By Erica DeMarch - November 2, 2018
August 3, 2018
June 22, 2018
Decreased hip extension, push off
and trunk rotation
Decreased dissociation of hip/trunk
Improved hip and trunk extension,
push off and trunk rotation
Improved dissociation of hip/trunk
By erica demarch - May 24, 2018
I just reread a great article on the OPTIMAL theory of motor learning and decided to apply it to my class for people with PD this am and was impressed with the results. I had the attendees focus on external focus of attention rather than internal focus of body movements. For example, during the warmup, I said “reach toward the ceiling and push through the floor” to improve posture extending their hips and knees as they pushed through the floor and extending their trunk, elbows and fingers as they reached toward the ceiling. Reflecting on my past cues, at times I emphasized more on the internal focus of body movements, such as spread your fingers, shift your weight to your left foot etc. The research shows changing just one word or focus can change a movement pattern. Yoga and Tai Chi and some sports do this well, but do we do this in everyday movement training?
Try today to use an external focus of attention and see if it improves performance.
The article I read is “Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning” by Rebecca Lewthwaite and Gabriele Wulf. It states “Evidence has amassed for the advantages of concentrating on or adopting an external focus of attention on the intended movement effect (e.g., motion of an implement, striking a target, exerting force against an object) relative to an internal focus on body movements.” https://pdfs.semanticscholar.org/a86e/822320b34cf10017089a6b87919a9189d2c6.pdf
Stay tuned for my next blog using auditory feedback to help with the timing and speed of movement.
By Erica Demarch - November 27, 2017
Every patient with PD should be educated on neuroprotection and neuroplasticity, and the earlier they are educated, the better. In treating those diagnosed with a progressive disorder, you want to empower them on how they can change their brain and maximize the benefits of their exercise program. The intensity, difficulty, complexity and specificity of exercises need to be explained and incorporated in their exercise routines. Although they may consider themselves “active,” their intensity may not be at a sufficient level to promote the most benefits. An easy way to access the intensity of their walking is to count their steps per minute and use a metronome to maintain their speed and/or increase it (100 steps/min would be considered moderate intensity). Your role as a physical therapist is to increase the intensity level of practice beyond their self-selected energy expenditure. Many of my patients reports therapists do not work them hard enough and give in to their complaints. Make sure you always try to motivate and work your patient to their fullest ability; help them understand they are capable of moving more than they think.
Besides the intensity of exercise, the quality of movement maintained during repetitive movements is very important. One of the main movement problems due to basal ganglia disorder is the failure to automatically maintain an appropriate amplitude and timing of sequential movements. Training should include awareness of complete muscle activation, attention to effort and amplitude of movement. Use auditory cues (music or metronome while walking on a treadmill), visual or tactile cues (touching a target to maintain range of motion during calf raises) will immediately enhance the size and timing of their movement and therefore maximize overall performance.
You should become aware of your patient’s goals and interests (i.e. sports, hiking, dancing) and incorporate task specific exercises to help improve outcomes and compliance. For example, if your patient plays tennis, incorporate the racket in your session during reaching and stepping exercises.
How well do we maintain our own bodies for balance? As well as a rider would maintain their bicycle? If we want to keep both upright and moving forward, both our body and our bicycle need to be in good condition. The need for a maintenance plan and for repairs of a bicycle are determined bya professional mechanic after careful analysis of its current condition. We should also see health care professionals for an individualized plan for our balance to ensure we continue to keep moving forward. The better you maintain your bicycle, the less repair you will need. If you damage a bicycle during a crash, your mechanics goal is to restore function for a smooth ride. Similarly, if you fall, appropriate health care providers can help determine the cause, improve function and provide insight and education to prevent future falls.
Erica DeMarch, PT and Kenda Fuller, PT
South Valley Physical Therapy
Often people tell me they know exercise is important but do not know what is the best for them. Others tell me they know it is important but do not have the motivation to exercise. Exercise should change what you are able to do each day. Having more energy to do the things that are meaningful to you should be a part of your goal setting. This will increase your motivation to exercise and may also result in changes such as faster walking speed and increased safety on stairs. Individual goals such as hiking, traveling and/or a better golf game will be enhanced by consistent exercise.
There are so many ways to exercise. Finding something you enjoy will automatically increase regular performance. You will not reap the benefits of exercise if you are not enjoying it, and avoid doing it. You can also modify almost any exercise so you can continue what you like to do. The fun of dancing, cycling or boxing may surprise you and become your new passion.
Consultation with someone with the knowledge of the options is time well spent.
There is also extensive research on the benefits of music and movement. So put on your favorite tunes while exercising to help motivate and get you moving! One of the main movement problems due to basal ganglia disorder is the failure to automatically maintain an appropriate amplitude and timing of sequential movements. Cueing tackles this problem. The use of auditory cues using music or metronome along with visual cues will immediately enhance the size and timing of your movement and therefore maximize your overall performance. Cueing from a therapist, trainer or external cues will help you improve your quality of movement in both speed and size of movement.
The neuroprotective effect preserves nerve cells that are at risk for damage by slowing degeneration. If there is damage in one area of the brain, neuroplasticity drives rewiring of pathways; increases use of other parts of the brain; and makes new connections to improve function. The neurotransmitter dopamine becomes more efficient by modifying the areas of the brain where the dopamine signals are received. High intensive aerobic exercise shows the most promise of neuroprotection. Higher intensity, higher duration and task specific paradigms that are continually challenging and complex may be required to accomplish the changes in the brain.
Erica DeMarch, Physical Therapist