July 2010

Physical Therapists Jordan Tucker, PT, DPT and Joy McLaughlan, PT

Contact info:
Physical Medicine & Rehabilitation Department
Inova Fair Oaks Hospital

Jordan and Joy work in the outpatient neurological rehabilitation program   and are trained to work with people living with PD. They also work with speech and occupational therapists (like our September speaker, Sharon Gaskin). Physical therapy is also available at Fairfax, Mt. Vernon and Reston hospitals. Bill M. and David have been seeing them and recommend   them highly.

Jordan explained that everyone has different symptoms – as we know – and they evaluate each person to be sure they are given the best treatment for their particular problem. Flexibility, balance and learning how to stand and walk correctly are some of the problems they are concerned with. Keeping our ankles, hips and knees moving correctly is very important.

Based on their assessment, they’ll give you adaptations to make life better given the changes you’ve experienced from PD. They can also liaison with your neurologist to ask the right questions about your medications and symptoms.

Flexibility is important because muscles get tight. Muscles work easier when they are flexible. Balance depends on flexibility – muscles that   would keep you upright don’t kick in when they are tight.

Strength – Is loss of strength due to PD or less movement?
If muscles are short and tight (e.g. chest) and need to be stretched, the opposite group muscles are weak (e.g. upper back) and need to be strengthened. Increase core and back muscles for improved balance.

Posture & balance

Joy demonstrated how we should stand; ears, shoulders, hips should all be in alignment for good, safe posture.

If your pelvis tips back you’ll be inclined to fall backwards. It’s called retropulsion and is common with PD. A movement to correct it, is to sit on a chair in front of table, hands stretched out in front, and lean forward   to shift pelvis forward.

Your balance point is over your navel if your pelvis is properly aligned.

With stooped forward posture they would work on lengthening chest muscles and strengthening the upper back. Posture is a big proponent in balance & falling.

We need to have automatic balance reaction in order to keep from falling. They don’t want people to fall so they assess your fall risk like checking the flexibility of your ankles. Can you pick up your toes? If not, you could scuff your feet and trip.

With PD automatic balance reactions are slowed.

To improve your balance make regular activities harder. For instance, doing mind games while walking so you can deal with distractions.

Other considerations

Assisted device
Are you using an assisted device? Do you need one? is it the correct one? Are you using it correctly?

Exercise is important!!
. . . especially with PD. The more you can do the better, especially early on in the disease process. Keep moving – to challenge balance and increase strength and flexibility. Some suggestions are dancing, tai chi, water aerobics and going for a walk with family. Music can be a good motivator to get moving; dance classes are available to those interested. Just put on some good music and dance around your house (carefully) . Use music to make walking smoother. Hearing the beat helps the body move to the rhythm and it might help you move and pick up your feet better. If you’re freezing, try putting on music to help you move better or use a metronome.
Big Band music has a consistent good pace. If you don’t like the exercise you won’t do it so do something you like to do.

A study showed the effect of walking with alpine/walking poles – it is good for arm movement when you lose arm swing. Joy explained the use of alpine poles to keep arm movement natural and easier. Alpine poles are available from Target and REI, and other sporting goods stores. Make sure they’re tall enough for you and you’re not leaning forward. At REI they will help you get the right fit and height. Two poles are better than one for arm movement and trunk rotation. Your arm swings out with opposite forward foot.

Another study on cardiovascular exercise showed that people living with PD require more oxygen and energy so they tired out more easily leading to a desire to sit and not move (picture lots of nodding from our group). So find activities to use your heart and lungs and increase endurance.

Freezing is caused by a delay in transmission from brain to muscles to get   started.

Some suggestions to unfreeze:
• big, exaggerated movements. Think BIG a la Lee Silverman technique
• march in place lifting knees high
• practice stepping over things
• your companion can put his/her foot in front of yours so you can step over it
• visualize yourself moving
• concentrated relaxation will help unstiffen/unfreeze
• gentle rocking with companion gently pushing your forward and back or   side to side to unlock
All you need is a physician’s referral to see Jordan and Joy. They can also help with reorganizing your house; moving items around to make it easier for you to get around without the possibility of falling.

When out and about be prepared to call for help if needed.
• Mobile Help / Anywhere Help Button. A personal medical alert emergency response service but unlike Lifeline which only works in the home, the   Anywhere Help Button also works when you’re away from home. (Thanks Ruth   Ann!)
• Carry a cell phone with you so you can speed dial your spouse or 911
• Keep your phone in a holster on your belt rather than in your pocket for easier access.
• Medic Alert bracelets
• Road ID – ankle bracelet with contact ID and also available with Emergency Response Profile (ERP)

Four take-aways from Jordan and Joy’s talk
1. Stretch daily to decrease and prevent further stiffness and changes in posture. Good to stretch when meds are wearing off and when you get up in the morning but you can stretch anytime you’re feeling stiff. When you’re standing around and have nothing else to do – putting something in the microwave, commercial breaks (stand up and stretch)
2. Think about where your pelvis is – balance point should be between feet not forward or back
3. Practice exaggerated movements – marching, toes up
4. Exercise regularly – keep aerobic capacities

How long do PT’s work with you?
Depends on needs of patients
Medicare will pay for immediate needs, but also for you to come back some time later for re-evaluation and to work on new issues. It doesn’t need to be a one-shot deal.

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