The LSVT BIG ® program is a specialized program designed to address some of the physical limitations which occur due to Parkinson’s disease. These include small shuffling steps, difficulty initiating movements, forward/rounded shoulder posture, and difficulty with every-day tasks such as getting up from a chair, getting in or out of bed and getting dressed. The program has one focus, to increase the amplitude of movement – to make it BIG.
Patients attend physical therapy four consecutive days a week for a one hour session one-on-one with an LSVT BIG® certified therapist for four weeks. In this intense session patients are taken through the “maximal daily exercises” designed to move in all directions BIG. Five functional tasks which the individual and the therapist determine are important to the patient are addressed and repeated using LSVT BIG® movement strategies. Lastly, walking is conducted, encouraging the patient to take larger steps with a natural arm swing, often progressing to multitasking and obstacle negotiation. In addition to the sessions with the therapist, the patient is given a daily carry over assignment as well as a home exercise program which is a mini version of their therapy session. This repetition and consistency, all with the focus on BIG® movements allows the brain to be recalibrated to move in a more “normal” pattern with the added benefits of improved posture and balance.
(LSVT is a trademark of LSVT Global, Inc., registered in the U.S. and other countries)
***For more information please see our article on LSVT and the treatment of Parkinson’s written by Lindsay Wallicky.
Osteoporosis Treatment and Prevention
Osteoporosis and Osteopenia are conditions characterized by a loss of bone density, decreasing bone strength and increasing the risk of facture. The most common population affected by osteoporosis and osteopenia are post-menopausal women. Due changes in estrogen production, the body fails to produce the necessary amount of new bone mass required to maintain strong and healthy bones. Many risk factors are uncontrollable, including age, family history, race (more common in Asian and Caucasian population) and body frame size. Other risk factors within our control include tobacco use, excessive alcohol consumption, diet lacking calcium and sedentary lifestyle. The most commonly affected areas of Osteoporosis and Osteopenia are the spine, wrist and hip. Fortunately, there are now many interventions to help slow the progress of Osteopenia and over time reverse bone density loss. Medications, along with an appropriately designed exercise program can have a significant effect on the progression of Osteopenia and Osteoporosis.
One of the most common injuries secondary to osteoporosis and Osteopenia is a compression fracture of a vertebral body. Compression fractures occur due to the heavy load distributed through a weakened vertebral body. This load is generated with forward flexion motion (bending forward.) Through physical therapy, we are not only able to target the structures of demineralized bone but also reduce contributing factors to the compression forces. Many cases of osteoporosis are accompanied by lumbar stenosis. The combination of these two conditions can be dangerous. As lumbar stenosis progresses, the body will have a tendency to assume a flexed posture (bent over), this posture increases the compression loads on the vertebral body and will frequently lead to fractures. Through a thorough evaluation, your therapist will assess any structures that have adapted to flexed posture by shortening. Essentially, your therapist will address any structures prohibiting you from regain an upright posture through a variety of manual techniques as well as the use of modalities and stretching exercises. While addressing any structures holding the body in a flexed position, your therapist will begin to address and weakened muscles needed to achieve an upright posture. Our goal is to strengthen the muscles of the back and hips to help stabilize the spine.
The final stage of osteoporosis treatment and prevention addresses the demineralization of the vertebral body. The human body will adapt to stresses placed on individual structures. This is known as the S.A.I.D. principle (Specific Adaptation to Imposed Demand.) Through a series of exercises, we will increase the stresses placed on the vertebral body, in manner that will not induce fractures, to stimulate the body to lay down bone tissue. Frequently the term “weight-bearing exercise” is used to refer to the treatment of osteoporosis. While weight-bearing exercises are essential to increasing bone density, in many patients this load is not adequate to stimulate new bone growth. In these individuals, we must create a stress that will induce new bone growth. Specifically designed exercises can generate new bone growth.
A combination of exercises and manual techniques designed to reduce forces increasing risk of compression fractures in conjunction with exercises to increase bone density will help to not only restore postural changes but also prevent future injury.
***For more information written on treatment and prevention of osteoporosis and compression fractures written by Michael Yorke.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is the most common vestibular disorder. While the cause of BPPV is not known, the mechanism is understood. Crystals within a semicircular canal dislodge and interrupt the flow of fluid within the canal. Additionally, these crystals will most commonly create fluid movement when the individual is side lying and send false information to the brain that head is moving. This false information will not match the information being relayed by both the eyes and somatosensory systems. This will generally cause an intense bout of Vertigo where one feels as if the room is spinning. It is very important to understand that BPPV will NOT give you constant dizziness or effect your hearing, produce paraesthia (numbness or tingling) or effect your speech. If you have any of these symptoms please contact a health care provider immediately.
The good news is that there is a very simple and effective intervention to treat BPPV due to crystal issues within the posterior canal known as the Epley Maneuver. The Epley Maneuver uses as series of head movements to flush the loose crystal to the end of the canal known as the cupula. Once the loose crystal settles in the cupula, the crystal will dissolve and symptoms will resolve. The Epley Maneuver is believed to have an 80% cure rate and effective intervention in many case of BPPV.
While the posterior canal is believed to be the most common canal involved with BPPV, at times the dislodged crystal can occur in the horizontal or superior canal. Following a thorough evaluation your therapist will assess whether or not you are an appropriate candidate for the Epley Maneuver and which treatment will be most effective. If you believe you suffer from BPPV, Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”
*** For more information, please see our article on treatment of BPPV written by Alyssa Pillco.
Have you ever wondered what those strips of tape are on professional or Olympic athletes? In the past 10 years, Kinesiotaping has become a common intervention on both the elite athlete and weekend warrior. Kinesiotape is a form of tape that uses its elastic properties to create a proprioceptive effect on the tissues targeted to stimulate a specific response. It is made with all natural properties, so it can be used on many skin types and populations across all age groups, and physical presentations. The effectiveness of the tape lasts up to 5 days, so after applied in treatment it can stay in place and continue to address the deficit even after you walk out of the door of physical therapy.
In physical therapy, Kinesiotape is used as a manual therapy technique that coincides with the exercise, and hands on manual treatment given to increase the progress made. It can be used to facilitate or inhibit weak muscles, or muscles staying in spasm, increase lymphatic drainage, correct mechanical deficits of the body, increase support of certain tendons or ligaments, decrease adhesion, and increase space under specific areas. These are all intended to decrease the pain or stiffness causing your visit into PT. Whether you just underwent a knee or hip replacement, have a lot of shoulder pain that may be radiating down your arm, have an overuse injury, or have chronic pain that just doesn’t seem to go away, Kinesiotape may be applied to help decrease your symptoms. The tape works by creating a stimulus created by the elastic properties of the tape to tell your body how it should be moving during your everyday activities. When coming into physical therapy at All Care Physical Therapy Center, your PT or OT will assess if Kinesiotape will be right for you to increase the outcome of your treatment.
***For more information please see our article “Kinesio Taping and Physical Therapy” written by Sandra Macejak.
Instrument Assisted Soft Tissue Mobilization (IASTM)
Instrument assisted soft tissue mobilization (IASTM) is a manual therapy technique Physical and Occupational therapists may utilize to treat injuries affecting the fascia, muscles, tendons, and ligaments that make up the body. This technique involves the use of tools to help reduce restrictions in tissue mobility, break up adhesions and scar tissue, increase blood flow to the area, and encourage healing of damaged structures. The different shapes and edges of the tools allow the clinician to use them around all of the different contours of the body, which makes them useful for most conditions seen in the clinic.
Common conditions that warrant use of IASTM treatment are joint replacements, Rotator cuff tears and other surgical repairs, plantar fasciitis, muscle strains, and tendonitis. Clinicians may use these tools to break down scar tissue after surgery, decrease pain caused by sprains and strains to ligaments and muscles, reduce swelling/edema, and alleviate nerve restrictions. At All-Care Physical Therapy, we can evaluate you and determine if instrument assisted soft tissue mobilization would be an appropriate intervention as a part of your treatment plan.
***For more information please see our article “A Brief Introduction to Instrument Assisted Soft Tissue Mobilization” written by Olivia Santamaria.
Fighting Osteoporosis Through Physical TherapyApril 8, 2018
LSVT BIG: Exaggerated Movements for Parkinson’s Symptom ReliefApril 8, 2018
Talking the Talk About Walking the WalkApril 8, 2018
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