Occupational- and Physical therapy not helpful in PD for activities of daily living

[lempa_nik]

FYI:

news-medical.net/news/20160...

[beauxreflets]

Targeted Physio increases On time of Ledopa meds in my experience, 100mg lasts me up to 6 hrs instead of 3+hrs while improving / maintaining mobility.

That is a big benefit coming from just two half hour sessions per week

[soup]

To understand this better look at the frequency of the therapy. I don't know how anybody expected it to make a difference!

[lempa_nik in reply to soup]

Following common sense, I would agree with you: one PT session every two weeks sounds negligible. But reality is often counter-intuitive. Who would guess that Beauxreflets could gain so much benefit from just two half-hour sessions per week? For me, that is surprising.

[beauxreflets in reply to lempa_nik]

In my situation it may just be the spinal scenosis aspect. Where the regular physiotherapy is stabilising and assisting to minimise pressure on the central nerve.

Having recently changed to new Physiotherapists (following a retirement and period without physio) I am aware of the differences found and currently trying to determine more exactly the aspects at play; Especially after one of the new therapists commented upon the condition of an uneven alignment in the pelvis.

If the Physiotherapy is readdressing imbalances, then I tend to think it is worth it.

[paddyfields]

As my mother used to say "paper won't refuse print" or " you can't

believe half the lies you hear" (Irish of course). Academics are I understand under pressure to produce papers to maintain their credibility. Or let me put it another way - absolute unadulterated tosh.

[lempa_nik in reply to paddyfields]

God bless the Irish and their curmudgeonly maxims!

[partypants]

I would endorse these findings. I've been on a course of physiotherapy for over six months to see if it helps strengthen my legs and possibly improve my balance. This has been paid for privately and I've been given exercises to do at home. It doesn't seem to have helped much so I've stopped it recently.

[lempa_nik in reply to partypants]

Before I was diagnosed, when my GP and I suspected I had Parkinon's, she sent me to a physical therapy clinic to shore up my balance. They gave me, among other things, some eye exercises to do. But the only result of my attempting to flip my eyes back and forth was that my tremor went wild. Very frustrating, and I soon gave up. My poor, damaged brain could not handle the extra demands.

[Beckey in reply to lempa_nik]

Dumpelkin, that sounds agonizing.

[lempa_nik in reply to Beckey]

Beckey, It was humbling. I didn't want to admit that the gospel of "mind over matter" or "you can do anything if you try hard enough" was absolutely not going to work when my brain was this broken. Of course, I had come up against my mortal limitations countless times before, but this was a new and striking one.

[BillDavid]

A Different Perspective. I am responding to several of the previous replies, was not able to down load the url in the post?

Research clearly shows that “expectation” has a major impact on Patient outcomes. First the “expectation” of the Patient themselves and second the “expectation” of the Healthcare Provider or what the Patient believes their expectation to be. The impact will not be neutral. My take on several of the previous “Riplies” and my assumption on the post is that the message is to paraphrase, “Physical Therapy offers insufficient benefit, why bother?” Why bother? If you don,t expect any benefit from PT, most likely you won’t get any!

But, what is the evidence? Last month’s Third Thursday M J Fox Webinar discussing Physical Therapy at one point, recommend benefit of “prehab”, rather than rehab. Advocating certain benefits even before on set of Major Symptoms. Really, curious why? Know anybody who has been through LSVT BIG? Ask them.

Seems to me that in evaluating an opportunity, one would want to look at the outliers (folks who are doing well) to see what works for them?

Noone tells patients what is going on with the Disease. Briefly, Dopamine Producing Neurons in Black Nucleus die, this dopamine goes to striatum setting on top of Black Nucleus. Striatum controls among other thing both extensor and flexor muscles. In PD extensor muscles weakened, flexor muscles remain strong, results in posture problems. Bottom line, you can impact movement of joints, ankle, knee hip shoulders, by strengthening loint extensor muscles, and stretching joint flexor muscles.

I could go into a lot more research and details of how benefit from PT, my perspective. Bigger deal is healing possibilities of expectations.

BillDavid

[lempa_nik in reply to BillDavid]

Bill David, I noticed that you have had difficulty lately loading several URLs . The one I posted is also not working for me. So let's try a different one, for the same story: sciencedaily.com/releases/2... This gives a nice, detailed summary of the study.

An editorial appearing with the journal article suggested that therapy targeted for limited, specific problems may be effective:

"Intuitively, certain PD-related symptoms should benefit from routine physical therapy strategies, including problems such as gait freezing, imbalance/fall risk, or immobilized limbs. Patients with PD with shortened stride or reduced arm swing benefit from strategies for consciously increasing attenuated movements. Such circumscribed problems were not the focus of this investigation," the author notes.

"To summarize, first, current physical/occupation therapy referrals for those with PD should be for specific problems that are likely to benefit. Second, physical therapy practices should begin to incorporate facilitation of ongoing aerobic exercise and fitness," the editorial concludes.

[partypants in reply to BillDavid]

“Physical Therapy offers insufficient benefit, why bother?” Why bother? If you don,t expect any benefit from PT, most likely you won’t get any! "

mmm...

I had high expectations and it didn't make a jot of difference.

[paddyfields]

PD has been described as a designer disease. Therefore intervention must be focussed on the individual patient. I did not get much joy of the two times when I requested referral to the NHS "specialised"(!) physio. The PD nurse forgot to refer me on both occasions so I conclude they are not impressed either. On reflection, I suppose my understanding of physiotherapy may not be quite right. By physiotherapy I mean any physical activity undertaken with a view to improving ones functioning. Although there are general principles, you have to find what gives you personally the greatest benefit. For example, I have certainly found that after only an hour's tai chi class I can go from feeling quite wobbly to feeling much more balanced and centered . What I think is certain for the majority is that you must keep on the move to counteract the insidious effects of PD.

[Dear2016]

I think there is also a component of learning, or strengthening the neuropathways through movement (sensory integration) that is important in exercise. My love has agility and strength but can't make his leg move. It sometimes appears that he forgets how to move, which is why I think this fundamental foundation for movement is important in preserving the ability to move.