PWR! Moves for Parkinson’s Disease

This post is dedicated to PWR! Moves Mobility, a therapeutic approach both myself and Dr. Allison Leonard are proudly certified in. There are four main Moves we use in PWR! Moves Parkinson's Therapy. Each of them is special in their own way, but all of them work towards a strong, upright posture that lets you MOVE safety and efficiently in ALL of the direction’s life takes you.

You can read about this therapy on our website at https://healthyagingpt.com/pwr and check out some videos of these moves in action. Read on to learn more about each of these Moves and how they can improve your mobility if you are living with Parkinson’s Disease (or other Mobility Disorders!)

All about the PWR! Up...

The PWR! Up is all about ANTIGRAVITY EXTENSION. This move focuses on the STRENGTH and POWER to rise up from sitting, to squat down in standing and to get up and out of bed. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional muscle patterns that involve the glutes, quads, and scapular muscles and is a GREAT exercise for those of you who may feel STUCK in your chairs when you go to rise up.

All about the PWR! Rock...

The PWR! Rock is all about WEIGHT SHIFTING. This move focuses on the ROCKING and REACHING to achieve MOVEMENT outside of the straight plane. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional muscle patterns that strengthen your HIPS and SHOULDERS and is a GREAT exercise for those of you who may feel STUCK when you go to turn around or reverse directions.

All about the PWR! Twist...

The PWR! Twist is all about AXIAL MOBILITY. This move focuses on the SPINAL MOBILITY to achieve ROTATION across your body. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional movement patterns like OPENING AND CLOSING your arms and is a GREAT exercise for those of you who may feel STUCK when you go to roll over in bed or put on your shirt or coat.

All about the PWR! Step...

The PWR! Step is all about TRANSITIONS AND MOBILITY. This move focuses on the STEPPING STRATEGIES to achieve WALKING and MOBILITY. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional movement patterns like STEPPING and TRANSITIONING is a GREAT exercise for those of you who may feel STUCK when you approach a doorway or go to turn to sit in a chair.

Now that you’ve got an intro to the Moves, you can put them together for an entire Home Workout! Check out these great vides from the therapists at Parkinsons Wellness Recovery - the team that created the PWR! Moves Mobility Program.

PWR! Moves Seated Class

PWR! Moves Class - All Postures

PWR! Moves - Standing with Weights

PWR! Moves - Standing with Bands

To request an Free Phone Consultation to see How Healthy Aging PT can help you, click the button below:

To learn more about our Power over Parkinson’s Group Fitness Class, click the button below:

To learn more about BIG/LSVT & PWR! Moves Parkinson’s Therapy, click here the button below:

April is Parkinson’s Disease Awareness Month

Healthy Aging Physical Therapy strives to give people living with Parkinson’s the support they need to better manage their symptoms - at all stages of the disease.

Chances are, if you’re reading this, you either have Parkinson’s Disease, know someone with Parkinson’s Disease or care for someone with Parkinson’s Disease. This is because Parkinson’s is the 2nd most common degenerative neurological disorder after Alzheimer’s disease, affecting nearly ten million people worldwide. Not only is it a very common disease, but the number of people diagnosed each year is RISING. Whether because we are living longer as a population, or because we are simply getting better at diagnosing this disease, it is estimated that from 1999 to 2015, the number of people living with PD actually DOUBLED.

Impacting the ability of the brain to create essential neurotransmitters like dopamine and serotonin, it also leads to an overabundance of neurotransmitters like acetylcholine. While these imbalances cause all sorts of symptoms in the body, Parkinson’s Disease is most commonly associated with the four cardinal signs: Rigidity, Bradykinesia, Postural Instability and Tremor. While less talked about, but often more disturbing, there are also non-motor symptoms commonly associated with Parkinson’s Disease, like low blood pressure and autonomic dysfunction, impairments in memory and cognition, anxiety and depression, trouble swallowing and frequent aspiration and bowel and bladder dysfunction, just to name a few. Fortunately, there are a number of medications that provide symptom management for people with Parkinson’s Disease by way of dopamine-replacement, or dopamine-support. Unfortunately, as the disease progresses, people often need higher and more frequent doses of these medications, which cause their own slew of side effects, including dyskinesias, the writhing, dance-like movements people often associated with this disease.

What you may not know, is that Exercise and Physical Activity has a HUGE role to play in the management of Parkinson’s Disease related symptoms. Not only can the right kinds of exercise slow disease progress, but it can be incredibly effective at managing both the motor and non-motor signs of Parkinson’s Disease. Beyond exercise, there are also many tips and tricks a Parkinson’s Disease Physical Therapist can teach you to ‘trick’ your body into doing what you want it to do, by taking the focus away from what isn’t working and redirecting it to strategies that will. Healthy Aging Physical Therapy was established to be a support to the Parkinson’s Disease community, by hiring Physical Therapists with advanced training in the care of people with Parkinson’s Disease. To live better with this disease, you need an expert by your side who knows how to guide you through all stages of the disease, as your needs will change as your disease progresses. We have providers who are certified in both BIG/LSVT and PWR! Moves Therapies, as well as providers with extensive experience working with the Americans with Parkinson’s Disease Association, who are here to help you every step of the way. Whether you choose 1:1 At-Home Therapy or join us for one of our Power over Parkinson’s Group Fitness Classes, we want to help you feel and function at your best.

To request an Free Phone Consultation to see How Healthy Aging PT can help you, click the button below:

To learn more about our Power over Parkinson’s Group Fitness Class, click the button below:

To learn more about BIG/LSVT & PWR! Moves Parkinson’s Therapy, click here the button below:

Healthy Aging Tip of the Week - FALL PREVENTION !

ALWAYS TELL YOUR DOCTOR IF YOU'VE HAD A FALL - ESPECIALLY IF YOU HIT YOUR HEAD !!!

Only about half of all falls are reported to the right people (doctors, therapist or the ER.) This means half of all people are putting themselves at risk of head injury or death.

Bob Saget was back in the news this week after autopsy reports showed his cause of death was likely a fall, that caused a brain bleed. Initially, it seemed like he may have fallen backwards, thought nothing of it, and went back to sleep. However, given the fact that he had fractures at the back and front of his skull, it looks more like he had a BIG fall (down a set of stairs, possibly?) and this likely caused what is called a coup contrecoup head injury. These types of injuries can cause major swelling that can put pressure on the respiration centers and other critical areas of the brain. At best, they may cause temporary brain damage that can be reversed with the proper care (draining, shunting, surgery etc), but at worst, they can cause permanent brain damage or death.

As we age, blood vessels become more friable, and taking aspirin or other blood thinners make it more likely to have bleeding in the brain if you hit your head. This is why it is CRITICALLY important that you report any fall in which you hit your head to your doctor right away. I can’t say this LOUD ENOUGH. If you fall, and hit your head, PLEASE TELL YOUR DOCTOR OR VISIT AN ER! There are plenty of good reason to report falls, but this is arguably the most important. Even if you fall, and feel fine, and don’t hit your head, it is still a good idea to let your doctor know. Why? So they can call helpful people like ME to come check your balance, assess your fall risk and help you make a game plan that will help you stay on your feet (and be ready to land safely if you do head for the floor!).

Healthy Aging Physical Therapy takes pride in not only teaching our patients how to prevent falls, but how to be PREPARED for them. Chances are, if you’ve fallen once, you’ll fall again (#facts), so you are better of being ready for it, than going through life scared or trying to avoid any and all potentially fall-causing scenarios (when a new patient tells me proudly ‘oh I haven’t fallen, but I’m REALLY careful’ I know we have problem…). There are ways we can teach you to fall SAFELY with reduced risk of head injuries and fractures, and ways we can teach you to GET BACK UP so you can get on with your day.

There are three questions you can ask yourself to help determine if you are at risk for falls - and whether you may benefit from seeing a physical therapist for fall risk assessment and a course of therapy:

1. Have you had a fall in the last year?

   (If you’ve had a fall, you are 3x more likely to have another).

2. Do you feel unsteady while standing or walking?

   (This speaks to your balance perception - lack of balance confidence, leads to increased risk of falls)

3. Do you worry about falling?

   (Fear of falling = fear avoidance behaviors = reduced activity = increased risk of falls)

If you answered YES to any of these, we would LOVE to help you. And I’m not just saying this to drum up business (we are full and waitlisted!) but seeing stories in the news like Bob Saget’s untimely death just reminds me how important it is to spread the message that FALLS ARE AVOIDABLE and everyone deserves the chance to live life without fear of falling.

Actual Healthy Aging patient REDUCING her risk for falls!

If you are reading this and we don’t see patients in your area, reach out anyways - I’d be happy to try to help you find a good physical therapist near you. There are also GREAT resources out there for education on Fall Prevention and Fall Preparedness, including the CDC STEADI programs which we use to drive our fall assessment and intervention and the Stay on Your Feet AU program, that has some great printable resources.

If you live in and around Wakefield, Massachusetts, consider joining me at the new FUNctional Fitness class starting up at the Wakefield Council on Aging. We’ll meet every Tuesdays from 9-10AM staring March 1st to work on increasing our strength and balance exercises so we can stay ACTIVE and RESILIENT and FALL-FREE. This class is FREE for the month of March, and registration is required ahead of time by calling (781) 245-3312.

If you live further out, or prefer to take classes virtually, I also offer Strong Bones, Strong Life classes through the Steinberg Center for Mind and Body. These classes run in 8-week sessions and are offered Mondays from 1:15-2:15PM and Thursdays from 9-10AM. Focused on Osteoporosis Prevention and Management, we work on strength, postural control and balance designed to improve bone health and prevent falls and fall-related injuries. Next session starts up in March, and we kick off with a FREE Strong Bones, Strong Life workshop on March 3rd, from 7-8PM.

So, remember, if you’ve had a fall, don’t let pride or embarrassment get in your way of saving your life! Let your doctor know ASAP so they can make sure you’re okay and help you get on the path to Fall Preparedness!

See, therapy isn’t that bad…we actually have FUN!

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📆Upcoming Events:

🌟POWER over Parkinson's Class - Wednesdays 10:30-11:30 @ the Americal Civic Center in Wakefield, MA

🌟Strong Bones, Strong Life - Mondays 1:15-2:15PM and Thursdays 9-10AM Online through Steinberg Wellness

🌟Staying STEADI - Starting April 2022!

🌟FUNctional Fitness - Tuesdays 9-10AM @ the Wakefield Council on Aging staring March 1st, 2022

🔗Learn more @ www.healthyagingpt.com/classes

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⭐️Ready to schedule an Evaluation with a Healthy Aging Physical Therapist? ⭐

📞Call or Text: (617) 851 5315

📧Email: Katie@HealthyAgingPT.com

📝or Click the Button below request a Consultation Phone call:

FAQ # 4: How Do I Know if I’m at ‘Fall Risk?’

As you know, I love to counter a question with another question, or in this case, three:

1 ) Have you fallen in the past year?

2) Do you feel unsteady with standing or walking?

3) Do you worry about falling?

If the answer to any of these is yes, research has shown that you are likely at an increased risk for falling. Now while this may seem like a short and sweet, the actual answer is a bit longer and more involved. This is where I come in. When I check to see if a patient of mine is at increased risk of falls, I’m like a detective on a trail. While I may start with these questions, their answers lead me down windy trails where I pick up clues that not only determine IF you are at fall risk, but more importantly, WHY. And it’s the WHY that allows me to help you prevent them. But that’s a story for a different post.

So, back to the question at hand. What do I look at to determine if you’re at risk for falls? 

1) I look at how you move. First and foremost, I look at your mobility, in your own home environment, sometimes when you don’t even think I’m watching (‘hey, can you give me a tour of your house?’). Without even doing another test, this would probably give me the most valuable information I can get. Do you stumble over thresholds? Reach for walls? Get distracted and lose balance with turning? Are there environmental hazards (small pets, throw rugs and more egads!) that could cause you trouble down the road? Is it dark? Is it too bright? Are you moving too fast, or too slow? Are you using assistive devices or may benefit from one? Do your movement patterns indicate an area of weakness or contracture? As therapists, this is our bread and butter. If you’re every hanging with a PT and feel like you’re being watched (or judged), you are! We can’t help ourselves, and we’re truly sorry:) 

2) I look at your balance. Obvi. Your very ability to stand upright, balanced over your base of support requires an intricate and functioning relationship between your feet, your inner ear, your eyes and your brain. This combination is lovingly referred to as your somatosensory integration. It allows you to stay upright, and then allows you to control your body as it moves both purposely outside your base of support - and unpurposely (is that a word?), as in the case of a loss of balance. By putting you in a series of different foot positions, with different degrees of challenge to each of these systems (somatosensory, vestibular, visual), I can identify which system is working and which system could work better - and then develop a plan of action to improve your balance over all. 

3) I look at aaaaallll other systems that are involved with your balance. Do you have pain that surprises you and knocks you off your feet? Limited range of motion in places that make your feet more likely to catch on the stair? Do you get tired easily or have impairments in cardiovascular function that make it more likely for you to pass out? Are you taking medicines that could make you dizzy, or confused or sleepy? Are you taking medicines that make it more likely to get injured from a fall like steroids that can make your bones more brittle or a blood thinner that could put you at risk for a head injury? Do you have other comorbidities that could play a role? Diabetes with fluctuating blood sugars? COPD with oxygen rates that drop when you move? Covid that has left you exhausted and uncertain on your feet? 

Before this FAQ becomes a book, I’ll stop there. As you can tell, there is a lot that goes into answering this seemingly simple question. Fortunately, there are Physical Therapists, like me, who train for years to become Fall Risk Detection experts and are happy to help you figure it out. If you’d like to learn more about fall risk, fall prevention and how I figure this all out, please join me Tuesday night for a Zoom webinar titled ‘So You’ve Been Told You’re UNSTEADI. Now What?’ During this one-hour seminar, I’ll dive deeper into the fall risk assessment process, explain the STEADI initiative, and how it is used by your medical team to determine fall risk and address modifiable risk factors and give you tools to make changes on your own to help you stay on your feet.

To register ahead, please click the link below and you’ll receive the zoom link from there.  

So You've Been Told You're UNSTEADI Zoom Registration

Dementia 101

As a Physical Therapist, I don’t actually ‘treat’ dementia. But, I do treat a whole lot of patients with dementia. Why do people with dementia end up on my caseload? Frequently, people with dementia fall and have fall-related injuries that require physical therapy. People with dementia are also at increased risk for social isolation, malnutrition, inactivity and inevitably, functional decline. And more than anything, because I treat older adults as a specialty, dementia is simply one of the common diagnoses I find on that long list of age-associated diseases that follows my prompt for past medical history.

Now while we all learned about dementia in PT school, and as I’m sure any physical therapist can attest to, knowing the pathophysiology and clinical features of this disease does not inherently make you good at working with someone living with it. The challenge of working with someone with dementia is not knowing what they need (that’s the easy part), but in your ability to actually get a person with dementia to ‘do’ the things - to complete a motor task or physical activity - and even more so, to modify it, progress it, or make it safer for their bodies. This is the part that even the experienced physical therapist (quietly raises hand…) can actually find really challenging.

The Cold Hard Truth

I spent the first five years of my career working as an outpatient neurorehab therapist. The next seven, I spent as a homecare therapist seeing older adults with a wide variety of injuries, illness and sources of of their physical decline. I went to an excellent graduate school (shout out to MGHIHP!). This is not said to impress you, but to lay the ground work that even the most experienced and well-educated therapists may share some of the challenges, preconceived notions and perhaps even prejudices about working with people with dementia that I had. Here’s the Cold Hard Truth: working with people with dementia is HARD. PTs are BUSY. And sometimes, combining a patient whose diagnosis makes them more challenging, with busy schedules and the productivity demands commonly placed on physical therapists, leads us to draw the following common conclusions when we see that word ‘dementia’ on the laundry list of comorbid diagnoses:

“Oh, they have dementia, they won’t have any carryover.”

“This will be quick, I’ll only be in a few sessions.”

“I’ll just do the basics and get out of here.”

“Dementia means they have no potential to get better. I’ll focus on family teaching instead.”

Have you had some of these thoughts, too? Does this make us horrible therapists? Does it make us horrible people? NO! It makes us busy therapists trying to do our best for a large population of people with the resources (time, education, energy, sanity, empathy) that we have. Could we do better? Sure could. Before I dive into how, I want to give you a brief primer on this common brain disease.

Dementia 101

Dementia is not a specific diagnosis, but an umbrella term that accounts for variety of diseases that impair cognition, memory, processing and behavior. While impaired memory may be the classic sign, people with dementia experience a wide breadth of symptoms that progressively impacts their ability to care for themselves and others, to function within their communities, and to remain independent, mobile and healthy. While Alzheimer’s Dementia makes up the majority of dementia cases (60-80%), other types including Lewy Body Dementia, Frontotemporal, Vascular and Multinfarct Dementias are also commonly encountered by physical therapists. While some dementias are reversible (such as dementias due to dehydration or nutritional deficiencies, depression, medication toxicity or metabolic encephalopathy), the majority have a slow, insidious onset and progressive nature. There is, of course, some natural slowing of reaction time and processing associated with aging, and in the pathological realm, a condition known as ‘mild cognitive impairment’ that may share features with dementia, but they remain separate entities nonetheless. There are two key features that distinguish normal age-related cognitive changes and mild cognitive impairment with a true dementia:

1. The individual must demonstrate a decline from previous level of functioning.

2. The impairments must significantly interfere with work or usual social activity.

Early Signs and Symptoms of Dementia

Identified by the Alzheimer’s Association, the following ten signs are commonly seen in early Alzheimer’s disease and other dementias. Of course, many of these can also often be a symptom of other diseases and disorders, so if you find any of these signs concerning, it’s always best practice to bring your concerns to your primary care team.

1. Memory loss that disrupts daily life.

2. Challenges in planning or solving problems.

3. Difficulty completing familiar tasks at home, at work or at leisure.

4. Confusion with time or place.

5. Trouble with understanding visual images and spatial relationships.

6. New problems with words in speaking or writing.

7. Misplacing things and losing the ability to retrace steps.

8. Decreased or poor judgement.

9. Withdrawl from work or social activities.

10. Changes in mood and personality.

Other types of dementia have their own commonly associated features:

With damage found in the brain’s outer cortex, Cortical Dementia tends to cause problems with memory, language, thinking and social behavior, with memory problems generally appearing first.

With damage to deeper structures, Subcortical Dementia causes more change in emotion and movement, along with problems with memory. In these cases, gait disturbances typically appear first.

The cumulative effect of many small strokes, Multi-Infarct Dementia typically presents with a progressive, stepwise decline in mental function and is typically seen in patients with a history of hypertension, smoking and cardiovascular disease.

Similar to multi-infarct dementia, and sometimes used interchangeably, Vascular Dementia is a result of chronic oxygen deprivation throughout the brain. Vascular dementia presents gradually, often presents with changes in vision, sensation and language deficits.

Lastly, there are some types of dementia that develop alongside of other diseases. Lewy Body Dementia can be diagnosed on it’s own or along with a Parkinson’s Disease diagnosis. With a clinical prognosis generally more worse than Alzheimer’s, symptoms typically include syncope, falls, loss of consciousness, delusions and hallucinations. Parkinson’s can also be associated with mild cognitive impairment with or without an eventual progression to full dementia in around 50-80% of patients with Parkinson’s Disease. Common symptoms of Parkinson's Disease Dementia include trouble with memory and concentration, visual hallucinations, depression and frequently, sleep disturbances. Dementias can also be found in people with ALS, Huntington’s Disease and in the setting of Normal Pressure Hydrocephalus and may be a consequence of an underlying brain tumor.

Communicating BETTER With a Person with Dementia

Getting back to my story here, I had the opportunity this fall to attend a virtual Dementia Friends Massachusetts Training. Dementia Friends is a global movement developed in the UK, which has now become a worldwide effort to change the way people think, act and talk about dementia. While this training was not physical therapy-specific (it is actually designed to educate the lay person in the community about being more compassionate to people with dementia) I found I was able to apply what I learned to greatly improve the way I was able to communicate with my patients with dementia, which in turn, enhanced how effective I was able to be as their therapist. In fact, I found this talk so helpful for my practice as a geriatric physical therapist, that I decided to complete the training to become a Dementia Friends Champion, so I can, in turn, train others. I was pleased to find that when I offered this training to other therapists involved in the geriatric community, the response was overwhelming. I currently have sixty therapists signed up to take this training with me in the month of December, and hope it is as helpful for them as it was for me.

So, what was it that I learned in this session that changed the way I treat? It gave me concrete tools to make communication easier, strategies that now enable me to more effectively teach the functional mobility tasks, therapeutic exercises and balance exercises needed to help these patients get stronger, improve mobility and decrease their risk of falls. It gave me a different sense of compassion then I had previously, allowing me to be a kinder, more empathetic therapist. It impressed on me the importance of teaching these skills - to other therapists, to family members, to the community - to widen the network of understanding individuals that surround people with dementia living in our communities. What follows are my favorite take-home messages from this training that I found most influential in my physical therapy practice. If you want to learn more, I encourage you to sign up for a Dementia Friends training session - and if you want to teach it to others, the Champion training.

Dementia slows processing time, but doesn’t make it impossible.

It can take up to 20 seconds from the time you say something, for it to be processed and understood by a person with dementia. While our instinct may be to rephrase or redirect when our initial direction goes unfollowed, try waiting that 20 seconds first. Often, while we may be trying to rephrase to make it more easily understandable, this actually adds more layers to be processed and makes the process more convoluted to the brain. Wait the 20 seconds, then either repeat the same request - or try an alternative approach.

Keep directions clear and simple. Less words. More demonstration.

Visual information is processed in a different area in the brain than speech and words. People with dementia will struggle more and more with explicit direction and declarative learning as their disease progresses. However, the ability to process visual cues, mimic demonstration and learn procedurally remains in-tact longer. Using strategies to promote procedural learning (familiar tasks, repetition, use of functionally-relevant exercise programs) will be more effective than explicitly teaching the task.

Feelings, like emotion, love and happiness, remain the longest.

We’ve all been there. Sitting in a hospital room or an assisted living apartment, with a person with dementia, locked into their own confusion, unable to communicate in any meaningful way. Do we try to communicate or simply work with them in silence? Do we use our tone, words and body language to promote an atmosphere of empathy and caring - or match them with an equal lack of expression. Armed with a better understanding that people with dementia are still able to feel an intrinsic sense of emotion, love and happiness, even without the ability to provide any reciprocity in conversation, I’m far more apt to provide them with a caring smile, accepting body language and efforts to engage them beyond whatever therapeutic tasks I may have planned.

And you know who needs to know this more than anyone? Their families.

The more people that understand these concepts, the better.

How many times do we witness well-meaning family members and friends (even sometimes, coworkers) falling into the pattern of talking ‘above’ their loved one with dementia, as if they aren’t even there? Getting frustrated, even laying blame on lack of effort, or ‘behaviors’ instead of the underlying brain disease that causes it in the first place? Don’t you think if they better understood the cause of these behaviors, and had the tools to communicate with less struggle, that they would be better able to support their loved one in a more compassionate way? There are 5 million Americans living with Alzheimer’s Dementia. There are 16 million others who provide unpaid care for them. Not to mention the community members that interact knowingly or unknowingly these individuals every day. Waiters and waitresses. Medical assistants and other health care professionals. Retail store clerks, librarians and other acquaintances. The more people people we educate, the greater the chance that an individual with dementia can be met patience, empathy and respect.

Ready to become a Dementia Friend?

Check my Upcoming Events page to see if I am offering a training and feel free to join me.

Or, check the Dementia Friends website to find a session local to you.