How do we RETRAIN the BRAIN?
Ever wonder how to RETRAIN the BRAIN? Read on learn all about the wonderful world of NEUROPLASTICITY….
Ever wonder how to RETRAIN the BRAIN? Read on learn all about the wonderful world of NEUROPLASTICITY….
I asked a patient of mine to do a particular exercise "100 Times a Day" last week. I told him I didn't care if he did it 100 times in a row or if he breaks it up throughout the day, but I told him it was the only thing I wanted him to focus for the week. I walked in today, and not only did he tell me he's done it every day, but that one night he went to bed at 11:30PM, realized he forgot and got OUT OF BED to do his last 25. (Yes, this WAS the highlight of my day!)
Now, this is not something I do all the time, and certainly not an effective way to strengthen a muscle or stretch something tight. But what I wanted to do, is 'retrain' his brain to recognize a movement pattern and perform it better to improve his walking pattern. Did you know it takes an average of 2000 trials for an animal to learn a reward-motivated pattern (like tapping a lever for a treat), and even more for athletes or musicians to master a new motor skill involved with their sport or craft?
Rehab is no different. If we are asking our patients to make changes that we hope become habit, we need to follow the principals of neuroplasticity (neuro-what??! Yes, neuroplasticity is one of my favorite words - no surprise there, right!). Neuroplasticity is the ability for the brain to change - and this change can be positive, like learning a new skill, or negative, like losing a motor pattern like walking, dressing or eating, after experiencing a stroke, brain injury or other neurologic injury.
So what encourages 'positive neuroplasticity' - and how DO we 'retrain the brain?' It's simpler than you may think:
Repetition: Back 'in the day,' (aka when I went to grad school), it was thought that we had to complete repetitions in perfect form to retrain the brain properly. This meant lots of hands-on guidance from therapists, and even passive exercise like forced cycling. Fortunately, what the research has shown lately, is that the movement doesn't have to be perfect, but it does have to be repetitive...and INTENSE.
Intensity: Like the old adage says, nothing good ever comes easy, and harnessing the power of neuroplasticity is no different. Retraining the brain is just like strengthening a muscle. If I wanted stronger biceps, lifting a one-pound weight over and over is not going to cut it. I'd have to lift something heavier than I can currently handle, to stimulate the muscles to grow STRONGER to be able to manage this new load. The brain is the same. We need to give it a task that requires focus, concentration and demands attention. It needs to be INTENSE to give the brain a good reason to pay attention!
Saliency: PS. It's also got to MATTER. The brain pays more attention to something that it cares about. Picture someone on an assembly line doing the same menial task day in and day out. This is not salient to that person, but making money to feed his or her family may be, so they show up and do it again each day. We've got to choose tasks, and activities that are interesting, motivating and personally relevant to our patients, to encourage neuroplasticity. Whether this means linking an exercise or activity directly to one of their personal goals, or engaging them in activity that they get joy, pride or some other form of satisfaction from participating in, it’s got to MATTER to make a DIFFERENCE.
Repetition: See what I did there? (ahh, PT jokes...), but seriously, repetition MATTERS, maybe more than anything on this list. I'm learning as I become a more experienced (/OLDER) clinician to give less, while giving more. Ever been gone to PT and been given 10 pages of exercises only to 'lose them' on the way home, or tuck them away somewhere never to be seen again? (yes, I have too...no judgement here). What if we give them ONE thing to focus on - that hits all these criteria - something intense, meaningful and challenging - and ask them to do it over and over again? THAT'S where the magic is going to happen.
So back to my motivated, compliant, amazing patient above. Guess what? I came back to today, and he was walking BETTER. Five days of specific focus on one activity. It works, guys, I promise...
Who are we and where do we go?
Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.
We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.
PWR! Moves for Parkinson’s Disease
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.
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.
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 !
Lessons learned from Bob Saget and why it’s SO important to tell your doctor when you fall!
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:
Have you had a fall in the last year?
(If you’ve had a fall, you are 3x more likely to have another).
Do you feel unsteady while standing or walking?
(This speaks to your balance perception - lack of balance confidence, leads to increased risk of falls)
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
🌟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.
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