By Erica DeMarch - June 14, 2019
By Erica DeMarch - March 1, 2019
By Erica Demarch - December 31, 2018
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