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Group5 f


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Group5 f

  1. 1. Group 5 Case 1b Presentation Hemali Mehta I-Chen Liu Jinesh Gandhi Pei-Ren Tsai
  2. 2. Health Condition G.20 Parkinson’s Disease Pattern 5A: Primary Prevention/ Risk Reduction for the loss of balance and Falling
  3. 3. Impairments Posture Increased thoracic kyphosis and decreased lumbar lordosis Decreased ROM B Hip Extension (-10) and knee extension(-5) and ankle DF (0) Decreased Strength B Hip Abductors (3/5), Hip extensors (3/5), hip flexors (4/5) and Ankle PF (3/5)
  4. 4. Impairments Impaired Gait decreased step length and shuffling gait pattern Impaired Balance TUG: 35 seconds Berg: 40/56 Impaired Motor control difficulty in initiation, freezing episodes R hand resting tremor, R Bradykinesia
  5. 5. Activity Limitation Community walking ADLs Driving Lifting objects for grocery shopping Baby sitting
  6. 6. Participation Restriction Role as a Spouse/ Husband Role as an independent Individual Role as an grandparent/babysitter
  7. 7. Contextual Factors Personal Factors Age, good health with no co-morbidities, medication for Parkinson’s (senimet), History of frequently near fall Environmental Family support (wife to help him), Home environment
  8. 8. Impairments Activity Limitation Participation Impairer Posture Spouse / Husband Independent Individual Grandpa / Baby sitter Community walking ADLs Driving Lifting Objects Baby sitting Decreased ROM Decreased Strength Impaired Gait Impaired Balance Impaired Motor Control
  9. 9. Goals 1. The patient will improve muscle strength of hip extensors, abductors from grade 3 to 4, improve the BBS 5 points or more, to restrict nearly fall situation less than 3 times / week within 6 weeks 2. The client will demonstrate the ability to walk at least 40 ft without freezing 50% of the time within 6 weeks
  10. 10. Intervention Balance Training: Stepping Ex Direction: front and side Feedback: KR for 66% of time(i.e. 3rd trial w/o feedback) HEP: 5reps in each direction x 1 set, 2time/day (Baseline: The patient performed 6-7 reps for each directions)
  11. 11. Repetitive step training with preparatory signals improves stability limits in Parkinson’s patients,J Rehabil Med 2012; 44: 944–949 Studies effects of volitional step training on LOS, posture and gait. RCT with control and experimental groups Improvement in reaction time, movement velocity and LOS = improvement in balance 3 times/week, 1 hour sessions for 4 weeks
  12. 12. Intervention Gait training Cues: External Auditory-Metronome Feedback: Bandwidth HEP: Walk 10 ft more than usual, self cues
  13. 13. Cueing training in home improves gait related mobility in Parkinson’s disease: RESCUE trial, J Neurol Neurosurg Psychiatry 2007;78:134–14 Randomized Crossover trial. Cues given in a home based therapeutic intervention Cues; self selected ( auditory, visual or somatosensory) given at patients preferred frequency 3 times/week, 30 minutes, 3 weeks Improvements in gait speed and step length, tandem and one leg standing and reduction of freezing by 5.5%
  14. 14. Motor Planning and Learning Motor Planning Basal Ganglia: sensory integration Central motor drive: APAs Motor learning: Procedural/Nonprocedural REF: Evidence for motor learning in Parkinson's disease:Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues
  15. 15. Cueing? Dual Task? Cueing: cues V.S. no cues? In short term, change in gait parameters are better with no cueing In long term, there are significant changes in gait parameters with auditory cues(retention) Dual Task: Research has shown that dual task increase retention of PD REF: Evidence for motor learning in Parkinson's disease:Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues
  16. 16. Novel Approach Exercise Principle 1. Specificity 2. Progressive Overload 3. Varied Practice Stage of Application? REF: A novel conceptual framework for balance training in Parkinson’s disease: a study protocol for randomized control trial.Conradsson et al. BMC Neurology 2012