Download - Group5 f
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Group 5 Case 1b Presentation
Hemali MehtaI-Chen Liu
Jinesh GandhiPei-Ren Tsai
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Health Condition
G.20 Parkinson’s Disease
Pattern 5A: Primary Prevention/ Risk Reduction for the loss of balance and Falling
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Impairments
PostureIncreased thoracic kyphosis and decreased lumbar lordosis
Decreased ROMB 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)
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Impairments
Impaired Gait decreased step length and shuffling gait pattern
Impaired BalanceTUG: 35 seconds Berg: 40/56
Impaired Motor controldifficulty in initiation, freezing episodesR hand resting tremor, R Bradykinesia
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Activity Limitation
Community walking
ADLs
Driving
Lifting objects for grocery shopping
Baby sitting
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Participation Restriction
Role as a Spouse/ Husband
Role as an independent Individual
Role as an grandparent/babysitter
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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
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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
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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
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Intervention
Balance Training: Stepping Ex
Direction: front and sideFeedback: 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)
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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
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Intervention
Gait training
Cues: External Auditory-MetronomeFeedback: Bandwidth
HEP: Walk 10 ft more than usual, self cues
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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%
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Motor Planning and Learning
Motor PlanningBasal Ganglia: sensory integrationCentral 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
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Cueing? Dual Task?
Cueing: cues V.S. no cues?In short term, change in gait parameters are better with no cueingIn 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
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Novel Approach
Exercise Principle1. Specificity2. Progressive Overload3. 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