How to Stick to Your Home Exercise Program

If you’ve been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you’ll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they’re important, adherence to home exercise programs is terrible. It’s estimated that only 40 to 50% of patients do their exercises the way they’re supposed to. What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.

Plan ahead

Think about what’s going to get in your way – your schedule, that you’ll forget, or that you don’t have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they’re no longer problems.

Address pain and beliefs

You’ll need to work with your PT on these. If your exercises cause pain, you’re not going to do them. When your PT prescribes your exercises, try them out. If there’s pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won’t help, or that they’re a waste of time, you won’t do them. Again, work with your PT to understand why they’re prescribing those exercises, and what they’re meant to do. Once you know why you’re doing those exercises, you’re more likely to do them.

Get support

People who have a buddy or social system are more likely to do their exercises. This is why group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you’re doing your exercises, and how they’re going. This will keep you accountable and more likely to do them.

Use Technology

If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you’ve exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.

Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you’re one of the 50% of the people who do their home exercises consistently to get the best outcomes.

References:

https://pubmed.ncbi.nlm.nih.gov/32669487/

https://www.physio-pedia.com/Adherence_to_Home_Exercise_Program

If You Like a Good Bargain, You’re Going to LOVE Physical Therapy

It’s no secret that prices have been going up. Gas is expensive. Food is expensive. The housing market is crazy. If you’re looking for ways to pinch some pennies or stretch your dollars, physical therapy might be just what you’re looking for.

Physical Therapy Saves Cost

A study that looked at the claims data of 472,000 Medicare beneficiaries with back pain found that when PT was the first treatment, costs were 19% lower than when people got injections first and 75% lower than for people who were sent straight to surgery. The study also found that in the year following diagnosis, people who got PT first had costs 18% lower than those who got injections, and 54% lower than those in the surgery group.

Another example happened in 2006 when Virginia Mason Health Center in Seattle teamed up with Aetna and Starbucks. They sent workers with back pain to see both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work, and were more satisfied with their care. The cost savings were so great that Virgina Mason was losing money on treating back pain, so Aetna ended up paying them more for PT treatments because they were saving so much money.

Physical Therapy First Means Fewer Visits…

A paper published in Physical Therapy looked at outcomes when patients went to a PT first vs. seeing a physician first for back pain. It found that patients who went to their physician first needed 33 PT visits on average, while those who went to their PT first only needed 20. Seeing a PT first saves money, but it also saves time.

It Also Means Better Outcomes

A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit.

High-quality research consistently shows that taking advantage of direct access and getting to your physical therapist quickly leads to better outcomes in fewer visits with lower costs. We think that’s a deal worth taking advantage of.

 

 

 

References
  1. https://ww1.prweb.com/prfiles/2010/11/03/4743604/0_ANovelPlanHelpsHospitalWeanItselfOffOfPriceyTests.pdf
  2. https://pubmed.ncbi.nlm.nih.gov/33245117/
  3. https://www.apta.org/news/2017/07/26/study-says-cost-savings-of-physical-therapy-for-lbp-are-significant#:~:text=Researchers%20say%20that%20not%20only,over%20treatments%20that%20begin%20with
  4. https://academic.oup.com/ptj/article/77/1/10/2633027?login=true
  5. https://newsroom.uw.edu/news/early-physical-therapy-benefits-low-back-pain-patients

Why Isn’t Postpartum Physical Therapy Standard Practice? It Should Be

Now imagine you are told all this pain, leakage, and weakness is a “normal” part of your postpartum journey. It can be isolating and scary, and leave you with more questions than answers.

Most women (and men!) hardly know what their pelvic floor does, let alone feel comfortable talking about it. But it is a vital part of our function, supporting our bowels, bladder, and sexual activity. And it is especially crucial during the “fourth trimester” immediately following childbirth, which is where the system often fails new moms.

This is when physical therapy can have a strong impact — during a time of healing, hormonal shifts, and altered body mechanics when new mothers might be particularly vulnerable. Pelvic health physical therapy during that fourth trimester can empower them with the skills they need to feel confident and protected. Physical therapists can offer guidance on when to return to therapy should their problems persist. We can give them the same care and support they had during their pregnancy.

Our goal has been to have a more open conversation surrounding pelvic health, to destigmatize the topic, and empower women on their postpartum journey.

In our own journey to help healing mothers, we facilitated a program at our hospital to see new moms during their inpatient postpartum stay. After all, most patients who have had simple abdominal surgery automatically are referred for physical therapy; why not new moms? Postpartum care is not just important, it is crucial.

Typically, new moms stay between two to three days postpartum, and we see them the day or two after delivery. We are pelvic floor physical therapists who work in an outpatient center attached to the hospital, so we are able to bounce back and forth easily. In our current program, we have two-to-three hours reserved during different times of the week to see these patients. Most often we see patients who had cesarean deliveries, experienced more severe perineal tears, or who have given birth to multiples.

We start by chart reviewing all new mothers, with attention to medical history and their birth notes to see if there was any trauma or labor complications. When we first started the program, we next would call the resident obstetrician for verbal orders to see our patients. After a few months of building a good rapport with the physicians and registered nurses, we have been fortunate enough to receive standing orders for our patients, only calling the obstetrics team with complex patients. As any inpatient physical therapist knows, the nurses are invaluable. We talk to them prior to seeing patients, gathering important information about the patient’s pain and activity levels, and gaining some insight into their healing journey since delivery.

Our sessions differ a little bit from traditional mobility inpatient physical therapy. We go in expecting to talk to them about their bowels, bladder, and body mechanics since most are ambulating independently. For our subjective examination, we ask about past deliveries and current pain levels. We also discuss voiding and bowel movements, asking about issues such as straining, pain, and incomplete emptying. Our mothers who have had a cesarean delivery, in particular, listen up at this and tell us if they have been worried about having a bowel movement or if doing so has been painful.

For the objective exam, we perform a general movement assessment, including bed mobility, transfers, standing activities, and gait. Adding the pelvic floor to that, we look at quality of breathing, transverse abdominis recruitment, and pelvic floor muscle recruitment.

Patients often are used to using accessory muscles to breathe during pregnancy, because the organs shift in the abdomen as the baby grows, causing the diaphragm to compromise on its own movement pattern. To address this, we start teaching them gentle diaphragmatic breathing. We talk to them about the importance of managing pain, cramps, and scar tissue as well as helping them to void and have a bowel movement without straining. In some cases, new moms have difficulty voiding after delivery, and addressing diaphragmatic breathing and toileting posture has helped those patients avoid having to use a catheter.

These discussions lead into the topic of intra-abdominal pressure, and we have found that some patients tend to perform the Valsalva maneuver with movement. In most cases, we can easily manage the increased pain that comes with holding their breath and “bracing” during movement by using breathing techniques. We discuss exhaling and contracting the pelvic floor or transverse abdominis (as long as it is pain-free) with functional mobility. Teaching them to breathe more effectively and efficiently has been beneficial to their pain management.

Along the same lines, we also discuss the benefits of abdominal binders to support healing in the abdomen and help with diastasis. We teach them how to don and doff the device, and how and when to wear it. We remind our patients that abdominal binders are not “waist trainers” or shapewear meant to help them “get their figure back,” as those would interfere with the breathing exercises we’ve taught them, impede their core strength recovery, and could even cause harm.

Does this seem like information overload for someone already overwhelmed by new motherhood? We give all patients a postpartum packet that discusses everything we have taught them. The packet also contains information on body mechanics for holding and carrying a baby, indications that they should follow up in outpatient physical therapy for pelvic health, and the clinic phone number if they have questions. Patients get a lot of information during their stay, and our hope is that having it all written out will give them better retention and confidence when they return home.

In the time we have been doing this program, we have had some growing pains, but we are constantly changing to meet the needs of this patient population. We are incredibly proud of the service we are providing to these postpartum mothers, we appreciate the support of the obstetrics team, and we hope this will become a more common practice in all hospitals.

____________________________________________

source: apta

Date: Monday, May 9, 2022
Perspective Authors: Jessica Enge, PT, DPT, and Elizabeth Farmer, PT, DPT

Physical Therapy Guide to Diastasis Rectus Abdominis

Diastasis rectus abdominis is a separation of the left and right sides of the outermost abdominal (stomach) muscle. It is caused by forces that stretch the connective tissue called the linea alba. This condition most often occurs in pregnancy, but also may occur in infants, older women, and men. Physical therapists help adults with DRA manage their symptoms, improve their strength and stamina, and safely return to their regular activities. DRA is fairly common in infancy. For babies with DRA care and monitoring is provided by a pediatrician.

 

What Is Diastasis Rectus Abdominis?

The most common cause of DRA is pregnancy. As the fetus grows, the uterus expands and increases pressure against the stomach wall. This pressure causes the connective tissue to widen, increasing space between the right and left sides of the muscle. It may be noticed during or after pregnancy. Typically, DRA develops during the second or third trimester when the fetus grows most rapidly. DRA often resolves on its own during the first three months after the birth (postpartum). Other potential causes for DRA include:

  • Frequent or rapid changes in weight.
  • Stomach obesity.
  • Genetics.
  • Poor training technique or overloading the stomach wall during heavy lifting activities.

Infants commonly are born with a DRA that resolves over time without treatment. Pediatric doctors may monitor infants for the development of an umbilical hernia.

Several factors may make a person more prone to developing DRA. These include age, being pregnant with multiple children, and having had many pregnancies. The stomach muscles have many important functions within the body. These muscles aid in postural support, movement, breathing, and protection of the internal organs. For some people, a DRA may:

  • Persist after pregnancy.
  • Change the appearance of the stomach muscles.
  • Result in reduced muscle strength.

For someone juggling the normal stresses of a new baby, discomfort, weakness, and changes to postural control, the added muscle weakness from a DRA may impact quality of life.

How Does It Feel?

Separated stomach muscles are usually painless and often have no symptoms. Some people, however, report problems that may be related to DRA that can include:

  • Appearance.
  • Discomfort.
  • Difficulty doing certain activities.

A person with DRA may experience any of the following symptoms:

  • A separation of the rectus abdominis muscle that is visible and felt by touching the stomach.
  • Feelings of “flabbiness” in the stomach muscles.
  • Low back, pelvic, or hip pain.
  • Poor trunk posture.
  • Feeling weak through the midsection.
  • Doming or tenting of the middle of the stomach. This can occur during activities such as lifting, rolling over in bed, or certain exercises.

How Is It Diagnosed?

Your physical therapist will review your medical history and conduct a thorough interview. For women, this may include specific questions about:

  • Pregnancies.
  • Labor and delivery history.
  • Type of delivery (cesarean or vaginal).
  • Pain.
  • Activities that make your symptoms better or worse.
  • History of abdominal organ illness or surgeries.
  • Types and level of physical demands at work, home, and sport.

Your physical therapist also will ask you when your symptoms began and how they impact your daily life.

They will gently feel your stomach muscle (palpate) to find if it has separated. Your physical therapist also will assess factors that can influence your strength, mobility, and endurance. These factors can include your:

  • Posture.
  • Breathing.
  • Flexibility.
  • Overall muscle strength.
  • Movement patterns during certain activities.

How Can a Physical Therapist Help?

Physical therapy is a very effective way to manage the symptoms of DRA. It can improve your strength and stamina so you can return to normal activities. Your physical therapist may help you with:

Education. Your physical therapist can identify which movements or activities to modify or avoid as you recover. They will help you safely progress your activities as you heal. Your physical therapist will teach you safe and effective ways to regain your full function, so you can return to the activities that you enjoy.

Postural training. Learning to engage the deep core muscles through posture and breathing is one of the most important parts of treatment for people with DRA. This involves posture training and breathing to activate your deep core muscles as a unit. Postural training will focus on the:

  • Transverse abdominis muscles.
  • Diaphragm.
  • Low back muscles.
  • Pelvic floor muscles.

Your physical therapist will show you ways to do daily activities, such as lifting and carrying a baby or other objects. These methods will help to strengthen and reduce pressure on your stomach muscles

Exercise training. There are four layers of stomach muscles, and all are important in DRA rehabilitation. These muscles are the:

  • Transverse abdominis.
  • Internal and external obliques.
  • Rectus abdominis.

A physical therapist can teach you the right type and intensity of exercises for your condition and goals. They can help you progress through them as you get stronger. Your physical therapist can address muscle imbalances. They also can show you stretches and diaphragm releases to help restore normal breathing patterns.

Bracing. Taping or braces for the abdominal region can provide support for some women with DRA during pregnancy. Your physical therapist also may recommend the use of support in the early phases of recovery. Support garments put the abdominal muscles in a more normal position. The tape or brace may remind you to safely use your core muscles during activities that increase pressure on the stomach. A brace or tape does not make your muscles weaker. Physical therapists treating pregnant women can make sure a support brace or garment is right for use during pregnancy.

Electrical muscle stimulation. This treatment may be used by a physical therapist to reduce DRA. It is used after pregnancy and in other adult populations. Electrical muscle stimulation gently activates the rectus abdominis muscle. It has been shown to improve function and reduce the amount of separation.

Can This Injury or Condition Be Prevented?

DRA is a natural consequence of pregnancy. In most cases it resolves on its own and does not impair function. Studies show that starting a program to stabilize the core and pelvic-floor muscles in early pregnancy is highly effective. It can improve function and help you manage the pressure that may worsen a DRA during and after pregnancy. A physical therapist can help women learn safe and effective exercise strategies to improve their:

  • Pregnancy.
  • Labor.
  • Delivery.
  • Experience after giving birth.

Physical therapy strategies to manage abdominal pressure during work activities and a personalized program of safe, progressive exercise also are effective for men and women with non-pregnancy-related DRA. If you develop DRA, the earlier you see a physical therapist, the faster you will be able to return to the activities you enjoy.

 

source: www.choosept.com

 

Constipation Blues: Abdominal Massage for Constipation


by: Kennan Wyne, PT, DPT
Women’s Health Specialist

Constipation is obviously uncomfortable, but did you know it can lead to health issues like fecal impaction, colon cancer, digestive problems, and pelvic floor issues.

Constipation occurs when the colon absorbs too much water, or when the colon’s muscle contraction is slow or sluggish delaying transit time. The result is a hard and dry stool, which can lead to straining and the inability to release your movement with ease. So, trying to avoid the pain and discomfort caused by constipation should be high on your prevention checklist.

The colon is oriented in your abdomen in an upside-down “U” shape, as shown in the picture below. Performing massage to the abdominal area is an effective and easy way to help relieve constipation, and is safe to perform daily!

To begin, I recommend applying 10 minutes of heat to your abdomen (optional) before massaging your abdomen. Then start massaging 10 times in each direction with firm pressure.

I. Start in the center of abdomen at your navel and perform small circular motion in clockwise direction (10 circles total).

II. Next, place hands at right hip bone and perform 10 small circles in clockwise direction then move up working towards the right ribs. Spend more time massaging areas of blockage, tightness, hardness, pain, cramping, or tenderness.

III. Next, when you reach the right ribs perform 10 small circles in clockwise direction then move across working towards the left ribs.

IV. Last, when you reach left ribs perform 10 small circles in clockwise direction then move down working towards left hip.

Perform these techniques 1-2x daily as needed.

New Study Examines Impulse Control, REM sleep and Dopamine

Impulse control behaviors (ICBs) affect between 14% and 40% of people with Parkinson’s disease (PD). Examples of ICB’s include compulsive gambling or shopping, hoarding and hypersexuality. ICBs become impulse control disorders (ICD) when they impair one’s ability to function at work, home and navigate day-to-day life. Only 2% of people have ICBs in the general population.

Why the dramatic disparity? It has to do with the gold standard medication for PD: Dopamine replacement therapy, such as L-dopa, as well as dopamine agonists, such as Requip (ropinirole), Mirapex (pramipexole) and Neupro (rotigotine), are all strongly linked to experiencing ICBs. This is because dopamine, in addition to relaying messages that plan and control body movement, also plays a primary role in the reward pathway in our brains ― in other words, it makes us feel good, even elated.

Since ICBs are commonly experienced as highly pleasurable ― and even anxiety-relieving ― people with ICBs may go to great lengths to hide their compulsions from friends, family and their healthcare professionals. Unfortunately, all too often, this concealment results in detrimental personal and financial consequences. There is a need to better understand the Parkinson’s-ICB connection.

A large, three-year, prospective, multi-center study published in Neurology titled, “Impulse control disorders in Parkinson disease and RBD: A longitudinal study of severity” (Baig et al., 2019) sought to address four key questions:

  1. What is the distribution and severity of PD-ICBs?
  2. How does this vary over time?
  3. How common are Parkinson’s ICBs?
  4. Which clinical factors are associated with PD-ICBs?

In this study, otherwise healthy people with ICBs were compared with those who had PD and a REM sleep behavior disorder (RBD). Why was REM chosen? Previous studies have suggested that the presence of RBDs may infer a higher risk of developing PD-ICD. However, it is not known whether RBD itself, or whether a particular RBD-PD subtype, increases that risk.

There were 932 PD participants in the study. Due to factors such as withdrawal and deaths, 531 completed the study. Those with RBD (and the control arm) were clinically screened for ICBs using the Questionnaire for Impulsivity in Parkinson’s Disease. Those who were ICB-positive were then invited to participate in a semi-structured interview, that was repeated every 18 months. Clinical assessments were performed with a variety of tools to assess a broad range of motor and non-motor symptoms at each visit. The severity of the ICB was assessed with the Parkinson’s Impulse Control Scale, and ICB prevalence and associations were mathematically calculated.

Results

  • Impulse control behaviors were common in the early stages of PD (19.1% prevalence).
  • There were no increased risks for having ICBs associated age, sex, cognition, sleep disorders or marital status.
  • The incidence of depression was higher among participants with PD with ICD than those without.
  • There was significant variation in the severity (both the impact and intensity) of PD-ICB – fluctuating within a relatively short period of time.
  • Internal factors (mood and coping mechanisms) impacted the severity of PD-related Impulse control behaviors.
  • External factors (major life events and social support) also impacted the severity of the PD-ICBs.

What Does This Mean?

This study found that ICBs are common in the early stages of PD, with a larger proportion of this population having symptoms of ICD, but not enough for the behavior to be designated a disorder. While scientists have known for over a decade that dopamine-related drugs could be linked to ICDs in some people with PD, it wasn’t until 2004 that people living with Parkinson’s began to learn that ICDs could be a rare side effect of dopamine agonists.

Thus, dopamine dosage changes may need to be considered, when ICB or ICD behaviors appear to be present. Lastly, people with PD, and their care partners, need to be aware that internal (mood and coping mechanisms) and external factors (major life events and social support) were found to be contributing causes for progressing from an impulse-control behavior problem to a disorder.

Learn More

Learn more about Parkinson’s and impulse control issues in the following Parkinson’s Foundation resources or by calling our free Helpline at 1-800-4PD-INFO (473-4636):

References

Baig, F., Kelly, M. J., Lawton, M. A., Ruffmann, C., Rolinski, M., Klein, J. C., . . . Hu, M. T. (2019). Impulse control disorders in Parkinson disease and RBD: A longitudinal study of severity. Neurology, 93(7), e675-e687. doi:10.1212/WNL.0000000000007942

Barone, D. A., & Henchcliffe, C. (2018). Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clin Neurophysiol, 129(8), 1551-1564. doi:10.1016/j.clinph.2018.05.003

Fantini, M. L., Figorilli, M., Arnulf, I., Zibetti, M., Pereira, B., Beudin, P., . . . Durif, F. (2018). Sleep and REM sleep behaviour disorder in Parkinson’s disease with impulse control disorder. J Neurol Neurosurg Psychiatry, 89(3), 305-310. doi:10.1136/jnnp-2017-316576

Figorilli, M., Congiu, P., Lecca, R., Gioi, G., Frau, R., & Puligheddu, M. (2018). Sleep in Parkinson’s Disease with Impulse Control Disorder. Curr Neurol Neurosci Rep, 18(10), 68. doi:10.1007/s11910-018-0875-x

For more insights on this topic, listen to our podcast episode “Clinical Issues Behind Impulse Control Disorders.”

Why Physical Therapy Should Be Your Top Priority: At Least For the Moment.

Ensuring you have an accessible, customized, and engaging physical therapy experience from start to finish will get you on your road to recovery.  However, we also need you to make physical therapy a priority for a short period of time (in most cases).

Before Your Visit

Avoid Roadblocks. Once you are prescribed physical therapy, it’s important that you don’t run into any roadblocks during the appointment-making process because your physical therapy will be a series of visits.  So decide what’s important right now, and say no to extra obligations.

Make a list of any questions you have and want to ask your physical therapist.

Write down any symptoms you’ve been having and for how long. If you have more than one area of symptoms, begin with the one that bothers you the most. Describe whether your pain or symptoms are:

  • Better or worse with specific movements, activities, or positions such as sitting or standing.
  • More noticeable at certain times of the day.
  • Relieved or made worse by resting or a specific task or activity.

Write down key information about your medical history, even if it seems unrelated. For example:

  • List all prescribed and over-the-counter medicines you take or have taken within the last month. Don’t forget to include any vitamins and supplements you take.
  • Make a note of any relevant personal information. Include things that you believe might be linked to your condition, such as:
    • Recent stressful events.
    • Injuries.
    • Incidents or accidents.
    • Your home or work environment.
    • List any medical conditions of your parents or siblings.

Ask a family member or trusted friend to go with you to your appointment. They can help you remember details from your health history and take notes to help you remember what was discussed during your visit.

If you wear glasses or use a hearing aid, take them with you. Tell your physical therapist and clinic staff if you have a hard time seeing or hearing.

Take any lab, imaging, or reports from other health care providers with you that are related to your medical history or current condition.

Bring a list of your doctors and other health care providers. Your physical therapist can discuss their findings and your progress with them. Physical therapists partner with other health care providers to ensure you get the best possible care.

When you make your appointment, ask whether you should wear or bring a certain type of clothing for your first visit. Don’t wear clothing that doesn’t stretch. Your physical therapist may have you take part in treatment activities during your first session.

Financial Considerations

  • Carefully review the clinic’s financial policy. If you do not receive it at your first appointment, ask for a copy. If anything is unclear, ask questions or ask for someone to explain the policy to you before starting treatment.
  • The physical therapy clinic will ask you to sign the financial agreement. Read it carefully and ask questions if anything is unclear.
  • The clinic staff will request payment of any deductibles and copayments before or after each visit. Paying these at the time of service will help you better manage health care costs and avoid a large bill after treatment ends.
  • If you need to change how often you have physical therapy for financial reasons, discuss this with your physical therapist. They can explore options and develop a workable plan to help you get the care you need.
  • If you change or lose your insurance coverage, be sure to inform your physical therapist and the clinic’s front office staff.

What To Expect During Your First Visit

Your physical therapist will begin by asking you lots of questions about your health. These will include specific questions about your condition and any symptoms that led you to see them. The details you give will help your physical therapist assess whether you are likely to benefit from physical therapy. It also will help them choose the treatments that are most likely to help you.

Your physical therapist also will ask you specific questions about your home or work setting, your health habits and activity level, and your leisure and sports interests. Their goal is to help you become as active and independent as possible and return to the activities you enjoy.

Your physical therapist will perform a detailed exam. Depending on your symptoms and condition, your physical therapist may evaluate your:

  • Strength.
  • Flexibility.
  • Balance.
  • Coordination.
  • Posture.
  • Blood pressure.
  • Heart and respiration rates.

A physical therapist using manual therapy on a patient's leg.

Your physical therapist may use their hands to examine or feel on or around the area of concern. They also will assess the motion and function of your joints, muscles, and other tissues.

Your physical therapist also may check:

  • How you walk (your gait).
  • How you get up from a lying position or get in and out of a chair (functional activities).
  • How you use your body for certain activities, such as bending and lifting (body mechanics).

Your physical therapist will work with you to determine your goals for physical therapy. Then, they will create a treatment plan for your specific condition and goals. In many cases, the physical therapist will diagnose your condition and begin treatment right away.

A main goal of treatment is to improve or maintain your ability to do daily tasks and activities. Your physical therapist may address pain, swelling, weakness, and limited motion to help you reach this goal. They will check your response to each treatment and make changes as often as needed. Physical therapy treatment also may speed your recovery.

Education is an important aspect of your physical therapy treatment. Your physical therapist may teach you special exercises to do at home. They also may show you different ways to do your work and home activities. The goal is to lessen or get rid of the problem believed to be the reason for your pain, strain, or injury and show you ways to stay healthy.

Your physical therapist will assess your need for special equipment. For example, they may suggest special footwear, splints, or crutches. They also may advise that you use special devices to help make your home a safer place for you, especially if they find that you are at an increased risk of falling. They will determine what equipment you need based on your situation. They may either provide it for you or tell you where you can find it. If you do need special equipment, your physical therapist can show you how to use it properly.

Your physical therapist will share important information with your doctor and other health care providers at your request.

Your physical therapist will recheck your progress often throughout your plan of care. They will work with you to plan for your discharge from physical therapy when you are ready. Make sure to talk with your physical therapist about what to do if you have questions after discharge or if your symptoms or condition worsens.

Your physical therapy visit may include working with a physical therapist assistant on exercises prescribed by your physical therapist. Physical therapists and PTAs work together and with other health care providers to make sure you get the care you need.

Get the Most Out of Physical Therapy

You will get out of your physical therapy sessions what you put into them. It will take a certain amount of effort on your part, as agreed between you and your physical therapist, to get the most benefit from each session. Here are four tips to help you get the most out of physical therapy:

1. Keep Your Appointments

  • Arrive for your sessions on time or a few minutes early. Being late may reduce your one-on-one time with your physical therapist and affect other patients.
  • Engage in the discussion to decide how often you will see your physical therapist and determine your treatment goals. Then, work with your physical therapist to meet your goals.
  • Attend your appointments. Missing appointments can delay your recovery. Failing to show without canceling in advance may result in a fee and disrupts the physical therapist’s schedule. If an emergency keeps you from going, try to give notice as soon as possible. Review the facility’s financial and cancellation policy before you begin treatment.
  • If you plan to stop therapy or change how often you receive treatment for personal or financial reasons, discuss this with your physical therapist.

2. Follow Your Physical Therapist’s Instructions

It is essential to follow your physical therapist’s guidance. They may recommend that you:

  • Modify an activity.
  • Limit or restrict the use of a specific body part (such as reducing weight on one leg while walking).
  • Avoid certain movements.

Ignoring these precautions may lead to injury or delay your recovery.

If your physical therapist provides special devices (splints, walkers, canes, or braces) for home use, follow the exact usage instructions they give you. Be sure to ask questions if you are unclear. Incorrect use may be harmful.

Your physical therapist also may recommend making changes in your home for your safety, such as:

  • Removing throw rugs.
  • Rearranging furniture.
  • Setting up safety rails.

3. Do Your Home Exercise Program

Doing your home program as often as prescribed by your physical therapist is essential to your recovery. If the instructions are unclear, ask your physical therapist to explain them to you. Only do exercises that your physical therapist prescribed. Follow their instructions for:

  • How often (times per week).
  • How many times (repetitions).
  • The specific resistance (weight in pounds or band color).

More is not always better and may cause injury!

 

Parkinson’s: The Shaking Palsy

Read Time: 4 minutes

Parkinson’s disease is the second most common degenerative brain disorder affecting adults. (Alzheimer’s disease is the most common.) People of all ethnic groups can develop PD, but it occurs less among African American and Asian populations. James Parkinson’s Essay about Parkinson’s Disease was first defined as only a “motor” (movement) disease, but research has shown that it also causes “nonmotor” symptoms (such as lightheadedness when standing up) in other systems of the body. People with PD are at risk of falling and sustaining other injuries due to their movement and balance challenges.

What Is Parkinson’s Disease?

Parkinson disease is related to a loss of nerve cells in the brain that produce a chemical called dopamine. Dopamine and other brain chemicals are normally in balance and are important for the control of body movements, thought processes, decision-making, moods, and other behaviors.

The exact cause of PD is not yet known. Family history, aging, or exposure to certain environmental toxins may contribute to the onset of PD. It is a chronic degenerative disease, which means that it gets worse over time; however, people usually do not die from it.

The severity and symptoms of PD can vary widely. Some people have the disease for 20 to 30 years and experience a slower decline in mobility and thinking over a longer period of time. Others may experience difficulty with physical movements and thought processes within 5 to 10 years, as the disease progresses more rapidly.

Signs and Symptoms

Nonmotor symptoms of PD, such as a decreased sense of smell, sleep problems, and lightheadedness when first standing up, can begin many years before motor (movement) symptoms develop. Motor symptoms of PD, which typically include muscle and joint stiffness (rigidity), shaking (tremors) in the hands and limbs, slowed movement, and balance problems, most often begin at or around age 60. However, early-onset PD can affect people at a younger age.

The motor symptoms of PD can be very mild at first. A common early symptom is a tremor in 1 hand, most often when you are at rest. It might look like you are rolling a pill between your thumb and forefinger. Tremors also can occur in your legs or jaw when you are at rest. Since the tremors are most apparent during rest, they usually go away when moving and typically don’t interfere substantially with daily functions.

As the condition progresses, people with PD may notice other motor symptoms, such as:

  • Movements that become smaller, possibly resulting in:
    • Shuffling when walking.
    • The arms swinging less when walking.
    • The voice becoming quieter.
  • Muscle stiffness or rigidity, causing discomfort in the neck, trunk, or shoulders.
  • Pain due to muscle stiffness.
  • Postural instability, resulting in poor balance and a greater risk of falling.
  • Movements that become slower during daily activities such as dressing, showering, or moving in bed.
  • A feeling of the feet being “frozen” to the floor, making it hard to take a first step, or to turn around when walking.
  • Stooped posture.
  • Difficulty speaking at a normal voice level.
  • Difficulty swallowing.
  • Difficulty performing tasks that were once easy to do, such as gardening or swinging a tennis racquet or golf club.
  • Difficulty making facial expressions.
  • Difficulty holding and releasing urine (bladder urgency and incontinence).

Nonmotor symptoms might include:

  • Difficulty paying attention to a task for a long period of time or dividing attention between 2 or more tasks.
  • Fatigue.
  • Lack of motivation.
  • Lightheadedness.
  • Depression.
  • Anxiety.
  • Disturbed sleep.

How Is It Diagnosed?

Because there is not one definitive test for PD, it can be difficult to diagnose. A diagnosis is usually made based on a person’s medical history and a neurological examination. If your physical therapist suspects that you have symptoms of PD, you may be referred to a neurologist for further examination.

A diagnosis of PD may be made if a person is found to have:

  • Slowing of motion and tremor when resting, or muscle rigidity
  • A significant improvement in symptoms when taking a medication to treat PD.
  • Initial symptoms on 1 side of the body only.

How Can a Physical Therapist Help?

Because PD affects each person differently, your physical therapist will partner with you to manage your specific situation—now and as your condition changes. You are not alone!

Following a diagnosis of PD, your physical therapist will conduct a comprehensive evaluation, including tests to examine your posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on your test results, your physical therapist will develop an individualized treatment plan to help you stay as active and as independent as possible. Your program will include exercises and techniques to combat the symptoms of PD.

Depending on the nature and severity of your condition, your treatment program may focus on activities and education to help you:

  • Improve your fitness level, strength, and flexibility.
  • Develop more effective strategies to get in and out of bed, chairs, and cars.
  • Turn over in bed more easily.
  • Stand and turn to change directions more efficiently.
  • Improve the smoothness and coordination of your walking.
  • Improve your ability to perform hand movements.
  • Decrease your risk of falling.
  • Improve your ability to climb and descend stairs and curbs.
  • Perform more than 1 task at a time more efficiently.
  • Participate in activities that are important to you.

A physical therapist working with a patient on movement and balance skills

Some of the medications designed to manage PD symptoms may have an immediate positive effect. For example, movement is typically much easier shortly after you begin taking certain PD medications. Your physical therapist will know how to time treatments, exercise, and activity based on both the schedule and the effects of your medications to get the best results.

Parkinson’s disease can make daily activities seem frustrating and time-consuming. Your physical therapist will become a partner with you and your family to help you combat and manage the symptoms of PD. As your condition changes, your treatment program will be adjusted to help you be as independent and as active as possible.

Some people with PD benefit from using a cane or a walker. Your physical therapist can work with you to determine if any of these devices may be helpful to you. If you need physical assistance to help you with moving in bed or getting out of a chair, your physical therapist can team with you and your family to develop strategies to make moving easier and help prevent injury. In addition, your physical therapist can make suggestions on changes to your home environment to optimize safe and efficient daily function at home.

Go Big, LSVT BIG!

Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in the early or middle stages of your condition when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.

Can This Injury or Condition Be Prevented?

To date, there is no known way to prevent PD. Studies have shown improved walking, balance, strength, flexibility, and fitness in people with PD, who participate in a regular exercise program. However, these studies also indicate that people with PD gradually lose the gains they make when their supervised exercise program ends. It’s important to work with your physical therapist to help develop good long-term exercise habits.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat patients with PD. You may want to consider:

  • A physical therapist who is experienced in treating people with neurological disorders. Some physical therapists have a practice with a neurological focus.
  • A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in neurologic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you are looking for a physical therapist (or any other health care provider):

  • Get recommendations from family, friends, or other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with PD.

During your first visit with the physical therapist, be prepared to describe your concerns in as much detail as possible, and let the physical therapist know what you would like to accomplish by going to physical therapy.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. Treatment includes a combination of medication and physical therapy—and in some cases surgery. Physical therapists partner with people with PD and their families to manage their symptoms, maintain their fitness levels, and help them stay as active as possible.

You can contact our physical therapist’s directly for FREE CONSULTATION or evaluation.

 

Exercise for Parkinson’s Disease is More Than Healthy; It’s a Vital Component.

Exercise is an important part of healthy living for everyone. For people with Parkinson’s disease (PD), exercise is more than healthy — it is a vital component to maintaining balance, mobility, and activities of daily living (i.e. bathing, toileting, cooking, and dressing). Exercise and physical activity can improve many PD symptoms. These benefits are supported by research.

The Parkinson’s Outcomes Project shows that people with PD who start exercising earlier and a minimum of 2.5 hours a week, experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is essential to overall disease management.

What Type of Exercise Should I Do?

To help manage the symptoms of PD, be sure your exercise program includes a few key ingredients:

  • Aerobic activity
  • Strength training
  • Balance, agility, and multitasking
  • Flexibility

The Parkinson’s Foundation, in collaboration with the American College of Sports Medicine, created new Parkinson’s disease (PD) exercise recommendations to ensure that people with Parkinson’s are receiving safe and effective exercise programs and instruction.

The new exercise guidelines include recommended frequency, intensity, time, type, volume, and progression of exercises that are safe and effective for people with Parkinson’s across four domains: aerobic activity, strength training, balance, agility, multitasking, and stretching. Each recommendation is paired with specific types of activity and special safety considerations for people with PD.

Parkinson’s Exercise Recommendations (available in multiple languages)

These elements are included in many types of exercise. Biking, running, Tai chi, yoga, Pilates, dance, weight training, non-contact boxing, qi gong and more — all have positive effects on PD symptoms.

There is no “exercise prescription” that is right for every person with PD. The type of exercise you do depends on your symptoms and challenges. For sedentary people, just getting up and moving is beneficial. More active people can build up to regular, vigorous activity. Many approaches work well to help maintain and improve mobility, flexibility and balance to ease non-motor PD symptoms such as depression or constipation.

Researchers in the study did not distinguish between what type of exercise participants did and determined that all types of exercise are beneficial. The most important thing is to do the exercise regularly. We suggest finding an exercise you enjoy and stick with it.

Challenges to Exercising

  • People in the early stages of PD tend to be just as strong and physically fit as healthy individuals of the same age.
  • Disease progression can lead to the following physical change:
    • Loss of joint flexibility, which can affect balance.
    • Decreased muscle strength or deconditioning which can affect walking and the ability to stand up from sitting.
    • Decline in cardiovascular conditioning, which affects endurance.

Tips for Getting Started

  • First, be safe. Before starting an exercise program, we recommend you to see a physical therapist specializing in Parkinson’s for full functional evaluation and recommendations..
  • Use a pedometer (step-counter) and figure out how many steps you take on average each day, then build up from there. Many smartphones or smartwatches have a built-in pedometer feature or an application that can be downloaded.
  • Exercise indoors and outdoors. Change your routine to stay interested and motivated.
  • Again, most importantly pick an exercise you enjoy.

source: www.parkinson.org

Fitness for Every Age … and Stage

Like most people, you have probably heard that muscle strength, absent some weightlifting, starts to decline in middle age. And you probably expect things like your balance, coordination and flexibility to naturally take a bit of a downturn …. someday. But new research from Duke University shows that these fitness-related changes begin much earlier than many people expect — often when they’re still in their 50s.

To assess age-related changes in people’s fitness abilities, researchers at Duke’s Center for the Study of Aging and Human Development had 775 participants from their 30s to their 90s perform tests designed to measure things like strength, endurance, balance and walking speed.

At all ages, the men generally performed better than the women, but the age at which physical declines became truly apparent was consistent for both genders — the 50s. That’s when both sexes began to have trouble rising from and sitting in a chair repeatedly for 30 seconds (an indicator of declines in lower body strength) or standing on one leg for up to 60 seconds (a measure of balance).

Additionally, people in their 60s and 70s showed a marked slowing of gait speed (based on distance covered per second of a four-meter walk) and a drop in aerobic endurance (based on a six-minute walk test). By contrast, those in their 80s and 90s had dramatic declines in their balance, gait speed, lower body strength and aerobic endurance.

“People were very surprised by these changes because most of these tests aren’t typically done if you go to the doctor,” says study coauthor Katherine Hall, an assistant professor in medicine at Duke University School of Medicine’s Division of Geriatrics. “Some of this is inevitable — our bodies are machines, and if you put 60 or 70 years of wear on any machine, it’s going to show some decline.” Even so, the rate or severity of these declines varies significantly from one person to another based on how active — or sedentary — you are.

The benefits of banking fitness

“What’s really happening is many of these changes start to occur earlier in life but don’t manifest themselves and become problematic until later in age,” explains Cedric X. Bryant, chief science officer at the American Council on Exercise. There’s also a domino effect involved: Declines in muscle strength and bone mass start to occur in the 30s, he notes, and “losses of lower body strength and balance will eventually impact walking speed.”

It’s a mistake to wait until these declines in physical fitness set in. After all, these fitness factors affect not only your general level of functionality but also your overall health: In a practical sense, your gait speed, for example, may determine whether you can cross the street safely before the light turns red. But it’s more than that, too. “Gait speed is now being called the sixth vital sign,” Hall says. “It’s the strongest predictor of hospitalizations, as well as a person’s risk for developing chronic diseases, disabilities and cognitive decline.”

That’s why it’s smart to look at building and maintaining physical fitness in a way that’s similar to how you might amass savings for retirement. “You get the greatest returns on your investment the earlier you start,” Bryant says. “But the beauty is: It’s never too late to start. All these systems respond to the right dose of stress in the form of physical activity and exercise.”

Participating in regular physical activity can modify all of these age-related declines in muscle strength, balance, mobility, agility and endurance considerably. “As much as 50 percent of these age-related deficits can be attributed to our lifestyles,” Bryant says. That means you have the power to profoundly influence how or whether these fitness parameters change as you get older.

The power of a plan

To minimize or delay such declines, you’ll want to follow a well-rounded exercise program that targets endurance, strength, balance, and agility. In every decade, it’s important to start with aerobic exercise — whether it’s walking briskly, jogging, bicycling, swimming, dancing, using a cardio machine (like an elliptical trainer) — several times per week, for at least 150 minutes of moderate-intensity per week. (A good gauge of what’s moderate intensity, Bryant says, is being able to talk, but not sing, while you’re working out.)

Staying aerobically active is especially important, as you get older, because “losses in cardiovascular fitness occur more rapidly than losses in muscle strength,” notes Fabio Comana, a faculty instructor at the National Academy of Sports Medicine.

Beyond that aerobic baseline, here’s what to add in by age.

In your 50s

If you haven’t already, it’s critical to work on building and maintaining muscle strength, especially in your lower body because “you lose muscle strength faster in your lower extremities than in your upper body,” Comana says. Whether you choose to use your own bodyweight (by doing squats, lunges, pushups or triceps dips), weights or resistance bands is up to you. But it’s best to target all the major muscle groups including the glute muscles (in the buttocks), the quadriceps and hamstrings (in the thighs) and the calf muscles.

If you can do a whole-body strength-training regimen that also addresses the pectoral muscles (in the chest), the latissimus dorsi (in the back), the deltoid muscles (in the shoulders) and the biceps and triceps (in the upper arms), that’s even better, Bryant says. “Start with one set of eight to 15 repetitions and work up to two to three sets, twice a week.” Add plank exercises to build and maintain core strength and you will have covered all your bases.

In your 60s and 70s

Make an effort to walk more often and to vary your pace so that you’re alternating between bouts of faster walking and a more comfortable pace, Hall advises. You can work on protecting your balance by trying to stand on one foot for up to 60 seconds with your eyes open, sitting in a chair and lifting one foot from the floor with your eyes closed, or continuously going from a seated to a standing position without using your hands, Comana suggests, noting that these balance exercises can be “somewhat remedial.” To take extra precautions to protect your balance, you might try a mind-body form of exercise such as yoga, Pilates, or tai chi, which would “provide agility, mobility, flexibility and some muscular fitness benefits as well,” Bryant says.

In your 80s and beyond

As far as cardiovascular activities go, “find something you enjoy that provides social engagement and makes you feel energized,” Hall advises. This could involve taking a water aerobics class with friends or joining a walking group. An added perk: “Cardiorespiratory exercise is one of the best deterrents to developing cognitive decline,” Hall says. Continue working on your balance by alternately standing on one leg then the other with one hand on a counter to steady yourself and the other by your side. Or try standing with one foot behind the other, with the heel of the front foot against the toes of the back foot (maintain your balance for 10 seconds then switch placement of the feet). “Be sure to wear supportive shoes,” Hall says. If you find yourself really struggling with balance, consider working with a trainer in a supervised setting.

And don’t give up. As the Duke study found, “There are people in their 80s who are doing better than some people in their 60s are,” Hall says. “The body is a malleable machine that responds well to challenges, which means there’s a lot of room for being an active agent in your own health.”

source: https://www.aarp.org/health/healthy-living/info-2018/banking-fitness-any-age.html