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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

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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

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

So.. what’s new?

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A couple of recently published reviews (for folks that want to stay on top of things) :

What do we know about PD and what can we do about it?   This one is more of a commentary piece, that is to say, it isn’t an experiment or a structured desk review of other papers. It covers PD in (almost) layman’s terms, the causes (genetic, environmental, and perhaps lifestyle choices – nicotine and caffeine seem to have a neuroprotective effect), and the signs and symptoms:

… symptoms appear in other diseases as well so that not everyone with one or more of these symptoms has
the disease. In some people, the disease evolves more quickly than in others and it is not possible to predict what course the disease will take.

According to the author, the younger the age at onset, the more likely it is to be genetically related. Later onset symptoms appear more gradually. ( my note: I had many of the prodromal symptoms beginning around age 16, including REM Sleep Behavior Disorder, depression (probably due to environmental (e.g., workplace management) factors), essential tremors,  and have the LINGO1 gene variant that has been linked to both essential tremors and Parkinson’s. A recent Michael J. Fox Foundation – 23AndMe study found another couple of dozen or more gene variants associated with a higher risk for Parkinson’s. Clearly, there is a need for earlier detection and mitigation of Parkinson’s and parkinsonism conditions).

PD dementia and dementia with Lewy bodies differ in when dementia occurs, among other things. In PD, dementia occurs after PD diagnosis, in the latter, dementia occurs before PD symptoms become apparent. 

The author continues to provide an overview. But for me the sentence that stuck out glaringly was “Scientists still do not know what causes cells that produce dopamine to die.” (I need to finish reading this one… Will have to put it on my to-do list). 

Parkinson’s patients’ needs during the pandemic   This was a survey study done in Northern Italy with PD patients. Findings included:

(i) fearing the risk of contracting coronavirus,

(ii) the reduction of physical activity,

(iii) perception of the risk of not being able to access outpatient clinics or support services, and

(iv) the suffering from the important reduction in socialization.

The authors also noted that the perception could be greater than the actual difference, especially for item iii.

Enhanced differentiation of human induced pluripotent stem cells toward the midbrain dopaminergic neuron lineage through GLYPICAN-4 downregulation    I just tossed this link in for kicks – it is way outside of my area of expertise, but might be of interest to someone who knows something about the workings of the brain.

A scoping review of the nature of physiotherapists’ role to avoid fall in people with Parkinsonism – Now, here’s something I have a little more experience with – having fallen 3 times in October 2020 while stepping backward off of boulders, or trying to step up onto a boulder, either in my yard or in a park/preserve. Fortunately, I was referred to an excellent Physical Therapist who zeroed in on the greatest source of pain and then has moved toward improving strength, balance and posture. She noted my habit of leaning back when stepping high, and suggested that this might have caused the last, and most painful fall. 

As for the review, it noted that PT can have a positive effect on many issues related to falls in Parkinsonism. But the many studies were so varied, that many more studies would have to be done to specify which therapy works best for which problem at what stage of the disease. (surprise, surprise).

And now, to sleep, perchance to dream (Shakespeare) and hopefully, not to be tossin’ and turnin’ all night (Phillip Upchurch).

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