Department of Physiotherapy THE AGA KHAN UNIVERSITY HOSPITAL

1. Department of PhysiotherapyTHE AGA KHAN UNIVERSITY HOSPITAL STAYING FIT! by Dr. MUHAMMAD ARIF ALI Sr. Physical Therapist

2. PROFILE OF PARKINSON'S DISEASE • It is estimated that millions of people all over the world have Parkinson's disease. • Most people are diagnosed in their 50's or 60's, although 10% are classified as "young onset", diagnosed prior to age 40.

3. The etiology (cause) • This chronic neurological disorder remains a mystery • James Parkinson, a London physician, first described the syndrome in 1817 as the "shaking palsy“ Parkinson's disease • Results from a deficiency of dopamine, a neurotransmitter (chemical messenger) produced in the midbrain region called the substantia nigra • Early symptoms are typically unilateral (present only on one side of the body). Both symptoms and rate of progression vary from person to person

4. Signs and symptoms of Parkinson's disease include • Bradykinesia - profound slowness of movement • Resting tremor - shaking, worse on the affected side • Rigidity - marked stiffness, worse on the affected side • Decreased arm swing on the affected side • Problems with walking and balance - may experience a shuffling gait or episodes of "freezing", being unable to initiate a step forward • Micrographia - small, cramped handwriting • Masked face - reduced facial expression • Dysarthria - lower volume or husky quality to the voice • Impaired manual dexterity • Depression, anxiety or other mood disorder • Some people fatigue easily and have increased PD symptoms in response to external stress

5. How physical therapist can help ? • Design an exercise program to meet your particular needs. • Evaluate and treat problems of mobility and walking. • Evaluate and treat joint or muscle pain which interferes with the activities of daily living. • Help with poor balance or frequent falling. • Treat difficulties accomplishing activities of daily living • Recommend and teach the correct use of adaptive equipment.

6. Essential PD rehabilitation components in early and middle stage • Breathing control • Stretching knowledge • Strength training • Aerobic activity • Balance training • Posture correction • Speech and Swallowing Rehab • Role of adaptive and assistive devices

7. Breathing exercises

9. Stretches

10. SEATED NECK ANDCHEST STRETCH

11. SEATED ROTATIONSTRETCH

12. OVERHEAD STRETCH

13. STANDING BACK STRETCH

14. HAMSTRINGSTRETCH

15. LYING SHOULDERSTRETCH

16. SEATED SIDE STRETCH

17. STANDING SHOULDERSTRETCH

18. ROTATION STRETCH

19. CALF STRETCH

20. ANKLE CIRCLES

21. Strengthening Exercises

22. BRIDGING

23. SHOULDER BLADE SQUEEZE

24. SHOULDER BLADE SQUEEZES

25. QUAD STRENGTHENING

26. QUADRAPED TRUNK

27. PRONE ON ELBOWS

28. Aerobic activity

29. Aerobic activity

30. Balance, Falls, and Posture • Balance problems are one of the main symptoms of PD. Another name for balance problems is postural instability. • Balance problems increase the risk of falling, especially when combined with other symptoms and complications of PD, including:

31. Slowness of movement, also called bradykinesia, which causes delayed reaction time. • Stooped posture • Shuffling walk. • Freezing • Falling backwards, also called retropulsion • Quick, short steps forward, festination

32. BALANCE EXERCISES

34. Preventing Falls • DO NOT pivot your body over your feet when turning. Instead try: “U-turn” while walking “U-turn” - Useful for more open areas. Move your feet & body together in an arc...

35. Clock-turn “Clock-turn” Technique - Useful in small areas & for when you are stopped & must turn. Start at 12PM & take 2 slow steps to 3PM, and so on

36. Avoid walking backwards try: • ■ Stepping sideways “Side-step Arc” Technique - Useful in small spaces & as a way to avoid stepping backwards. Take slow side-steps in an arc...

37. Tripods No Avoid tripod or quad canes

38. One point cane Yes A straight cane with a rubber tip is better.

39. Posture • PD can cause many changes in the body. One easily recognizable change is posture. The characteristic changes in posture can include: • A forward head position. • Rounding of the shoulders and upper back. • A forward trunk position with increased bending of the hips and knees.

40. Some typical Poor positions • Sitting on the couch watching TV. • Leaning over to work on the computer. • Driving/riding in the car. • Looking downward while reading, or propping your head against the headboard while reading.

41. Example of poor sitting posture

42. Example of good sitting posture

43. What are Assistive\adaptive aids? • Adaptive aids are items that can help you stay as independent as possible for as long as possible. • These devices can make your daily life easier and safer, and improve your quality of life.

44. Assistive aids • A urinal (available for both men and women), bedpan, or bedside commode can help reduce bathroom trips at night

45. Condom catheters for bladder incontinence for men

46. Bathing and toileting aids

47. Continu…

48. Dressing • Do a few stretching exercises before getting dressed to “warm up” muscles. • Sit down when dressing. • Allow plenty of time for dressings

50. Helpful bedroom aids Helping handle/bed rail