Exercise & Parkinson’s Disease:Parkinson’s Wellness Recovery (PWR!)

Lauren Kesteloot, PT, DPT, PWR Certified TherapistAnne Mahnke, OT, MOT, OTR/L, LSVT BIG & PWR Certified TherapistJen McKune, PT, MPT, LVST BIG & PWR Certified Therapist

Nebraska Medicine Outpatient Rehab

Exercise for Brain Change• Exercise is a physiological tool that promotes

brain health, repair, adaptation and behavior recovery from the inside

• Address both motor and non-motor symptoms

Meds Alone are not Enough

Exercise targets many different motor & non-motor symptoms

▪ Motor: Rigidity, bradykinesia, incoordination▪ Emotional: depression, anxiety, apathy▪ Cognitive: attention, executive function

Multi-system Benefits of Exercise• Prevention of

• CV complications• Depression

• Decrease• Constipation• Fatigue• Stress

• Arrest osteoporosis• Improve sleep• Improve cognitive function• Drug efficacy• Functional motor performance• Management of Sensorimotor symptoms

• Bradykinesia• Rigidity• Tremor• Impaired kinesthesia/proprioceptive processing• Incoordination• Postural Instability (Ebersbach et al 2010; Goodwin et al. 2008; Cruise et al. 2011)

How can therapy help manage Parkinson’s disease?

• Using large amplitude movements at high intensityto increase dopamine output and counteract Parkinson’s symptoms of bradykinesia, rigidity, and tremor.• There are programs specifically designed using these principles. Instructed by a certified PT or OT.

• LSVT BIG• Parkinson’s Wellness Recovery (PWR!)

What can Physical Therapy do?

• Physical therapy provides services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan.

• This includes providing services in circumstances where movement and function are threatened by ageing, injury, pain, diseases, disorders, conditions or environmental factors.

• Functional movement is central to what it means to be healthy.

(World Confederation for Physical Therapy, 2015)

Physical Therapy Goals:

• Promote quality of life and independence by encouraging activity and maximizing functional mobility

• Promote safety and fall prevention

• Improve movement for daily activities by recalibrating the body through large amplitude exercises

• Improve walking by incorporating large movement patterns and using internal and external cues

What can Occupational Therapy do?• Dressing: pulling on/off clothes, buttoning,

zippers, reaching feet/shoes

• Fine motor: hand-writing, opening containers, typing

• Mobility for Self Cares: getting in/out of bed, on/off of toilet, movements for bathing, cooking, and laundry.

• Driving: addressing coordination, reaction time, and visual skills needed for safe driving.

Occupational Therapy Goals:

• Increase independence with daily self cares through use of restorative or compensatory strategies.

• Provide caregiver education

• Educate on high amplitude movements to increase ability to complete daily tasks.

• Improve coordination and strength for dressing, bathing, cooking, leisure activities, and work-related tasks.

PWR! Principles

• Evidence-Based & neuroplasticity-based

• Early intervention

• Intermittent intensive bouts for life

• Forced use

• Continuous access

• A PWR! Therapist designs a comprehensive treatment plans that are neuroplasticity-principled to optimize brain health, learning, function and slow motor deterioration [Exercise4BrainChange]

Parkinson’s Wellness Recovery

PWR!

GET BETTER and STAY BETTER with EXERCISE

Amplitude + Progressive Aerobic Training = Optimal Functional (essential for optimal brain change)

PWR! Four Moves1- PWR! Up

2- PWR! Rock

3- PWR! Twist

4- PWR! Step

PWR! Up (posture)

PWR! Up (posture)

• Why it matters• Addresses poor posture, which leads to: Impaired balance reactions Pain (low back, neck) Decreased movement efficiency

• What do to about it: Train posture directly Improve flexibility of specific muscle groups (flexors) Improve strength of specific muscle groups (extensors)

Capecci et al 2014

PWR! Rock (weight transfer)

PWR! Rock (weight transfer)

Why it matters How we start movements Affects functional mobility Can prevent falls Reduces freezing

What we can do about it Train the ability to shift weight in different positions With different bases of support With support to reduce fear

PWR! Twist (trunk rotation)

PWR! Twist (trunk rotation)

Why it matters Improves trunk motion Improves functional mobility (bed mobility, dressing) Reduces pain (back, neck etc)

What we can do about it Utilize specific exercises to improve trunk rotation Encourage exercises in different positions to utilize sensory

information/feedback (floor/wall) Evidence for rhythmical rotation/twisting and repetitive

throughout the day

PWR! Step (transition)

PWR! Step (transition)

Why it matters Because we need to go places Improves gait pattern and activities of daily living (lower body

dressing) Step responses for balance

What we can do about it Practice repetitive stepping Practice in multiple directions Simulate daily activities

Jobges et al J Neurol Neurosurg Psyciatry 2004; 75: 1662-1667

PWR! BoostsPWR! BreathImprove lung expansionImprove swallowing

PWR! HandsHelps manage hand rigidity

PWR! VoiceLoudness of speech

PWR! EyesMaintain eye movement

Dual TaskingMental sharpness

When to get a referral to PT/OT?

• Advocate for yourself• A new diagnosis of Parkinson’s to learn

appropriate exercises in order to maintain function and mobility

• Decreased mobility

• Increased difficulty with daily activities

Questions?

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