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101 Cards in this Set
- Front
- Back
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Center of mass vs. center of gravity
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Point corresponds to the center
of the total body mass-perfect equilibrium gravity - Slightly anterior to the second sacral vertebrae CG of a body is the point where the vector sum of gravitational forces on all its particles acts |
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Limits of stablility
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Sway boundaries - 12˚ant-post / 16˚4" apart frontal plane
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Sensory Systems and Balance Control
Visual system Somatosensory system Vestibular system Semicircular canal otoliths Sensory organization for balance control |
Sensory Systems and Balance Control
Visual system - Position of head relative to environment, orientation of head, direction and speed of head movements Somatosensory system - Information re: position and motion. Muscle proprioceptors, jt receptors, skin mechanoreceptors (clue…can’t use ankle, would use hip strategy) Vestibular system - Position and movement of the head w/ respect to gravity -Semicircular canal: angular acceleration, fast movements - otoliths: linear acceleration, slow head movements Sensory organization for balance control - CNS ability to suppress/select, basis of treatments |
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Types of balance control
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Static, dynamic, automatic
Feedforward, anticipatory control, closed loop control |
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Motor strategies for balance control
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preprogrammed synergies (reflex, automatic, involuntary)
Ankle Strategy (Anteroposterior Plane) - muscle activation, response to smaller perturbation, muscle response is usually distal to proximal Weight-Shift Strategy (Lateral Plane) - distal to proximal Suspension Strategy - quick lowering of CoM Hip Strategy - response usually to a larger perturbation, muscle response usually proximal to distal, manifested as hip flexion or extension. In rehab can facilitate this walking on a beam, or on a straight line Stepping Strategy - displace CoM beyond limits of stability Combined Strategies |
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Impaired balance may be from
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Sensory Input Impairments
Sensorimotor Integration Biomechanical and Motor Output Deficits Deficits with Aging Deficits from Medications |
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Impaired balance from:
Sensory Input Impairments Sensorimotor Integration |
Sensory Input Impairments
- proprioceptive. dec jt position sense -Reduced somatosensation - peripheral neuropathies -Visual -Vestibular system (note said 'rely on hip strategies' near the proprioceptive line and 'poor ability to use hip strategies' near the visual line, but might have been out of order) Sensorimotor Integration -Damage to basal ganglia, cerebellum -Sensory organization problems |
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Balance impairments from:
Biomechanical and Motor Output Deficits Deficits with Aging Deficits from Medications |
Biomechanical and Motor Output Deficits
-Musculoskeletal -Neuromuscular -pain Deficits with Aging -Slower latencies -Inc hip strategy -Limited w/ inc perturbations of inc mag/velocity Deficits from Medications -Increased risk of falling for individuals taking 4 or more medications |
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Examination and evaluation of impaired balance
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Static Balance Tests
Dynamic Balance Tests Anticipatory Postural Control Tests Reactive Postural Control Tests Sensory Organization Tests Functional Tests |
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Balance training
(types) |
Static Balance Control - Vary postures, support surfaces, incorporate external loads
Dynamic Balance Control - Moving support surfaces, move head, trunk, arms, legs Anticipatory Balance Control - Reaching, catching, kicking, lifting Reactive Balance Control - Standing sway, hip/ankle strategy Sensory Organization - Reduce visual input and somatosensory Balance During Functional Activities - Dual or multitask activities Safety During Gait, Locomotion, or Balance |
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Health and environmental factors for balance
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Low Vision
Sensory Loss Medications |
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Evidence-based balance exercise programs for fall prevention in the elderly
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Home Exercise Program for Reducing Risk of Falls for People at High Risk:
-OTEGO Home Exercise Program - Leg strengthening and balance train -30’ Supervised Group Program Incorporating Strengthening, Walking, and Functional Activities: - 6 week, 11 on 6-20 Borg exertion, 13 Borg scale Multi-System Group Exercise Program Incorporating a Circuit of Activities to Address Balance Impairments and Function - One-hour ex 1/wk for 10 wks Tai Chi for Balance Training - COM Displaced |
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Ortego home exercise program
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Cost effective
>80 yrs Individually tailored 30 min Leg strength and balance 24 weeks Booklet Ankle weights Resistance: 8-10 reps before fatiguing 2 sets of 10 reps before increase Ankle PF/DF body weight 5 minute warm-up Unilateral knee extension Repeat opposite leg Unilateral knee flexion Repeat opposite leg Unilateral hip abduction Repeat opposite leg Raise up toes Rock back on heels Knee bends – 10 reps Backwards walking – 10 steps four times Walk figure 8 2 times Sideways walk – 10 steps 4x Tandem stance – 10 second Tandem walk – 10 steps 4x Heel walking – 10 steps 4x Toe walking – 10 steps 4x Sit to stand – 5x (2H) 5X (1H) |
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Supervised group programs for balance
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Incorporate strength, walking, functional activities
Research > supervised more effective than usual exercise program |
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Multi-System Group Exercise Program Incorporating a Circuit of Activities to Address Balance Impairments and Function
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Nitz and Choy
strength, coordination, sensory systems, cognition, reaction time, static and dynamic ability education booklet on how to prevent fall 1-hour exercise session , 1/week for 10 weeks Both reported reduced number falls Reduction falls greater in circuit group Also Greater improvement functional tests |
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Benefits of Tai Chi for balance
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Slow, continuous, rhythm facilitate sensorimotor integration and awareness
Maintain vertical posture, enhance posture alignment and perception orientation Weight shift facilitates anticipatory balance, motor coordination, and LE strength Large dynamic , flowing, circular movement of extremities promote joint ROM and flexibility |
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Evidence-based balance training programs for specific musculoskeletal conditions
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Ankle Sprains
McGuine and Keene reduced risk ankle sprains 38% SLS, 5/wk 5 wks, 3/wk season Anterior Cruciate Ligament Injuries Fitzgerald and colleagues perturbations, 5x more likely return to high level activity 2-3 sessions week for 10 sessions Low Back Pain Cacciatore and associates 6-month, 1/wk 20 weeks feedforward postural adjustments |
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FRIDAY, March 14, 2014 (HealthDay News) -- Neuromuscular training of all young athletes is a _____ strategy for reducing the ___ and ___ associated with anterior cruciate ligament (ACL) injuries, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 11 to 15 in New Orleans.
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FRIDAY, March 14, 2014 (HealthDay News) -- Neuromuscular training of all young athletes is a cost-effective strategy for reducing the costs and morbidity associated with anterior cruciate ligament (ACL) injuries, according to a study presented at the annual meeting
The implementation of a universal training program would, on average, save $275 per player per season, and would reduce the incidence of ACL injury from 0.03 to 0.011 per player per season. Using the range of reported sensitivity and specificity values, screening was not deemed cost-effective. |
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Tests that assess fall risk in elderly, balance during functional
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Assesses fall risk in elderly, balance during functional
Timed up and Go Test (TUG) Tinetti Dynamic Gait Index |
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Test specifically used for patients with vestibular disorder
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Functional Gait Assessment: specific use for patients with vestibular disorder
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Test that assesses automatic postural response = Reactive postural control
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Pull Test:
Assesses automatic postural response = Reactive postural control |
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Changes in stroke volume with aerobic exercise
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Increase venous return
Increase end-diastolic volume Increase in ejection fraction SNS stimulation Increases myocardial contractility |
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Changes in stroke volume with resistance exercise
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Workload dependent
Lighter loads No appreciable change Heavier loads No change or decrease High intrathoracic or intra-abdominal pressure -Limits venous return |
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VO2 =
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VO2 = Q x a-vO2
Amount of O2 available and consumed by the body tissue Rest = 3.5 mLO2/kg/min Max = 25-80 mLO2/kg/min Aerobic Best estimate of cardiorespiratory fitness |
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Summary of acute cardiovascular effects with aerobic exercise
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Increased:
Cardiac output Stroke volume Oxygen uptake Systolic blood pressure Blood flow to active muscles and skin Decreased or no change: Diastolic blood pressure |
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Summary of acute cardiovascular effects with resistance exercise (heavy loads)
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Increased:
Heart rate Diastolic blood pressure Systolic blood pressure No change: Oxygen uptake Cardiac output Stroke volume |
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Cardiorespiratory responses to aerobic training:
changes in heart rate, stroke volume and cardiac output at rest, at submax exercise, and at maximal exercise |
Rest Sub Max Max
Heart Rate: lower, lower, same Stroke volume: higher, higher, higher Cardiac output: same, same, higher |
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Cardiorespiratory responses to aerobic training:
changes in heart mass/volume, blood pressure, blood flow to muscle at rest, at submax exercise, and at maximal exercise |
Rest Sub Max Max
Heart mass: increased (all the time) Blood Pressure: decreased, decreased, decreased Blood flow to muscle: decreased, same, increased |
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Cardiorespiratory responses to aerobic training:
Minute ventilation, respiratory rate, tidal volume at rest, at submax exercise, and at maximal exercise |
Rest Sub Max Max
Minute ventilation: same, same, higher respiratory rate: same, same, higher tidal volume: same, same, higher |
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Bone responses to aerobic and resistance training
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Age-dependent effects
Aerobic Observational vs. intervention studies Athletes vs. non-athletes Weight bearing vs. non-weight bearing Plyometrics Resistance Magnitude Versus aerobic training |
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Acute response of cardiac output with Resistance exercise: workload dependent
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Resistance: workload dependent
Lighter loads Similar to aerobic, but smaller effect Heavier loads Small increases due to increased HR |
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Changes in BP with acute exercise
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Aerobic
Systolic BP (SBP): increases linearly with work Max 200-240 mmHg Diastolic BP (DBP): no change or slight decrease Resistance Increase in SBP and DBP Vasoconstriction Increase in total peripheral resistance |
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Minute Ventilation: VE
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VE = VT x RR
Volume of air breathed in one minute Rest: 5-10 L/min Maximal: 100-200 L/min Increases with exercise immediately Aerobic Light effort: increase in VT Moderate to high effort: RR also increases |
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Influences on Bone
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Dietary factors
calcium kcals Endocrine factors sex steroids IGFs Genetics Other factors medications And, Mechanical Loading The pre-eminent factor in terms of bone mineral accumulation, bone architecture and the overall integrity of the skeleton is mechanical loading Galileo, 1638; Darwin, 1859; Roux, 1885; Wolff, 1891; Thompson, 1917; Frost, 1987; Bailey, 2000; Rauch 2003 |
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Dose-response
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3 types of responses to the addition of exercise to a sedentary life
Y axis = health benefits X axis = minutes of exercise or physical activity level/week A - steep curve that starts to level off B - linear C - gradual increase that gets steeper (looks exponential) |
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Physical fitness and all-cause mortality
Aerobics Center Longitudinal Study |
Aerobics Center Longitudinal Study
- prospective observational study of physical activity, physical fitness, and health - 10,000 men and 3,000 women - all performed a GXT at Cooper Clinic in Dallas, TX - measured all-cause mortality rates in relation to initial fitness levels Results: cardiorespiratory is a strong and independent predictor of all-cause mortality. Men and women in the lowest quintile were 3.44 and 4.65 times more likely to die of any causes compared with men and women in the highest quintile, respectively. Greatest decrease in mortality risk occurred when moving between the first and second quintiles. |
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Physical fitness and all-cause mortality
Harvard Alumni Study |
Harvard Alumni Study
- 17000 men who attended Harvard from 1916-1950 - 16 year follow up of self reported activity levels Results: There is a inverse dose-response relationship between physical activity levels and all-cause mortality. Greater levels of physical activity were associated with lower risk of death from all-causes, and men who expended >2000 kcals/week of energy in physical activity had a 27% lower risk of mortality compared with men expending <2000 kcals/week. |
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Deciphering the recommendations
Intensity of physical activity Adults 18-65 years old |
Moderate-intensity
Equivalent to a brisk walk Noticeably accelerates heart rate Vigorous-intensity activity Jogging Causes rapid breathing and substantial increase in HR |
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Deciphering the recommendations
Intensity of physical activity Adults 65+ years old |
Moderate-intensity = moderate level of effort relative to an individual’s aerobic fitness
10-point scale, where sitting is 0 and all-out effort is 10 Moderate-intensity = 5 - 6 Produces noticeable increase in HR and breathing Vigorous-intensity = 7 - 8 Produces large increases in HR and breathing |
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Deciphering the recommendations
Health benefits Dose-response of exercise on all-cause mortality |
Yes
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Deciphering the recommendations
Health benefits Dose-response of exercise on: CVD, esp. CHD Blood Pressure and Hypertension Blood lipids and lipoproteins Vascular health |
CVD, esp. CHD: Yes
Blood Pressure and Hypertension: yes/unknown Blood lipids and lipoproteins: unknown Vascular health: unknown/no |
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Deciphering the recommendations
Health benefits Dose-response of exercise on: Overweight, obesity Fat distribution Type 2 diabetes mellitus |
Overweight, obesity: yes
Fat distribution: yes Type 2 diabetes mellitus: yes |
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Deciphering the recommendations
Health benefits Dose-response of exercise on: Cancer Osteoporosis Osteoarthritis |
Cancer: yes/unknown
Colon cancer: 30% reduction in risk Breast cancer: 20-40% reduction in risk Dose-response: apparent, but unclear details Osteoporosis: unknown Effect: 1-2% for studies of 1 year Does not persist at same levels > 1 year Small improvements in BMD → large increases in bone strength No evidence for dose-response effects of exercise training on BMD Osteoarthritis: no No evidence that physical activity increases the risk of developing OA Following current guidelines Low-to-moderate levels of physical activity: may provide protection against OA |
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Deciphering the recommendations
Health benefits Dose-response of exercise on: Skeletal development; peak bone accural Quality of life; independent living in older people Depression and anxiety |
Skeletal development; peak bone accural: unknown
Quality of life; independent living in older people: yes/unknown Depression and anxiety: no evidence of consistent dose response Substantial evidence that regular physical activity protects against the onset of depression symptoms and major depressive disorder |
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Physical activity by demographics
Lower percent of people meeting physical activity recommendations and higher percent of non-physically active people in these groups: |
Age
-Older Education -Lower Sex -Women Race/ethnicity -Black and Hispanic |
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Strength training has been shown to favorably impact:
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Strength training has been shown to favorably impact:
Blood pressure Type 2 diabetes Body composition Osteoporosis Cancer Mental health |
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Recommendations for Type of physical activity at different ages
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Type of activity
Infancy: motor skills Preschool: basic movement patterns 6-9 y/o: basic and specialized motor skills Largely anaerobic 10-14 y/o: individual and group activiities Organized sports 15-19 y/o: structured programs |
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PTs as agents of behavior change
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Increase the number of people at low risk for chronic diseases
Rather than focus primarily on high-risk individuals Personal, bi-directional model Rapport building, trust, commitment, and follow-up Individual assessment to determine barriers and facilitators of learning Role model for healthy behavior |
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Assessment methods for exercise prescription
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Graded exercise testing – maximal or submax
-Treadmill -Cycle/arm ergometer Field/functional tests -12 minute walk test -6 and 3 minute -Timed up and go test -Shuttle test -1 mile walk test -Bench step test Physiologic measures Intensity measures |
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Exercise training principles
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Overload
“For a tissue or organ to improve its function, it must be exposed to a stimulus greater than it is normally accustomed to” Repeated exposure with tissue adaptation Includes: mode, intensity, frequency, and duration Specificity “Training effects derived from an exercise program are specific to the exercise performed and muscle involved” Wide variety to carry over into recreational, vocational, and functional activities For improvements in cardiorespiratory fitness, muscular strength, muscular endurance, and flexibility. |
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Conditioning phase
Components of an aerobic exercise program |
Frequency
Intensity Type Time |
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Linear Relationship between HR and VO2
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64-94% of HRmax (77-90% HRmax)
40-85% of HRR or VO2R (60-80% HRR) RPE: 12-16 (Borg scale) 3+ METs Linear relationship between heart rate and VO2 |
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Intensity in METs: moderate and vigorous
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Moderate (3-6 METs)
Brisk walking Bicycling (level) Low impact aerobics Swimming Mowing grass Vigorous: >= 6 METs Inclined walking or hill climibing Jogging Bicycling (hills) High impact aerobics Lap swimming |
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Intensity: Heart Rate Reserve: Karvonen Formula
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Target HR range = [(HRmax – HRrest) x percent intensity] + HRrest
Example: 40 year old Resting HR = 60 bpm Maximal HR = 180 bpm Target HR at 60% intensity = [(180-60)*0.6]+60 = 132 Target HR at 80% intensity = [(180-60)*0.8] +60 = 156 Target HR range for aerobic exercise = 132-156 |
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Resistance Exercise effects
musculoskeletal cardiovascular |
Musculoskeletal
Performance of ADLs with less physiologic stress Cardiovascular HR elevation disproportionate to work Minimal increases in VO2max May see increases in cardiovascular endurance |
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Resistance exercise prescription: intensity
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Intensity
Weight: 60-80% 1RM; 8-12 RM, etc Number of repetitions: 8-12 reps (3 to 20) Number of sets: 1 set to the point of volitional fatigue Repetition duration: ~3 sec concentric, ~3 sec eccentric Maintaining muscular tension RPE: 15-16 |
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How can we come up with how many calories a person expends with exercise?
Kcal/min = |
Kcal/min = [MET * 3.5 * body weight(kg)]/200
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Why use PNF?
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give PT a good working knowledge of functional movement patterns
enhances the ability to evaluate patients gives a wide variety of treatment alternatives Enables the PT to utilize the patients strengths to enhance function Muscles are facilitated in an optimal way promoting normal movement patterns Gives the patient the opportunity to work their body parts together in integrated, "normal" movement patterns Develops strength |
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Bilateral asymmetrical "chopping"
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Left extremity does D1 extension
R moves in D2 extension. Hand grips wrist of leading arm (L) Reversing from extension (D1 and D2) to flexion (D1 and D2) is "reversal of chop" |
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Bilateral Asymmetrical "lifting"
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in lifting the hand opens with abduction, D1 flexion and D2 flexion, and closes with adduction, D1 extension and d2 extension
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Lower extremity D1 Flexion and extension
Hip: Ankle: Foot: Toes: |
Hip: flexion, adduction, external rotation
Ankle: dorsiflexion Foot: inversion Toes: extension Extension is opposite |
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LE D2 flexion and extension
Hip: Ankle: Foot: Toes: |
Hip: flexion, abduction, internal rotation
Ankle: dorsiflexion Foot: eversion Toes: extension Extension is opposite - point toes, ER, adduct |
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PNF: Reciprocal vs. nonreciprocal
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Reciprocal: paired extremities perform opposite movements (ex: flex/ext)
Non: same movements (flex/flex) Can be arms or arm and a leg Val says: reciprocal - extremities perform movement in opposite directions at the same time Diagonal reciprocal = contralateral extremities move in the same direction at the same time while opposite extremities move in the opposite direction (like walking?) |
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PNF: ipsilateral vs. contralateral
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Ipsi: UE and LE on same side move together
Contra: UE and LE of opposite sides move at the same time Val says: ipsilateral - extremities of the same side move in the same direction at the same time Contralateral- extremities of opposite sides move in the same direction at the same time (does it actually have to be the same direction?) Diagonal reciprocal = contralateral extremities move in the same direction at the same time while opposite extremities move in the opposite direction (like walking?) |
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PNF: symmetrical vs. asymmetrical
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Symmetrical: paired extremities (upper or lower) perform identical movements on both sides of center body line (ex: left ext d1/right ext D1)
Asymmetrical: paired extremity movements are not identical on both sides of center body line (ext: left ext D1/ right ext D2) Val says: symmetrical - extremities perform "like" movements at the same time Asymmetrical extremities perform movements toward one side at the same time |
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Beevor's axiom: The brain knows only
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The brain knows only motion, not individual muscle action
Neuromuscular system 'thinks' in postures and movements we do every day during normal activity (walking, stair climbing) |
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Characteristics of normal movement
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Movements are rhythmic and reversing
Must reverse movement for function Goal of treatment: balance antagonists volitional grasp present at 3 months, can't let go until 7 months, flexion dominance |
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PNF Layers of Facilitation
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Patterns
Body position Vision - show where Stretch - facilitates shortening Normal timing - hand before shoulder Verbal Cues Resistance - smooth and coordinated Resistance to facilitate and relax - max resistance to max relax Traction/approximation - help joint feel better/mobility, stability |
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A successful PNF treatment program will:
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Analyze total patterns, diagonal movements, and combining movements during evaluation
include them during treatment Progress treatment utilizing higher levels of total patterns and combining movements Use an endless variety of positions, activities, and combinations of movements in many directions during treatment |
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PNF: Rotation and diagonal movement are....
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last to develop (diagonal)
and first to disappear in injury, trauma, and aging Low back pain or TBI, not doing diagonals |
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Development of Direction
Direction: vertical Total pattern: Anatomical Planes: |
Direction: vertical
Total pattern: forward/backward, up/down Anatomical Planes: flexion/extension |
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Development of Direction
Direction: horizontal Total pattern: Anatomical Planes: |
Direction: horizontal
Total pattern: sideward, L/R Anatomical Planes: abduction, adduction |
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Development of Direction
Direction: circular Total pattern: Anatomical Planes: |
Direction: circular
Total pattern: clockwise, counterclockwise Anatomical Planes: External/internal rotation, or lateral medial rotation |
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Development of Direction
Direction: oblique/diagonal Total pattern: Anatomical Planes: |
Direction: oblique/diagonal
Total pattern: forward to L/R, backward to R/L Anatomical Planes: diagonal flex, L/R, Diagonal Ext. R/L |
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sequence of development of interaction of extremities (PNF)
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Symmetrical
Asymmetrical Ipsilateral Contralateral Reciprocal |
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Therapist body position during PNF
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in line with desired movement
D1 is by the bum D2 toward the shoe? Resistance comes from body, not hands/arms diagonal when possible |
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Therapist manual contacts in PNF
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firm pressure over agonist facilitates agonist
Firm pressure over antagonist inhibits agonist -stimulates sensory receptors, Merkles' disks - creates a static or holding response light touch: -stimulates free nerve endings -facilitates movement -anywhere on dermatome or muscle facilitates Strength is decreased following light touch of skin over antagonist muscle |
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Neutral surfaces for manual contact in PNF
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crown of head
heel side of arm and leg |
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PNF manual contacts in presence of pain
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place contacts away from painful area
touch agonist and antagonist simultaneously Place contacts on trunk for proximal stability and limb movement |
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Contraindications for stretching with PNF
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pain
instability |
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Val
Exercise targets multiple systems! benefits of ex |
Motor/cognitive/emotional/autonomic systems
Prevention of cardio complications arrest of osteoporosis improved cognitive function prevention of depression improved sleep decreased constipation decreased fatigue improved functional motor performance improves immune system |
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Parkinson disease is the only chronic neurodegenerative disease for which there are highly effective _____ ____
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symptomatic therapies (exercise!)
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PD is the most common movement disorder second to ___ ___, and the second most common neurodegenerative disease after _____
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second to essential tremor
after Alzheimer's |
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Pathological hallmark of PD
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loss of pigmented dopaminergic neurons in the SN pars reticularis
50-60% cell death at diagnosis 70-80% loss of DA terminals Proceeds Dx ~5-6 years (brain is amazing - can be 50% reduced and still not symptoms |
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Types of Parkinsonisms
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Primary Idiopathic (IPD?) - 85%
15% familial, 85% sporadic Tremor dominant, postural instability, gait dominant Secondary parkinsonism - 10-12% -metabolic, toxins, trauma, brain tumor, post encephalitic slow virus - vascular 1% - drug induced 7-9% Atypical 3-5% - OPCA ataxia - SDS -Striatonigral degeneration -PSP 1.4% - Parkinsonianism, dementia, ALS -Corticobasilar degeneration |
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Age of onset of PD
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Typical: 52-60
Young: 21-40 Late - 78 |
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Clinical diagnosis of PD
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early motor symptoms 2/3 (bradykinesia, tremor, rigidity)
insidious onset -nonspecific nonmotor and motor early symptoms Asymmetrical distribution |
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Hoehn and Yahr Scale of PD
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Stage 0: no signs
Stage 1: unilateral symptoms only Stage 1.5: unilateral and axial involvement Stage 2: bilateral symptoms, no balance impairment Stage 2.5: mild bilateral disease with recovery on pull test (recover by himself with max of two steps) Stage 3: balance impairment, mild to mod disease, physically independent Stage 4: severe disability, but still able to walk/stand unassisted Stage 5: needing a wheelchair or bedridden unless assisted |
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Common motor symptoms at the time of diagnosis of PD
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bradykinesia
gait hypokinesia resting tremor micrographia hypophonia stooped posture decreased dexterity masked face rigidity |
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Common motor symptoms at the time of referral for PD
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(in addition to those at diagnosis)
Generalized Hypokinesia Akinesia (go problems - start hesitation) Festination (no-go impairment) Freezing episodes (no-go/go impairment) Postural instability Swallowing Adaptive responses (e.g. weakness, contractures, decreased aerobic capacity) |
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Non-motor symptoms of PD
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Depression
-25% major/17% minor -precedes motor symptoms -may contribute to dementia Loss of higher cognitive functions -shifting cognitive set -slow thinking -retrieval -self-cueing -sustaining attention Dementia -30% -occurs 6.6x as frequently than in elderly non-PD -shortens survival Autonomic abnormalities -hypotension, bowel/bladder, sexual, blurry vision, short of breath Sensory Changes -Pain, tingling, burning -loss of smell -generalized decreased kinetic proprioceptive awareness --self-perception/monitoring Sleep Disorders Anxiety |
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Osteoporosis is ____ higher in PD
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Osteoporosis is 20% higher in PD - "that's what'll kill ya"
Men don't get effects until later because they have more bone mass |
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Secondary impairments and complications of PD
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deconditioning
muscle atrophy/weakness osteoporosis (20% higher in PD) Psychological implications Circulatory changes Contractures Respiratory Constipation and GI problems Medication side effects |
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Basic motor circuit through the BG
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Basal ganglia - thalamo-cortico circuit
SMA/MC -> Descending cortical drive for muscle activation is overall underscalled and timing signals are inconsistent W/o dopamine, Basal ganglia -> thalamus = inhibitory Thalamus -input to cortex Bradykinesia, hypokinesia, loss of coordination and fluidity of movement |
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The basal ganglia specializes in the integration of _______ information for
PD |
The basal ganglia specializes in the integration of proprioception information for body awareness and body in space orientation
In PD - poor self monitoring/correction, underscaled perceptions/plans, visual/spatial orientation problems loss of DA = loss of joint/directional sensitivity/specificity |
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What types of drugs can help a person with PD be optimally medicated?
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Optimal medication improves QOL
-drugs that decrease breakdown of dopamine -drugs that mimic dopamine - dopamine agonists - help it do a better job |
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Best candidate for Deep Brain Stimulator
Contraindications |
Best:
Severe motor fluctuations or diskinesia that can't be managed with optimal meds -tremor refractory to meds -intolerance of med <70 years old (STN) -Levadopa responsiveness. Best on = DBS outcome -GPI for older & diskinetic -VIM for tremor and older Contraindications -significant cognitive, psychiatric or medical co-morbidities -atypical parkinsons -significant non-levadopa responsive symptoms (i.e. frieezing, postural instability) Move better with it, but postural instability is the same, so more falling Effects decrease with time Increases QOL, covered by Medicare |
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Aspects of the Exercise 4 Brain Change model
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Prepare:
Motor priming, cognitive strategies, sensory feedback, biochemical priming Activate: High Effort Progressive difficulty Whole body FUNctional training External Cues (visual/auditory/somatosensory) Reflect: Goal achievement Performance Attention to Action Teach accountability (self-monitoring and correction) Reduce vision Motivate: Empower with potential Saliency Promote vigor Group social structure Creativity |
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Aerobic + PD-specific skill learning
Essential components for optimal brain change |
whole body activation
forced-use arm swing cues posture retrains stride length, gait symmetry, and walking speed provides for stretching reduces fear and pain of PD increases endurance |
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Brain change in Parkinson disease in animal models
Preclinical Early/moderate Advanced |
Preclinical - neuroprotection
Early/moderate - neurorepair Advanced - adaptation |
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Evidence about effect of intensive bouts of exercise on people with PD
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Evidence that intensive bouts of exercise reduce the need for medications after 1 year
50% less medication than control group Evidence for neurorepair - intensive aerobic activity + skill acquisition = more D2 receptors! |
