PT Classroom - PWR! Parkinson's Wellness Recovery ׀ by  Kristine Decant, PT

 

Kristine Decant, PT is a Physical Therapist at United Hospital System, Inc. at Somers Medical Office Building, 3400 Market Lane, Somers, WI 53144. She runs the Neuro Wellness Aftercare Program and is LSVT BIG certified. She is conference chair for the upcoming PWR! Parkinson’s Wellness Recovery Therapist training course October 29 and 30, 2016, as well as for the free Community lecture on Friday October 28, 2016 at United Hospital Kenosha Medical Center Campus, 6308 8th Avenue, Kenosha. For information on these programs, please call 262-551-4700.

 

PWR! Parkinson's Wellness Recovery

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Research suggests that WHAT you do is important! The WHAT you do should be about vigorous aerobic exercise and Parkinson's Disease (PD) - specific skill training. The skills that deteriorate in PD interfere with everyday movement, therefore, movements become slow, small, and poorly sequenced. To maintain or restore those PD-specific skills, a PWR!4Life Program involves the daily rehearsal of big and fast, whole body functional movements – these are called the BASIC4 | PWR!Moves. Studies suggest that the combination of these types of exercise (aerobics and skill training) may enhance learning and automaticity beyond what is possible with either one alone!*

Finally, HOW you practice is essential to your ability to GET BETTER and STAY BETTER. It is not enough to just practice the same small and slow movements over and over again without paying attention to the quality of the movement. Instead, it is about improving the quality of your practice, being engaged, and being challenged physically and cognitively to DO MORE!

PWR!Moves is a PD-specific skill training program to maintain or restore skills that deteriorate and interfere with everyday movements.

Dr. Farley created PWR!Moves« as the EVOLUTION of her original LSVT BIG« exercise program. The BASIC4 | PWR!Moves« offer a flexible and functional amplitude-focused exercise approach that targets multiple symptoms, and that allows for adaptation for disease severity.

PWR!Moves can be combined and progressed into a stand-alone group program or integrated into ANY exercise program, ANY activity (function, activities of daily living, recreation, sports, and hobbies), in ANY setting (community group or rehab 1:1), by therapists and fitness professionals.

The BASIC4 | PWR!Moves are performed with large amplitude, high effort, and attention to action in multiple postures (floor, all 4’s, sitting, and standing). They specifically target “4” skills shown by research to interfere with mobility in people with PD (antigravity extension, weight shifting, axial mobility, and transitional movements).

All of the BASIC4 | PWR!Moves may be performed differently to specifically target different symptoms of PD:
~ PREPARE ~To Counteract Rigidity: then PWR!Moves are performed slowly, rhythmically and with sustained effort.
~ Activate ~To Counteract Bradykinesia; then PWR!Moves are performed as BIG and FAST as possible with repetitive high effort.
~ Flow ~To Counteract Incoordination; then PWR!Moves are linked together into gradually longer sequences that mimic everyday movement and improve overall function in LIFE.
~ Boosts ~To Counteract Loss of Automaticity; then PWR!Moves are combined with secondary motor and cognitive tasks to create real world environmental context

PWR!4Life™ Program Essentials for Wellness Recovery

Exercise4BrainChange represents Dr. Farley’s translation of the research about “how to exercise” to optimize brain health (neuroprotection), brain change (neuroplasticity) and function. There are “4” essential constructs (high physical effort, cognitive engagement, attentional focus, emotional engagement). The constructs are founded on basic and clinical research in motor control, motor learning, and exercise physiology.

About PWR!
The aim of PWR! is to use exercise as a physiological tool to optimize brain function (i.e. neuroplasticity) and health. Her program is based on: early intervention, continuous access and research-based exercise programs. PWR! also trains clinicians and fitness professional with techniques to focus on PD-specific exercise.

Her exercise tips:
1 “start from a position of power!”. Your body needs to be ready, your brain needs to be focused and the task needs to feel important (or fun!) for change to occur. Make your exercise engaging!
2 Use equipment (i.e. bungees, ropes, balance boards, harnesses) to get the experience of the full movement safely (especially in people with PD who have difficulty balancing etc.), then start to take some of those supports away as you progress and apply that experience to everyday movements!
3 For people with PD, especially those with dyskinesias – seek exercises that gain core stability
4 Sensory feedback – i.e. pacing, metronome, music – can help push you to exercise faster, harder and with more smooth movements
5 “Prime” your body by starting your exercise program with progressive aerobic training, then follow up with skill acquisition-type exercises.
6 Focus not only on increasing muscle mass, but want to increase useable muscle and focus on functional movements in your exercises… not just “curls for the girls” but include things like:
lateral rotations, cross-body, sequential movements, extensions, quick position changes, side-to-side weight shifting)

How does exercise help brain function in Parkinson’s?
Exercise can help increase brain volume, improving working memory and attention. Also, it increases blood vessels and leads to more neurotrophic (growth) factors (like “gatorade” for the brain!) and a more supportive environment for neurons. Exercise also increases the redundancy in brain synapses. Redundancy is good! If you have some synapses that aren’t working, you will have back ups to replace them!
Specifically in PD, research tells us that exercise increases survival rate, increases physical functional ability, and improves cognition! It can help “repair” the dopamine system in early/moderate stages of PD by increasing dopamine D2 receptors and helping your brain make better use of remaining dopamine.

 

Last revised: 10/17/16
by Kristine Decant, PT

 

References
“How might physical activity benefit patients with Parkinson disease?” Speelman, Nature Reviews, 2011

“Effectiveness of intensive inpatient rehabilitation treatment on disease progression in parkinsonian patients” Giuseppe et al., Neurorehabil Neural Repair, 2012
Neurodegener Dis Manag. 2011 Apr 1;1(2):157-170.

Ahlskog JE. Neurology 2011;77:288-295.
“Does vigorous exercise have a neuroprotective effect in Parkinson disease?” Ahlskog Je, Neurology, 2011


Farley BG, Koshland GF. Experimental Brain Research 2005;167(3):462-467.
Exp Brain Res. 2005 Dec;167(3):462-7. Epub 2005 Nov 11.


Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson's disease.
Farley BG, Koshland GF.


Farley BG, Fox CM, Ramig LO, McFarland, D. Top Geriatric Rehabilitation 2008;24(2):99-114.

King LA, Horak FB. Physical Therapy 2009;89:384-393.

Kleim, JA, Jones TA. Journal of Speech Language Hearing Research 2008;51(1):S225-S239.

Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec M. Lancet 2013;12:716-726.

Petzinger, G, Fisher, B.E., Jacobson, S., Beeler, J.A., Walsh, J.P. and Jakowec, M.W. (2013). Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurology, v12, pp. 716-726.

Petzinger GM, Fisher BE, Van Leeuwen JE, et al. Movement Disorders 2010;26(Suppl 1):S141-S145.

The role of exercise in facilitating basal ganglia function in Parkinson's disease.
Petzinger GM1, Fisher BE, Akopian G, Holschneider DP, Wood R, Walsh JP, Lund B, Meshul C, Vuckovic M, Jakowec MW.

Petzinger GM, Holschneider DP, Fisher BE, McEwen S, Kintz N, Halliday M. et al. Brain Plasticity 2015;1:29-39.
The Effects of Exercise on Dopamine Neurotransmission in Parkinson's Disease: Targeting Neuroplasticity to Modulate Basal Ganglia Circuitry.

Petzinger GM, Holschneider DP, Fisher BE, McEwen S, Kintz N, Halliday M, Toy W, Walsh JW, Beeler J, Jakowec MW.
Brain Plast. 2015;1(1):29-39.

Speelman AD, van de Warrenburg BP, van Nimwegen M, Petzinger GM, Munneke M, Bloem Br. Nature Review Neurology 2011;7:528-534

Terms & Conditions

Please review our terms and conditions carefully before utilization of the Site. The information on this Site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. It is recommended that you seek professional and medical advise from your physical therapist or physician prior to any form of self treatment.



 
 
      
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