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2009 SAE-P: Rehabilitation Intervention in Parkinson Disease: Focused Review
Answer Key and Commentary
2009 SAE-P: Rehabilitation Intervention in Parkinson Disease: Focused Review Question: 1. Answer: (d)
Question: 4. Answer: (a)
Commentary: Significant improvement in quality of life was attributed to better sleep cycle regulation, which appeared to be sustained at 3-month reassessment. The study also reported improved speed and integration of motor control.
Commentary: Although the pathophysiology for freezing of gait is unclear, treatment strategies that have been beneficial include the use of assistive devices for augmentation of proprioceptive delivery, along with relaxation and reinitiation of gait with proximal hyperflexion. The use of selftriggered laser beams attached to wheeled walkers or canes can provide a visual cue to initiate this proximal flexion response. Partial body weight-supported treadmill training was superior to standard physical therapy in increasing gait velocity but has not been directly studied in the treatment of freezing of gait.
Question: 2. Answer: (a) Commentary: The strategy of using external sensory (visual and auditory) cues is based on the observation that patients with Parkinson disease have a reduced central delivery of proprioceptive feedback. The use of these aforementioned visual cues improved stride length and more effectively improved initiation than did auditory cues, which incorporated the use of music and metronomes. An alternative theory is that these cues enhance attention to gait tasks rather than serve as a compensatory strategy to enhance feedback. Question: 3. Answer: (b) Commentary: Eccentric strengthening was found to result in greater muscular hypertrophy, force generation, and mobility than concentric exercises. Further, in a small test group, eccentric resistance exercises of both lower limbs for 12 weeks failed to show significant elevation in serum creatine kinase levels or differences in visual analog scale scores.
PM&R
S50
1934-1482/09/$36.00 Printed in U.S.A.
Question: 5. Answer: (d) Commentary: Surveys examining the burden of care sustained by spousal caregivers of patients with Parkinson disease (PD) revealed the need for both fall prevention and recovery training to minimize potential injury to the caregiver. Prolonged duration of their mate’s PD was identified as the strongest predictor of spousal caregiver depression. Failure to sustain benefits from a structured, multidisciplinary rehabilitation day program has been attributed to mistiming of the intervention. In the advanced stages of PD, particularly among the elderly population and among persons with significant cognitive impairment, rehabilitation efforts should be refocused on caregiver training.
© 2009 by the American Academy of Physical Medicine and Rehabilitation Suppl. 1, S50, March 2009 DOI: 10.1016/j.pmrj.2009.01.010
2009 SAE-P: Rehabilitation Intervention in Parkinson Disease: Focused Review Question: 1. Answer: (d)
Question: 4. Answer: (a)
Commentary: Significant improvement in quality of life was attributed to better sleep cycle regulation, which appeared to be sustained at 3-month reassessment. The study also reported improved speed and integration of motor control.
Commentary: Although the pathophysiology for freezing of gait is unclear, treatment strategies that have been beneficial include the use of assistive devices for augmentation of proprioceptive delivery, along with relaxation and reinitiation of gait with proximal hyperflexion. The use of selftriggered laser beams attached to wheeled walkers or canes can provide a visual cue to initiate this proximal flexion response. Partial body weight-supported treadmill training was superior to standard physical therapy in increasing gait velocity but has not been directly studied in the treatment of freezing of gait.
Question: 2. Answer: (a) Commentary: The strategy of using external sensory (visual and auditory) cues is based on the observation that patients with Parkinson disease have a reduced central delivery of proprioceptive feedback. The use of these aforementioned visual cues improved stride length and more effectively improved initiation than did auditory cues, which incorporated the use of music and metronomes. An alternative theory is that these cues enhance attention to gait tasks rather than serve as a compensatory strategy to enhance feedback. Question: 3. Answer: (b) Commentary: Eccentric strengthening was found to result in greater muscular hypertrophy, force generation, and mobility than concentric exercises. Further, in a small test group, eccentric resistance exercises of both lower limbs for 12 weeks failed to show significant elevation in serum creatine kinase levels or differences in visual analog scale scores.
PM&R
S50
1934-1482/09/$36.00 Printed in U.S.A.
Question: 5. Answer: (d) Commentary: Surveys examining the burden of care sustained by spousal caregivers of patients with Parkinson disease (PD) revealed the need for both fall prevention and recovery training to minimize potential injury to the caregiver. Prolonged duration of their mate’s PD was identified as the strongest predictor of spousal caregiver depression. Failure to sustain benefits from a structured, multidisciplinary rehabilitation day program has been attributed to mistiming of the intervention. In the advanced stages of PD, particularly among the elderly population and among persons with significant cognitive impairment, rehabilitation efforts should be refocused on caregiver training.
© 2009 by the American Academy of Physical Medicine and Rehabilitation Suppl. 1, S50, March 2009 DOI: 10.1016/j.pmrj.2009.01.010