STAGES OF PROGRESSIVE SUPRANUCLEAR PALSY( PSP)
Middle Stage
People often notice that they are moving into the middle stage when they need a bit more assistance completing daily activities. People who did not get a PSP diagnosis in early stage are likely now diagnosed. The progression and impact of symptoms typically looks something like: Motor symptoms people may experience:
• Regular falls
• Worsened coordination with walking
• Possible freezing of gait
• More difficulty performing manual tasks, such as using utensils Visual symptoms people may experience:
• Difficulty reading and looking down due to eye movement changes
• Dry eyes or blurry vision Speech and swallowing symptoms people may experience:
• Worsening slow, soft and slurred speech
• Coughing when drinking liquids or eating certain foods Non-motor symptoms people may experience:
• Disinhibited or impulsive behavior
• Difficulty organizing thoughts
• Waking up multiple times at night and daytime sleepiness
• Urinary frequency and urgency
• Constipation Impact on daily living:
• Some assistance is needed to complete daily activities such as dressing, showering, getting out of chairs or moving outside of the home
Treatment, care or resources people can utilize:
• Outpatient rehabilitation therapies with focus on strategies to help with daily activities, safety with ambulation and moving, communication and care partner training
• Exercise from a chair with close monitoring and assistance
• Possible benefit from oral medications or botulinum toxin( Botox) injections to manage symptoms, such as muscle stiffness
• Neuro-ophthalmology / optometry for vision concerns
• Use of an appropriate walker and evaluation for future use of a wheelchair
• Grab bars or other equipment in the home to make getting around easier and safer
• Social work and palliative care services for additional support and to initiate discussions around care planning
• Urology and / or pelvic health therapy to manage urinary changes and constipation
• Sleep study or sleep specialist to address nighttime sleep quality and daytime sleepiness
• Occasional or regular professional care services( in-home care or adult day care) may be helpful for added support and assistance for the person with PSP and the family
• Make future healthcare decisions before they need to be made, such as designating a power of attorney and deciding on advanced directives like a do not resuscitate( DNR) order or a living will