Physiotherapy Management in Parkinson's Conditions

MODULE 2 Physiotherapy Management in Parkinson's Conditions There are functional walking disorders due to rigidity, loss of postural impaired coordination related to Parkinson's disease reflexes and 1. Physiotherapy Program a) Short Term Goals 1) Improve balance 2) Improved postural control (weight bearings) b) Long Term Goals The patient can walk and travel independently 2. Physiotherapy Intervention a. Maintenance of joint range of motion (LGS) The decrease in LGS in patients is minimized by providing static muscle stretching (by a physiotherapist) in muscle groups that experience tension, especially in the flexor, adductor and internal rotator muscle groups. b. Improving the quality of voluntary movement Rigidity can reduce the quality of voluntary movement, to improve the quality of movement, patients can be given bufferrhythmic initiation,rocking exercise, stretching extensor muscles, and administrationrhythmic movement. c. Maintenance and enhancement of thoracic expansion Thoracic expansion can be increased by providing trunk rotation exercises,deep breathing,and physical exercise to improve cardiovascular function. d. Postural maintenance and improvement The patient's postural control correctionAndequilibrium training. can be improved by administrationpostural e. Improves functional mobility In improving patients need to be trained so they can carry out daily activities and mobility. Increasing functional mobility can be done in the following ways: 1) Actively train the patient's trunk rotation. 2) Teaches the beginning of functional movements and improves motor coordination. 3) Training activitiesrollingAndsitting upin bed, getting up from sitting to standing, standing, and walking. 4) Increase muscle strength, especially the extensors of the trunk, shoulders (adductors), and lower extremities to help improve posture and improve balance. 5) Practice walking by paying attention to the initiation of movement,stride length, speed of walking, stopping, and turning/changing direction. 6) Train your step height (step height), to reduce the risk of falls 7) Providing walking training with cues and music to enable them to walk rhythmically, paying attention to trunk rotation and arm swings. 8) Train oral & facial movement skills (on symptomsface masks). A. Equipment Required 1. Mattress 2. Bed Treatment 3. Weights (Dumbells/Barbells) 4. Towel B. Practical Activities a. Lower extremity stretching 1. Preparation - Patient position: Supine lying - Therapist position: standing next to the patient - The therapist provides stretching to the patient, starting from stretching the lumbar region, trunk rotation, M.quadriceps, M.hamstring, M.tibialis anterior, and triceps surae. - Each stretch is held for 8 counts with repetition 3 times. b. Bridging exercise Method : Active exercise Dose SOUP : 2 times a week, 8x repetitions 1. Preparation - Patient position: Supine lying - Therapist position: standing next to the patient 2. Implementation - The therapist helps position the patient's legs in preparation for bridging. - The patient is asked to lift the pelvis straight and is asked to hold that position for a count of 3. - Bridging is done 8 repetitions c. Diagonal moving cone Objective : Improves movement coordination and balance method : Active exercise Dose : 2 times a week, 2 sets : 1. Preparation - Patient position: standing straight with both feet together - Therapist position: standing behind the patient, keeping the patient from falling 2. Implementation - The patient is asked to link both hands (like praying) then take 5 cones on the floor to the patient's left. - The cone is moved diagonally, to the table or assistant (position parallel to the patient's shoulder) which is on the patient's right side (diagonal). - The patient's target movement is head and trunk rotation when picking up and putting down the cone. - Exercise is done 2 times for each right & left side. - Exercise variation 1: 1 patient's leg stands up straight and the other leg is on the block. - Exercise variation 2: the patient moves the cone slowly while walking on the block. d. Practice walking across the Goal cone : Strengthening the iliopsoas muscle, increasingstride length, Andtrain weight bearing control. Method : Active exercise Dose : 2 times a week, 2 repetitions. 1. Preparation - Patient position: standing, preparing to walk - Physiotherapy places 6 cones (25cm high) in a straight line, with a distance of 30 cm for each cone - Therapist position: standing behind the patient, keeping the patient from falling 2. Implementation - The patient is asked to walk with high steps until they pass the top of the cone. e. Postural Control Direct Objective: improves postural stabilization, balance, andweightbearings. Method : Active exercise Dose : 2 times a week : 1. Preparation: - The patient is put on a harness which is connected by cubing (rubber) to the framePostural Control Direct (PCD) - Patient position: standing, preparing to walk - Therapist position: standing next to the patient, keeping the patient from falling 2. Implementation - The patient is asked to step forward 1.5 meters from the original position - The patient is asked to take 4 steps to the right, and vice versa - This exercise is done 2-3 times - Exercise variations: Physiotherapy places 6 cones on the board, the patient takes the cones from the right side then moves them to the upper left side (diagonal). f. Throw and catch the ball on the trampoline Goal: Improve anticipatory reflexes, balance and coordinationmotion. Method: Active exercise Dosage : 1 time a week, 10 repetitions, 3 sets. SOUP 1. Preparation - Patient position: standing on the trampoline - Therapist position: standing next to the patient, keeping the patient from falling - The physiotherapist assistant prepares to throw a basketball from a distance of 1.5 meters in front of the patient 2. Implementation - The assistant bounces the ball towards the patient - The patient receives the bounce of the ball from the physiotherapist assistant and bounces it back. g. Passing the ball with head & trunk rotation Method: Active exercise Dose : 1 time a week, 10 repetitions, 3 sets. 1. Preparation - Patient position: standing with feet shoulder-width apart - Therapist position: standing behind the patient, keeping the patient from falling - 2 physiotherapist assistants stand parallel to the patient at a distance of 2 meters to the right and left of the patient, facing the patient. 2. Implementation - The two assistants take turns throwing the basketball, while the patient's position when catching remains in place. - This drill targets basketball passing with head and trunk rotation. - The patient receives the ball bounce from the physiotherapist assistant and bounces it back alternately to the right and left side.