May 2024 Newsletter

This month we heard from Dr. Amy Popp, who presented on the importance of an integrative care approach in treating Parkinson’s Disease (PD). “What I Wish All People with Parkinson’s Disease Knew: A Physical Therapist’s Perspective.” Dr. Popp has worked as a physical therapist for the past 13 years, is an adjunct lecturer and contributor to the Neurolab at CSU Fresno, does mobile outpatient therapy, and is board-certified in neurology.

Dr. Popp explained that a care team should last forever. This care team will look different for everyone, but may include medical doctors, respiratory, occupational therapists, psychologists, physical therapists, wellness, speech therapists, social workers, etc. based on the patient’s needs. The ideal scenario for PD management is early diagnosis, and referral to a physical therapist, who would then refer the patient to some kind of wellness, or community exercise, and the patient would go back and forth between community exercise and PT based on progressions, falls, and regressions. Dr. Popp defined ‘wellness’ as exercise not covered by insurance but specializes in helping to manage PD, which is practiced regularly. In comparison, physical therapy is a skilled service that insurance pays for and is more like maintenance (once a week or month). 

Dr. Popp also explained that physical therapy should function more as maintenance, similar to dental care, where a dentist/hygienist is seen every six months (unless something changes), but teeth still have to be taken care of through brushing and flossing between visits. Dr. Popp further explained that physical therapists should be seen at a minimum of every six months. This should also be covered by insurance.

The goals of physical therapy include restoring, maintaining, and compensating. Techniques and focus areas should be tailored to the individual. Physical therapy should also focus on motor and non-motor concerns/symptoms, and impairments (Tremor, dyskinesia, pastoral instability, and gait). Some strategies include active stretching and external cueing. External cueing relies on external information to inform actions. One example of this is “step to this line” instead of “take a bigger step.” These cues can be auditory, visual, or mirroring. It is also important to address task-specific concerns, such as sit-to-stand, turning, bed mobility, gait training (arm swing, large stepping, dual tasking, uphill/downhill, etc.), Resistance training, balance training, and more.

Aerobic training is another important part of managing PD. This helps with cognitive decline, bowel irregularities, and endurance. Spending more time in higher-intensity zones can lead to a slower progression of PD. Dr. Popp explained that the minimum amount of aerobic training is thirty minutes a day, three times a week (at least 2.5 hours a week). To get to this goal, Dr. Popp recommended trying to increase the time spent on aerobic training by a minute every week. Activities can include using the treadmill with a harness to reduce falls, stationary bike, swimming, walking, and more. 

To combat freezing, Dr. Popp recommended the technique of the 4 S’s (Stop, stand tall, sway, and step big). Dancing and mirroring, counting, stepping over painter's tape, and using light cues or a U-step walker can also help combat freezing. Another strategy Dr. Popp recommended clock turning, or visualizing a clock face on the ground and stepping, and ski walking.

Dr. Popp further explained that vestibular therapy can also help with balance. This is because people with PD rely heavily on vision instead of proprioception. Vestibular therapy helps to challenge the ear/brain, vestibular systems, and somatosensory/proprioception to work harder.

Blood pressure is another thing that can be affected by PD and should be monitored. PD can cause a drop in blood pressure, especially when one changes in sitting or standing. This is a problem when blood pressure is below 90/50. Exercise can help with developing a more normal blood pressure. In PD, a drop in blood pressure can often cause freezing, not dizziness. 

Dr. Popp also recommended pelvic health specialists for care teams. This is because pelvic health specialists can help manage the constipation and urinary symptoms of PD. Frequency and urgency can increase stress, which can lead to more falls and a decreased involvement in exercise and wellness classes. A stiff posture can also mean a stiff pelvic floor.

Dr. Popp would also like people with PD to know that motivation is difficult. One way to combat this is adding a dopamine goal like an activity tracker and accountability. Accountability can also be found with participation from family and/or caretakers. One app Dr. Popp recommended was Strive PD. Exercise is incredibly important in managing PD symptoms, as Dr. Popp explained, “If you stop exercising, your symptoms will come back.” Consistency is also important in using exercise to manage PD symptoms because the more active the better the quality of life.