The Monday Memo
January 28, 2019 PITT DPT STUDENTS
What is it?
Parkinson’s disease (PD) is a neurodegenerative disease that progressively reduces the number of dopamine-releasing neurons in the substantia nigra. Dopamine is an important component of the motor pathways within the basal ganglia. It functions to excite the pathway that facilitates movement and inhibit the pathway that slows or reduces movement. This loss of dopamine results in the commonly seen signs of PD, including the resting tremor, rigidity, bradykinesia, and postural instability. A true PD diagnosis requires at least two of these signs, in combination with a positive response to a trial of Levodopa.
Common Signs and Symptoms of PD
Along with the four primary signs previously mentioned, people presenting with PD may report decreased writing size or micrographia, voice changes, and difficulty initiating movements. Additionally, they may exhibit gait deviations including decreased or lack of arm swing, decreased foot clearance, decreased step length, as well as a festinating gait pattern.
People with PD can benefit from a variety of modes of intervention, including cardiovascular endurance training, strength training, balance training, and task-specific functional training. Intensity is key. Studies have shown that high intensity training is superior to low intensity training for people with PD. There are a variety of high intensity exercise programs available to people with PD, including LSVT Big, PWR!, Rock Steady boxing, and Dance for PD.
LSVT BIG is a protocol driven, high intensity intervention specifically developed for people with PD. People with PD perceive their reduced movements to be of normal amplitude. This program focuses on encouraging what is perceived as high amplitude movement to facilitate normal amplitude movement. The program includes four parts, including a series of seven specific exercises incorporating large, purposeful movements, functional component tasks that are patient driven, gait training, and hierarchical task training based on patient needs and lifestyle. This program requires clinicians to be certified to provide it as an intervention to patients, however the concepts of large amplitude, high intensity movement can be applied to any task. Remember to Think BIG!
A special thank you to Dr. Dave Wert, PT,PhD and Jodi Krause, PT, DPT, NCS for their lectures on Parkinson’s Disease and the LSVT BIG protocol.
- Katie Schuetz, SPT
For more info:
Landers, M. R., Navalta, J. W., Murtishaw, A. S., Kinney, J. W., & Richardson, S. P. (2019). A High-Intensity Exercise Boot Camp for Persons With Parkinson Disease. Journal of Neurologic Physical Therapy, 43(1), 12-25. doi:10.1097/npt.0000000000000249