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Interventions for Individuals with Parkinson’s Disease

Interventions for Individuals with Parkinson’s Disease

Parkinson’s disease is a progressive neurodegenerative disorder that is characterized by bradykinesia, tremors, postural instability, and/or muscle rigidity.  Physical therapy interventions are often aimed at addressing these motor impairments. Recent research has highlighted the importance of programs addressing cognition in addition to the physical symptoms. High intensity aerobic exercise, forced cycling and exercises involving cognitive engagement (feedback, cueing and dual tasking) and random practice (change tempo, activity or direction) have been suggested to increase motor control and cognitive function.1,2  ACP offers several interventions to provide properly-dosed exercises in this patient population.

 

Omnicycle®:

  1. Provide therapeutically dosed aerobic exercise – Refer to AEAA course manual
  2. Consider high intensity intervals
  3. Consider varying direction and speed randomly throughout treatment
  4. Provide forced speed cycling vs. self-selected speed for greater motor improvement (80-90 revolutions/minute is recommended3)
  5. Use the biofeedback activities such as Soccer, Porcupine or Traffic Jam to provide visual and auditory feedback, vary tempo, and provide a dual task challenge.

 omnicycle picture.jpg

Virtual Reality via OmniVR®:

  1. Vary range of motion options in program settings to practice greater amplitude movements (i.e. UE puzzle,  Puzzle, Fox)
  2. Vary speed with gait (Fox, Wolf, Stroll)
  3. Practice multi-directional movement (Mole, Flower Garden, Vegetable garden)
  4. Vary the activity frequently with different difficulty levels and provide visual and auditory feedback as well as results and performance feedback.
  5. Engage posture by varying support – remove armrests, get individual away from the back of the chair, change support surface (firm, foam, balance ball/platform, etc.)

 VR picture.jpg

Omnistim® FX2 Patterned Electrical Neuromuscular Stimulation (PENS):

  1. Use PENS UE and LE triphasic patterns to facilitate extremity and trunk exercise targeting muscle strength and coordination.   Apply during goal task activity when feasible.
  2. Use PENS functional cycle or walk program to provide input to the CNS for gait initiation, symmetry, and flow.  Vary between slow and fast walk/cycle options as clinically indicated.

 FX2 picture.jpg

References:

  1. Petzinger G, Fisher B, McEwan S, Beeler J, Walsh J, Jakowec M.  Exercise-enhanced Neuroplasticity Targeting Motor and Cognitive Circuitry in Parkinson’s Disease. Lancet Neurology 2103, July;12(7); 716-726.
  2. Exercise and Physical Therapy/Parkinson’s Disease Clinic and Research Center, http://pdcenter.neurology.ucsf.edu/patients-guide/exercise-and-physical-therapy
  3. Ridgel A, Vitek J. Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson’s Disease Patients. Neurorehabilitation and Neural Repair 2009; 23(6); 600-608.

 

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