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
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
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