Summary phys.theory:PD intro+balance en gait assessment

Phys.theory: PD: intro+ assessment of gait & balance
INTRODUCTION
 Parkinson’s disease ≠ Parkinsonism
- Parkinsonism= umbrella term
 Symptomen gerelateerd aa PD
 Niet ziekte zelf
 Ook atypical symptoms/ aand.
 PSP means?
- Progressive supranuclear palsy
- Parkinson plus syndrome
 MSA means?
- Multiple system atrofie
- Parkinson plus syndrome
 Camptocormia means?
- Kunnen niet rechtzitten tegen Fz
- ≠stooped position
- flexed stooped posture, bend over position of the trunk
-> postural deficit that effects functioning
 Pisa syndrome means?
- ZW inclinatie
- lean to one side, type of camptocormia
 MMSE means?
- Mini mental state examination
- Cogn screening test
 <24 = kan op dementie aanwezigheid
 Largest barriers for rehab in PD?
- Motor learning deficits
- Motor symptoms
- no automaticity


PD-SAFE: FALL PREVENTION PROGRAM
 multiple center randomized controlled trail of PDSAFE, a physiotherapist delivered fall prevention programme for
people with parkinson’s (Seymour et al)
- hierop gebasseerd
 Concentrate on understanding the general framework for clinical reasoning in PD, i.e for problem analysis and
designing progressive exercise → for the trainable components that are contributing to the problems identified.
Not only relevant for fall prevention but also for other problems in PD. PROGRESSION!
 There is the document Draaiboek or Course contents which gives instructions on how to negotiate through the
course. -> guideline to go through the PD-safe document
 How
- STEP 1. Assessment (i.e. balance, cognition, strength, …)
- STEP 2. Identify most likely strategy to address the cause of falling episodes (e.g. tripping or freezing)
- STEP 3. Identify the modifiable risk factors (e.g. reduced muscle strength)
- STEP 4. Set up training strategy
 Exercises to improve risk factors
 Select corresponding category
 Implement progression and variation

1. Why PDSAFE included in this course?
 PD= fallin disease
 Early stage PD
- Op moment diagnose krijgen gaan al veel gevallen zijn
- Axial disease
 Primaire outcomes (tabel1) Baseline
- Val=4.5 en na 6-12M=2.7
- Controle heeft ook ↓
- Geen sign verschil (p=08824)

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, Phys.theory: PD: intro+ assessment of gait & balance
 Near fall rates wel sign ≠ (o=0.001)
- Kunnen zich nog tegenhouden aan object




 A unidimensional model, which only targets an individual risk factor for falls à Not effective
 A multidemensional and individually tailored training model for improving body function and structure in a task-
specific manner that is aimed at multiple modifyable risk factors for falls is necessary
 This training should be done in a variety of contexts
- Variatie in training
 Transfer naar ADL
 Model is applicable for other symptoms also

2. Target population




 fig forest plotwie meer vallen
- cogn. Impairment (MOCA)
- freezing of gait
- UPDRS




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, Phys.theory: PD: intro+ assessment of gait & balance
3. Key ingredients of PDSAFE
3.1. Warm-up
 Hand-outs
 Daily exercises, building self-confidence à 5-6 minutes
 6 exercises:
- Marching,
- Turning of the trunk,
- Sidebending trunk,
- ankle mobilisation,
- dynamic hamstrings stretches,
- elongation/stretching of the trunk
 Sitting or in stance
- Zitten= bij zeer slechte balans
 Dynamic (patients should learn to correct themselves)

3.2. Balance exercises
 hand-outs
 4 static balance exercises to choose from
 6 dynamic walking exercises
 Make sure that the level is adapted to the patients abilities.
- 6/7 levels beschikbaar
 Repetition & progression/regression!

3.3. Strengthening exercises
 hand-outs
 4 exercises à Select most appropriate level
 5-10 repetitions, 3 sets
 Make sure the quality of movement is preserved
 Weighted vest to use in advanced levels

3.4. Task oriented movement and strategy training
 Adapt to patient
 Is oriented at the activity and participation level of ICF.
 Make the exercises task oriented:
- making cup of tea;
- putting on pants, socks, shoes
- getting in and out of the car with groceries
- lying on the floor, crawling around, and getting back up
 eens gevallen moeten wij ze leren terug recht te geraken




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