Purpose of Physiotherapy

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Derrick McCarthy
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1 What role does physiotherapy play in the management of PD? Lynn Rochester PhD, Grad Dip Phys Professor of Human Movement Science Purpose of Physiotherapy Protect and preserve function Modify progression of Parkinson s symptoms Repair-restore brain function 1

Physiotherapy Approaches Two approaches 1 are taken Exercise broadly defined as structured activity aimed to increase or maintain physical fitness Compensatory strategies External cueing (auditory,

2 Physiotherapy Approaches Two approaches 1 are taken Exercise broadly defined as structured activity aimed to increase or maintain physical fitness Compensatory strategies External cueing (auditory, visual) and attentional 1,2 1 Rochester, 2011; 2 Nieuwboer, 2008; 33 trials 1518 participants 6 intervention types Short term benefit of physiotherapy Walking speed * Balance * Motor symptoms * All exercise but delivered in a different way to Endurance address specific impairments and disease state 1. General physiotherapy Complex mobility 2. Exercise Activities of daily life 3. Treadmill 4. Cueing 5. Dance 6. Martial arts Unclear Falls Long-term effect Type of physiotherapy 2

3 Improve strength, balance, gait, fitness, falls, motor symptom severity Safe and feasible in long-term with support Specificity of exercise type Optimal Exercise: Combination of exercise types best Dosage? 3

Types of exercise Who delivers it When is it delivered Where is it delivered Domain Strength Aerobic/Endurance Balance and co-ordination Flexibility Examples Weight training Resistance exercise

4 Types of exercise Who delivers it When is it delivered Where is it delivered Domain Strength Aerobic/Endurance Balance and co-ordination Flexibility Examples Weight training Resistance exercise Gardening Computer games Walking terrain, pace Treadmill Bike Walking at pace Swimming Dancing Computer games Home exercises Tai Chi Gardening Dancing Computer games Stretching class Home exercises Yoga Pilates Computer games Barriers People have low expectations of the influence of exercise Lack of time Fear of falling Considerations Targeting self-efficacy may help adherence 4

5 Summary: Exercise Significant benefits for gait (speed and endurance), balance, functional mobility and motor symptom control 1,2,3,4,5 Strength; endurance; balance; general exercise Still no evidence for falls reduction Safe, long term, high intensity - feasible 4,5 Which type of exercise is best? multimodal due to specificity of training 3,4,5 Possible disease modifying effects 6 Activity levels very low 7 - encourage active lifestyle reduce secondary risk factors 1 Tomlinson 2012; 2 Goodwin 2008; 3 Li 2012; 4 Shulman 2012; 5 Corcos 2013; 6 Fischer, 2013; 7 Lord, 2013 Compensatory strategies Improve gait 3,4 Reduce FOG 4,5 Immediate effect on gait characteristics 6,7 Training effect on gait characteristics 1,2,3,4,8 Improve dual-task walking 6,8 1 Rochester, 2011; 2 Nieuwboer, 2008; 3 Tomlinson, 2012; 4 Nieuwboer, 2007; 5 Frazzita, 2009; 6 Rochester 2007; 7 Morris 1996; 8 Rochester

6 Immediate effects: reduced speed, asymmetry Immediate effects: FOG 6

7 Cognitive Motor-Cognitive training Pharmacological approaches targeting cognitive function 1 Cognitive training to improve attention 1 Motor-cognitive training (dance therapy, virtualreality; computer exergames) 1,2,3,4 1 Hindle, 2013; 2 Duncan, 2012; 3 Mirelman, 2013, 4 Barry,

8 PD Kinection 8

9 Professional resources Guideline EU Physiotherapy Guideline Occupational Therapy Reference Keus et al., European Physiotherapy Guideline for Parkinson s disease. (2014) KNGF/ParkinsonNet, the Netherlands ( ccupational-therapy-people-parkinsonsbest-practice-guidelines When to refer for physiotherapy Physiotherapy should start early at diagnosis Early stage advice and encourage community exercise, personal trainers and local groups Later stages - specialist input 9

lifestyle first Exercise is anything that increases your level of activity, take a broad approach Acknowledgements Human Movement Science Team: Lynn Rochester Sue Lord

10 What to tell your patient! Take medication to optimise mobility/exercise Exercise and compensatory strategies are beneficial to manage impairments and reduce symptom severity Aim for an active lifestyle first Exercise is anything that increases your level of activity, take a broad approach Acknowledgements Human Movement Science Team: Lynn Rochester Sue Lord Brook Galna Alan Godfrey Dadirayi Mhiripiri Carol Shields Silvia Del-Din Lisa Alcock Gillian Barry Sam Stuart Rosie Morris Lisa Robinson Katherine Baker Elizabeth Hill ICICLE Team: David Burn Alison Yarnall UK NIHR Biomedical Research Unit for Lewy Body Dementia award to the Newcastle upon Tyne Hospitals NHS Foundation Trust 10

PD ExpertBriefing: The Effects of Exercise on PD

PD ExpertBriefing: The Effects of Exercise on PD Led By: Margaret Schenkman, P.T., Ph.D., F.A.P.T.A. Associate Dean for Physical Therapy Education, and Director, Physical Therapy Program, University of