Parkinson's Disease two problem assessment & treatment of each problem

1. Parkinson's
Disease

2. 01
Assessment of
balance
02
Assessment of
Resoiratory
system
03
Balance
Training
Table of contents
04
Resoiratory
system
Training

3. Assessment
01

4. Both static and dynamic balance are affected
Assessment of
balance

5. Assessment of balance
Berg scale
the therapist evaluate
the performance of the
subject
Timed Get Up and
Go Test (TGUAGT)
One of the most
commonly used tests of
gait and balance
Functional reach
test
Measures forward and
lateral balance
Reaction time
test
measures the ability to
respond quickly to a
stimulus

6. It is a 14 items list with each item
consisting of a five-point ordinal
scale ranging from 0 to 4
4= best performance
3=mild dependent
2= moderate dependent
1= severe dependent
0= no activity
Berg balance
scale

8.  Measures forward and lateral balance.
 Sensitive to change over time.
 Simple to administer.
 Arm extension with 90 degrees of
shoulder flexion while patient is upright
and leaning forward or sideways.
 Results < 6 inches related to falls
 Minimal fall risk if >10 inches of reach.
Functional reach
test

9. Technique: Direct the patient to do the
following:
• Rise from sitting position
• Walk 10 feet
• Turn around
• Return to chair and sit down
 Normal time within 10 seconds
 Patient takes <20 seconds to complete test is
mildly dependent in transfer and mobility.
 Patient requires >30 seconds to complete test
suggests higher dependence and risk of falls.
Timed Get Up and
Go Test (TGUAGT)

10. 1. This test measures the time taken for you to
press the stop button after the background
color changes.
2. Click the stop button as quickly as possible
after the background color changes (release
the mouse button quickly, as time stops when
you release the button, not when you press
down
Reaction time test

11. Environmental assessment of balance
Assessment
of bedroom
Assessment of
living room
Assessment of
bathroom
Assessment of
stairs and
outdoor

12. ‘
• Suitable bed height.
• Avoid cross wires.
• Avoid loose rugs.
• Light beside bed
• Wireless phone.
• Good furniture position.
• Rails in the wall to avoid fal
Assessment of
Bedroom

13. ‘
 Rubber matrix under foot
during taking shower.
 Rails to catch during
walking.
 Avoid slippery surface.
 Carpet in the floor.
 Arm seat over the toilet
Assessment of
bathroom

14. ‘
 Suitable height (12-15 cm).
 Suitable width (30cm).
 Good light.
 Repair missing steps.
 Not slippery.
 Parallel rails.
Assessment of
stairs and outdoor

15. ‘
• Avoid cross wires.
• Avoid loose rugs.
• Good Lightening.
• Wireless phone.
• Good furniture position.
Assessment of
living room

16.  Rigidity of chest and intercostal muscles.
 Flexed posture that causes decrease of excursion of the
diaphragm.
 Immobility.
Resoiratory
problems

17. General
Examination
Local
Examination
The position of the patient in bed
(decubitus)
Vital signs.
Body built.
Face.
Neck veins.
Cyanosis (central and peripheral).
Clubbing of fingers and toes.
L.L oedema.
Inspection.
Palpation.
Percussion.
Auscultation

18. Inspection
Observe the patient breath. Pay particular attention to:
•Shape of the chest (normal or deformity).
•Respiratory rate and depth.
•Use of accessory muscles of breathing (e.g., scalenes, SCM,levator
scapulae). Their use signifies respiratory difficulty.
•Inspiration/expiration ratio.
•Breathing through pursed lips (e.g., emphysema).
•Mode of breathing (thoraco-abdominal (females)or abdomino-
thoracic( males).
•Abnormal breathing pattern. •Asymmetry of movement and
expansion.
•Local lesions (scar of operation, dilated chest veins)

19. 1- Position of the trachea.
2- Position of the apex beat.
3- Assessment of chest expansion.
4- Assessment of Tactile Vocal
Fremitus TVF.
5- Investigating painful areas
Palpation

20. Percussion Auscultation
This technique makes use of
the fact that striking a surface
which covers an air-filled
structure (e.g. normal lung) will
produce a resonant note while
repeating the same maneuver
over a fluid or tissue filled
cavity
generates a relatively dull
sound.
Breath sounds
• Tracheal
• Bronchial
• Bronchovesicular
• Vesicular
Adventitious
• Wheeze
• Rhonchi
• Crackle
• Pleural rub
• Stridor

21. Treatment

22. Treatment of imbalance
 Mobilization technique to reduce stiffness.
 Gentle stretching exercise for the
shortened muscles.
 Range of motion exercise.
 Progressive resisted exercise program to
strengthen weak muscles.
 Balance exercises.
 Aerobic exercise program .
 Gait training.

23. Balance
Training

24. Single limb stance
A great place to begin is with the
simplest standing balance exercise.
Hold on to a chair and balance on one
leg.
This is a great place to begin to feel
your center of gravity over your ankles.
This is your goal, maintaining your
center over your ankles.
Try a few seconds balancing on each
foot. Work up to a minute if you can.
Then begin to hold on with one hand,
then one finger and finally try to let go
completely.

25. Eye Tracking
Hold your thumb comfortably in front
of your face with your elbow bent.
Move your thumb to the right as far as
comfortable. Then move your thumb to
the left as far as comfortable. Try not
to move your head. Follow with your
eyes only.
Then move your thumb upward, and
finally downward.

26. Eye Tracking
hold your thumb at arm’s length.
Move your thumb to the right as far as
comfortable. Then move to the left as
far as comfortable. This time, follow
with your eyes and head.
Move your thumb upward, then
downward.
.

27. Clock Reach
Begin by holding on to a chair with your
left hand. Visualize a clock with 12 in
front and 6 behind.
Stand on your left leg and bring your
right arm to 12 o’clock. Then reach to 3
and 6 o’clock. Repeat with the other
side.

28. Staggered Stance
Begin with feet together and hands at
sides
Step forward with your right foot.
Maintain this position for 10
seconds.Alternate putting the other
foot in front.

29. Single limb with
arm
Stand with feet together and arms at
sides. Hold on to a chair with your right
hand for support if needed.
Raise your left arm overhead. Then
raise your left leg off the floor.Hold for
10 seconds.Then repeat for the right
side..

30. Balancing Wand
Hold a wand in your dominant hand.
Focus at the top of the wand and begin
balancing.

31. Knee Marching
Stand with arms at sides, feet shoulder
width apart.
Raise one knee up as high as
comfortable.Lower, then raise the other
knee. Repeat 20 times..

32. Body circles
Stand with feet shoulder width apart,
hands at sides.
Keeping your body straight, slowly sway
in a circle. Continue for 1 minute

33. Resoiratory
Training

34. Resoiratory Training
Treatment administered to increase
ventilation & oxygenation
Breathing exercises
Positioning technique
Using devices to assist or resist
breathing.
Treatment administered to reduce O2
consumption
Reduce work of breathing
Reduce general body work
(Pain relieving electrotherapy modalities)
Treatment administered to improve
secretion clearance:
Treatment administered to reduce pain
To enhance muco-ciliary transport
(postural drainage)
To enhance cough (techniques to improve
cough)
Bronchial hygiene techniques ACB (active
cycle of breathing),Forced Expiration), High
frequency chest wall oscillations

35.  Nose breathing exercise.
 Diaphragmatic breathing (relaxed,
resisted) • Pursed lip breathing
 Segmental breathing (costal expansion
exercise)
a) Apical breathing
b) Lateral costal expansion
c) Posterior basal expansion d)
 Sternal breathing
Types of Breathing Exercise

36.  Positioning for cough
 Forced expiration or huffing stimulates cough
 Pressure over extra thoracic trachea, mid-rectus abdominis
or lower costal borders can elicit reflex cuff.
 Manual ventilation (manual ventilator may stimulate the
pulmonary mechanoreceptors).
 Nueromuscular facilitation: intermittent application of ice
over thoracic paraspinal muscle 3-5 sec.
 Manual-assisted cough
 Splinting
 Humidification
N.B.: Reflex cuff are stronger than voluntarily produced.
Techniques to improve cuff

37. Thank
you

38. Alternative
resources
Photos
● https://www.smallbusine
ssfreeforms.com/outpatie
nt-physical-therapy-
berg-balance-scale/
● https://www.physio-
pedia.com/Berg_Balance
_Scale
● https://eldergym.com/eld
erly-balance/