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HOW

WHY

WHEn

The Effect of External Attentional Focus to Improve

BIG Amplitude in Patients with Parkinson’s Disease

Eman A., SPT, Susan B., SPT, and Kendra G., SPT

Patient’s history and presenting symptoms

A.A. is a 73 years old who has a medical diagnosis of Parkinson's disease and unspecified Dementia

Clinical Problem

WHAT

  • Freezing
  • Lack of Initiation
  • Reduced Cognitive Ability
  • Extensive Load on the Caregiver

Perspective

Previous and New Information of Factors contributing to improve gait and decrease freezing periods

WHAT

add

subtopics

Tutorial Case

  • Treatment different considering different type of freezing
  • External Cues: Verbal, manual, visual, tactile, demonstration.
  • MInimize executive loading during cognitive phase.
  • Big movements for UE and LE.
  • Include caregive in POC
  • Retropulsion (debate).
  • LSVT BIG: gross and motor skills

add

subtopics

Strategies Applied during first session

CPG recommendations:

  • Aerobic
  • Resistance
  • Balance
  • External cue: Manual, Verbal, Tactile, demonstrations. Feedback of demonstration and of results
  • Task specific
  • Integrated care

IDEAS

Evidence Based Practice

From Research

TITLE

  • Can dual task walking improve in Parkinson’s disease after external focus of attention exercise? A single blind randomized controlled trial.
  • Effect of external and internal focus of attention on acquisition, retention, and transfer phase of motor learning in Parkinson’s disease.
  • External focus instructions reduce postural instability in individuals with Parkinson disease.

IDEAS

Discussion of Outcomes

Differences

TITLE

  • Gait Speed and Analysis under normal conditions

VS.

  • Gait Speed and Analysis with external attentional focus

References

  • Beck EN, Intzandt BN, Almeida QJ. Can dual task walking improve in Parkinson’s disease after external focus of attention exercise? A single blind randomized controlled trial. Neurorehabil Neural Repair. 2018;32(1):18-33. doi:10.1177/1545968317746782
  • Kakar C, Zia N, Sehgal S, Khushwaha S. Effect of external and internal focus of attention on acquisition, retention, and transfer phase of motor learning in Parkinson’s disease. Hong Kong Physiother J. 2013;31(2):88-94. doi:10.1016/j.hkpj.2013.02.001
  • Osborne JA, Botkin R, Colon-Semenza C, et al. Physical therapist management of Parkinson disease: A clinical practice guideline from the American Physical Therapy Association. Phys Ther. 2022;102(4). doi:10.1093/ptj/pzab302
  • Wulf G, Landers M, Lewthwaite R, Töllner T. External focus instructions reduce postural instability in individuals with Parkinson disease. Phys Ther. 2009;89(2):162-168. doi:10.2522/ptj.20080045

Thank you

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