Parkinson Ex by Dr Arif

8/8/2019 Parkinson Ex by Dr Arif

1/58

Living withLiving with

Mr. James ParkinsonMr. James Parkinson


2/58

Epidemiology of PDEpidemiology of PD

The most common movement disorderThe most common movement disorderaffecting 1affecting 1--2 % of the general population2 % of the general population

over the age of 65 years.over the age of 65 years.

The second most common neurodegenerativeThe second most common neurodegenerativedisorder after Alzheimerdisorder after Alzheimers disease (AD).s disease (AD).


3/58

The etiology (cause)The etiology (cause)

This chronic neurological disorder remains aThis chronic neurological disorder remains amysterymystery

Results from a deficiency of dopamine, aResults from a deficiency of dopamine, a

neurotransmitter (chemical messenger)neurotransmitter (chemical messenger)produced in the midbrain region called theproduced in the midbrain region called thesubstantia nigrasubstantia nigra

Early symptoms are typically unilateral (presentEarly symptoms are typically unilateral (present

only on one side of the body). Both symptomsonly on one side of the body). Both symptomsand rate of progression vary from person toand rate of progression vary from person topersonperson


4/58

Dopamine pathways in human brainDopamine pathways in human brain


5/58

Signs and symptoms of Parkinson'sSigns and symptoms of Parkinson's

disease includedisease include BradykinesiaBradykinesia -- profound slowness of movementprofound slowness of movement Resting tremorResting tremor -- shaking, worse on the affected sideshaking, worse on the affected side RigidityRigidity -- marked stiffness, worse on the affected sidemarked stiffness, worse on the affected side Decreased arm swing on the affected sideDecreased arm swing on the affected side

Problems with walking and balanceProblems with walking and balance -- may experience a shuffling gaitmay experience a shuffling gaitor episodes of "freezing", being unable to initiate a step forwardor episodes of "freezing", being unable to initiate a step forward MicrographiaMicrographia -- small, cramped handwritingsmall, cramped handwriting Masked faceMasked face -- reduced facial expressionreduced facial expression DysarthriaDysarthria -- lower volume or husky quality to the voicelower volume or husky quality to the voice Impaired manual dexterityImpaired manual dexterity

Depression, anxiety or other mood disorderDepression, anxiety or other mood disorder Some people fatigue easily and have increased PD symptoms inSome people fatigue easily and have increased PD symptoms in

response to external stressresponse to external stress


6/58

Clinical features of PDClinical features of PD

Three cardinalThree cardinalsymptoms:symptoms:

pp resting tremor

p bradykinesia(generalizedslowness of

movements)p muscle rigidity


7/58

How physical therapist can help ?How physical therapist can help ?

Design an exercise program to meet your particularDesign an exercise program to meet your particularneeds.needs.

Evaluate and treat problems of mobility and walking.Evaluate and treat problems of mobility and walking.

Evaluate and treat joint or muscle pain which interferesEvaluate and treat joint or muscle pain which interfereswith the activities of daily living.with the activities of daily living.

Help with poor balance or frequent falling.Help with poor balance or frequent falling.

Treat difficulties accomplishing activities of daily livingTreat difficulties accomplishing activities of daily living

Recommend and teach the correct use of adaptiveRecommend and teach the correct use of adaptiveequipment.equipment.


8/58

Essential PD rehabilitation components inEssential PD rehabilitation components inearly and middle stageearly and middle stage

Breathing controlBreathing control

Stretching knowledgeStretching knowledge

Strength trainingStrength training

Aerobic activityAerobic activity

Balance trainingBalance training

Posture correctionPosture correction

Speech and Swallowing Rehab Role of adaptive and assistive devicesRole of adaptive and assistive devices


9/58

Breathing exercisesBreathing exercises


10/58


11/58

StretchesStretches


12/58

SEATED NECKANDSEATED NECKAND

CH

EST STRETCH

CH

EST STRETCH


13/58

SEATED ROTATIONSEATED ROTATIONSTRETCHSTRETCH


14/58

OVERHEADSTRETCHOVERHEADSTRETCH


15/58

STANDING BACKSTRETCHSTANDING BACKSTRETCH


16/58

HAMSTRINGHAMSTRINGSTRETCHSTRETCH


17/58

LYING SHOULDERLYING SHOULDERSTRETCHSTRETCH


18/58

SEATEDSIDE STRETCHSEATEDSIDE STRETCH


19/58

STANDING SHOULDERSTANDING SHOULDERSTRETCHSTRETCH


20/58

ROTATION STRETCHROTATION STRETCH


21/58

CALFSTRETCHCALFSTRETCH


22/58

ANKLE CIRCLESANKLE CIRCLES


23/58

Strengthening ExercisesStrengthening Exercises


24/58


25/58

SHOULDER BLADE SQUEEZESHOULDER BLADE SQUEEZE


26/58

SHOULDER BLADE SQUEEZESSHOULDER BLADE SQUEEZES


27/58

QUADSTRENGTHENINGQUADSTRENGTHENING


28/58

QUADRAPED TRUNKQUADRAPED TRUNK


29/58

PRONE ON ELBOWSPRONE ON ELBOWS


30/58



31/58



32/58

Balance, Falls, and PostureBalance, Falls, and Posture

Balance problems are one of the main symptomsBalance problems are one of the main symptomsof PD. Another name for balance problems isof PD. Another name for balance problems is

postural instability.postural instability.

Balance problems increase the risk ofBalance problems increase the risk of

falling, especially when combined with otherfalling, especially when combined with othersymptoms and complications of PD, including:symptoms and complications of PD, including:


33/58

Slowness of movement, also calledSlowness of movement, also calledbradykinesia, which causes delayedbradykinesia, which causes delayedreaction time.reaction time.

Stooped postureStooped posture

Shuffling walk.Shuffling walk.

FreezingFreezing

Falling backwards, also called retropulsionFalling backwards, also called retropulsion

Quick, short steps forward, festinationQuick, short steps forward, festination


34/58

BALANCE EXERCISESBALANCE EXERCISES


35/58


36/58

Preventing FallsPreventing Falls

DO NOTDO NOT pivot your body over your feet whenpivot your body over your feet whenturning. Instead try:turning. Instead try:

UU--turn while walkingturn while walking

U-turn - Useful for more open

areas. Move your feet & body together

in an arc...


37/58

ClockClock--turnturn

Clock-turn Technique - Usefulin small areas & for when you

are stopped & must turn. Start

at 12PM & take 2 slow steps to

3PM, and so on


38/58

Avoid walking backwardsAvoid walking backwards

TryTry

Stepping sidewaysStepping sideways

Side-step Arc Technique -

Useful in

small spaces & as a way to avoid

stepping

backwards. Take slow side-steps in an

arc...


39/58

TripodsTripods

Avoid tripod or

quad canes

No


40/58


41/58

PosturePosture

PD can cause many changes in the body.PD can cause many changes in the body.One easily recognizable change is posture. TheOne easily recognizable change is posture. Thecharacteristic changes in posture can include:characteristic changes in posture can include:

A forward head position.A forward head position. Rounding of the shoulders and upper back.Rounding of the shoulders and upper back.

A forward trunk position with increasedA forward trunk position with increased

bending of the hips and knees.bending of the hips and knees.


42/58

Some typical Poor positionsSome typical Poor positions

Sitting on the couch watching TV.Sitting on the couch watching TV.

Leaning over to work on the computer.Leaning over to work on the computer.

Driving/riding in the car.Driving/riding in the car.

Looking downward while reading, or proppingLooking downward while reading, or proppingyour head against the headboard while reading.your head against the headboard while reading.


43/58

Example of poor sitting postureExample of poor sitting posture


44/58

Example of good sitting postureExample of good sitting posture


45/58

What are AssistiveWhat are Assistive\\adaptive aids?adaptive aids?

Adaptive aids are items that can help you stay asAdaptive aids are items that can help you stay asindependent as possible for as long as possible.independent as possible for as long as possible.

These devices can make your daily life easier and safer,These devices can make your daily life easier and safer,and improve your quality of life.and improve your quality of life.


46/58

Assistive aidsAssistive aids

A urinal (available for both men and women),A urinal (available for both men and women),bedpan, or bedside commode can help reducebedpan, or bedside commode can help reducebathroom trips at nightbathroom trips at night


47/58

Condom catheters for bladder incontinence for menCondom catheters for bladder incontinence for men


48/58

Bathing and toileting aidsBathing and toileting aids


49/58


50/58

DressingDressing

Do a few stretching exercises beforeDo a few stretching exercises beforegetting dressed to warm up muscles.getting dressed to warm up muscles.

Sit down when dressing.Sit down when dressing.Allow plenty of time for dressingsAllow plenty of time for dressings


51/58


52/58

Helpful bedroom aidsHelpful bedroom aids

Helping handle/bed rail


53/58


54/58

Speech and Swallowing difficulties inParkinson Disease

The same PD symptoms that occur in muscles of the body--tremor, stiffness, and slow movement- can occur in themuscles used in speaking and swallowing. This cancause

A soft voice

Mumbled or fast speech

Loss of facial expression

Problems communicating Trouble swallowing


55/58

Facial Exercises

Smile - hold - relax - repeat.

Pucker your lips - hold - relax - repeat.

Alternate puckering, then smiling.

Open your mouth and move the tip of your tongue all around the

lips. Open your mouth and move the tongue around the gum line

Open your mouth as wide as you can - hold - relax - repeat.

Say "KA" - a prolonged sound - as loud and hard as you can.

Say "PA"/"TA"/"KA" - as loud and fast as you can.


56/58

swallowing

Always sit upright

Chew small amounts of food well and swallow it all before addingmore.

Put your fork down between bites to slow yourself down

Make yourself swallow twice after every bite. Take small sips when drinking. Alternate bites of food and sips.

Take only one sip at a time. Do not drink gulp after gulp.

Use of straws!!

Keep your chin slightly down or at least parallel to the table.

Dont try to drink out of a can. Use a glass instead.

Dont talk with food in your mouth


57/58

Tips aboutDrooling

If you tend to drool, you probably dont have more saliva then youused to have; you are just not swallowing it as automatically asbefore.

Frequent sips of water or sucking on ice chips during the day canhelp you swallow more often

Always keep your head up, with your chin parallel to the floor, andyour lips closed

Drinking more water will help thinning the phlegm


58/58

We wish you all a very happy newWe wish you all a very happy new

year and healthy lifeyear and healthy lifeThank YouThank You

Documents

Parkinson Ex by Dr Arif