Treatment of rigidity in parkinsons patients?

[Liseann]

Hey there,

This question probably has a really simple answer but im stuck on it at the moment. Im trying to find out the best way to treat rigidity in a parkinsons patient and all Im coming up with is massage and stretching exercises. Any ideas?

Its the week before my exams and i would really appreciate some help

[Dr Damien]

your best best would be to use visual and/or cognitive cues

stretching and massage will only reduce the rigidity temporarily and may require passive efforts, you need something that the patient can learn and manage on his/her own

One method is to break down the activity the patient wants to perform into simpler sequences. Then the patient uses cognitive or mental tasks to replay the motion in his mind. He can then include several rocking motions that to achieve each step of the sequence. What you need to understand his the abnormality of movement which might be unique to the patient, therefore using visual cues or auditory cues will serve as reminders for the correction of abnormal movements. After a few training sessions, you can begin to combine all the sequence of movements and may perhaps time the patient as an outcome measure. The smoother the movement, the better the control over rigidity.

These steps are to avoid the onsets of rigidity, however if rigidity occurs before a task is complete you can include the stretching, relaxation (breathing techniques) or massage, postural tone correction using key points on the axial skeleton (e.g shoulder retraction plus elevation of head) to reduce the dystonia. the key is to overcome ridity before it occurs and that takes learning on the part of the patient


An example of these techniques would be

Case study:A patient who becomes rigid when trying to get up from sitting to standing on his walker.

Breaking down the sequence of movement;
hands on arm rest (sequence one)
Foreward head and retraction of shoulder (sequence two)
getting up from chair (sequence three)
Grabbing the handles of the walker (sequence four)
taking the first few steps (sequence five)

Mental/cognitive cues/tasks;
tell the patient to replay these mentions in his mind. You may need to demonstrate these movements and he can recite them as he thinks about them.

Rocking
For every sequence he should rock back and forth to avoid the CNS the time to become rigid. this is similar to the continuous passive movements used for stroke patients to reduce spasticity except this is active not passive.

Using visual cues
you could place colored spots on objects in the room as reminder that when these actions are about to take place, a certain posture is required. e.g head elevation, a flexed head causes protraction and rigidity.

Outcome measure
decrease the time spent on each phase of the movement to mimick a more natural movement

I know this is more than a year late but it may help other physiotherapists with a similar problem in their practice.

LoL