Corticobasal Degeneration( CBD)
The role of exercise with this disease is to prevent contractures and disuse atrophy rather than improve coordination. There is no literature to support improvement in FMC via performing in the clinic or in the home.
Signs and Symptoms Initially
• Slowness and stiffness
• Shakiness / UE / LE clumsiness
• Dyphasia and dysarthria and dysphagia
• Changes in gait and balance
• Mild memory or behavior problems
As the disease progresses
• Increased parkinsonian symptoms( rigidity, bradykinesia, postural instability)
• Tremor / myoclonus / dystonia
• Sensory loss
• Increased speech and swallow difficulty
• Cognitive impairments / frontal dementia
•“ Alien limb” phenomenon
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Treatment Strategies
• There is no treatment for“ alien limb”
• Avoid hand flexion / resistive exercise( e. g., Thera Putty ®/ foam squeezes); instead encourage hand / wrist extension to maintain an open hand for functional tasks
• Educate / train patient and caregiver on how to improve safety during ADL via modifications to the patient’ s routine / performance of tasks as well as to their home environment
Recommendations
• Use a shower chair with a back and a handheld showerhead to eliminate turning and conserve energy
• Install a grab bar to decrease risk of falls
• As the disease progresses, employ PROM, positioning and splinting as necessary to prevent contractures; consider a hand therapist consultation for custom splint fabrication
• ADL training – Adaptive techniques / compensatory strategies, adaptive devices( adaptive utensils), DME( bed rails / shower chairs), energy conservation, fall prevention
• Family / caregiver education on how to assist the patient safely throughout disease
• PT consultation for appropriate assistive device evaluation
• Weighted utensils do not always help with tremor and self-feeding deficits
• Generally, swivel-wheeled rollators with brakes work well in the early stages
• Eventually unable to ambulate due to progressive rigidity / cognitive changes; use caregiver assisted wheelchair