THE ROLE OF PHYSICAL THERAPISTS
THE ROLE OF PHYSICAL THERAPISTS
While many of the signs and symptoms of PSP, CBD and MSA appear similar, understanding the issues specific to each disease can help physical therapists develop and implement more successful treatment strategies.
Progressive Supranuclear Palsy( PSP)
Patients will benefit from continual exercise, physical activity and social engagement throughout the course of the disease, including appropriate group exercise classes. Caregivers should be educated about the likelihood of the patient’ s increased movement impulsivity and decreased safety judgment as the disease progresses.
While the literature on rehabilitation for PSP is limited, it suggests that PT plays a role in managing balance and gait and will be needed at various times throughout the course of the disease.
The acronym“ FIGS” will help to differentiate PSP from Parkinson’ s disease( PD):
F = Frequent, sudden falls( generally posteriorly; occurring early in the disease)
I = Ineffective medication
( antiparkinsonian meds do not work) G = Gaze palsy( vertical) S = Speech and swallow changes
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Treatment Strategies
• Patient and caregiver education about the disease
• Caregiver training in assistance techniques
• Dystonia: Botox( except for antecollis), stretching, positioning / bracing
• Blepharospasms: Botox, eye crutch
• Double vision: prism glasses
• Eye movement exercises, including tracking, searching for objects, reading words placed at various heights on paper on wall
• Aerobic, strength and balance exercises along with fall prevention training
• Gait training, with a focus on large steps with adequate foot clearance and heel strike
• Appropriate assistive devices: generally swivel-wheeled rollators with brakes work well; wheelchairs or scooters will eventually be needed
• Teach safe turns, i. e., U-turns in open spaces, avoiding pivot turns or crossing one foot over the other to turn
• Heel wedge in or on shoe to shift weight anteriorly( may help reduce posterior LOB)
• Home modifications
• Adaptive equipment / devices