Parkinson s disease and Femur fracture

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1 Clinical Decision Making Lecture 12 Case Study (Parkinson s Disease and Femur Fracture) presented by Y. Ko,Y. Kim, H. Kim Haneul Lee, DSc, PT

2 Parkinson s disease and Femur fracture

3 CONTENTS 01. INTRODUCTION 02. BODY 03. CONCLUSION What is the PT? Patient introducing Background Information Past history review Reevaluation S.O.A.P Exercise Treatment Summary Q&A

4 01 INTRODUCTION

5 01 What is the PT? Physical therapy ADL Occupational therapy PT aims to improve basic skill [BADL] OT aims to improve complex skill [IADL]

6 PT s core area balance Body postural gait Physical inactivity transfer Grasping & reaching

8 02 Patient introducing

9 Background Information

10 Joannes Paulus II Susan Hayward Muhammad Ali Ronald Reagan

11 01 What Parkinson s disease? Resting tremor Bradykinesia 4 major symptoms rigidity Unstable posture [ Keywords ] Progressive chronic motor disorder, Midbrain, Substantia nigra, Zona compacta, Dopamine

13 02 Parkinson s pathophysiology

14 02 Parkinson s pathophysiology No accurate cause By certain cause, substantia nigra impaired Dopamine which regulates basal ganglia lackage Encephalitis, trauma, syphilis, carbon monoxide poisoning, shock, accident, drug intoxication Influenced by age, genetic, environmental, toxin etc

15 02 Medication acetaminophen Colace sinemet Hydrocodone Sinemet

16 03 What is Levodopa? 도파민의전구물질인 L-dopa 가뇌에도달 뉴런이 L-dopa 를도파민으로전환 Levodopa 부작용 상실된도파민대체약물 메스꺼움 ( 구토 ) 오심저혈압이상운동인지기능장애

17 04 Diagnosis method(pd) MRI (magnetic resonance imaging) UPDRS (The united parkinson s disease rating scale) 뇌의구조적인이상유무를확인하여감별 정신행동및정서, 일상생활활동, 운동기능검사, 약물치료부작용등검사

18 MRI(magnetic resonance imaging)

19 What is UPDRS? Non-motor experiences of daily living 정신검사항목 Part1 Part2 Part3 Motor complication 운동기능과관련된합병증검사항목 Motor experiences of daily living Part4 일상생활활동검사항목 Motor examination 운동기능검사항목

21 01 Hoehn & Yahr scale

22 05 Schwab classification 등급질병발생의기간설명 Ⅰ 증상이진단후최소 5 년간전반적으로안정적이다. 독립적으로문제없으며약간의치료가필요하다. Ⅱ 5년후약간진행이관찰된다. 대부분독립적이며적당한약 물치료가필요하다. Ⅲ 3~5년후현저한진행이관찰된다. 대부분독립적으로살수없으 며부분적인운동장애가있다. Ⅳ Ⅴ 3~5 년후심한강직과떨림으로진행되며 8~10 년후에는양측으로진행한다. 몇개월내심한강직. 떨림운동장애가오며, 1 년이내급작스럽게발병한다. 보행은가능하나, 심한운동장애가있다. 운동불능상태

23 06 Modified Ashworth s Scale(MAS)

24 07 Function of femur + WALKING RUNNING ESSENTIAL Supporting the weight that passes through the pelvis and hip joint

26 ORIF (open reduction internal fixation) 이란? 고정기구를피부이하에위치하도록삽입하여고정하는방법으로빠른재활과일상생활의불 편을감소시켜준다.

27 01 What is ORIF PRECAUTIONS Stress Infection Bone destiny

28 01 Past history review 3 년전파킨슨병발병 넙다리뼈골절 ( 당일 ORIF) 전문요양방문 [ 입원 ] 외래방문

29 2 BODY

30 02 Reevaluation/Reexamination

31 02 S.O.A.P note S(Subjective) CC(chief complaint): Lt. hip pain & inconvenient gait pattern Discontinued from skilled nursing facility Independent self-care, but limited endurance with pain Rt. Shoulder and Hip pain (Rt. Hip pain VAS 4/10, Rt. Shoulder minimum pain VAS 1/10) Rt. Hip pain increased during running & excessive weight bearing Independent gait Motivated for rehabilitation using group & acuatic exercise

32 02 S.O.A.P note O(objective) V/S- T: 36.7, HR : 79 bpm/min, RR:18/min, BP:120/72 ROM Lt. Hip flexion 90 /120 Rt. Hip flexion 110 /120 Lt. knee flexion 130 /135 Rt. Knee flexion 125 / 135 MMT Lt. shoulder abduction 4- Lt. hip flexion 3- Lt. hip adduction 3- Lt. quadriceps 4 Rt. hip abduction 3 Gait both gluteus medius severe rigidity(left) 왼쪽다리에대한구두지시를통해서벌림근의활성으로인해 6 inche 계단을 3 개올라갈수있다. 계단을내려가는것은불가능하다. Berg-42/58 Measurement scale -hoehn and Yahr scale

34 02 S.O.A.P note A(Assessment) 1 Limited Strength and Balance 2 Abnormal Gait pattern 3 Abnormal body posture(postural dysfunction) 4 Post-ORIF pain in Lt. Hip

35 Plan

36 *Principle of therapy* 1. 치료시항상치료사가환자곁에서상태를모니터링한다. 2. 골절에유의해서실시한다. 3. 모든치료는최대주 3~4 회실시한다. 4. 모든치료는환자의상태에따라유동적으로수정될수있다.

37 02 Parkinson dz 보행시나타나는양상 짧은걸음걸이발을질질끌면서걷는양상팔움직임의저하 ( 구축이생겨서 ) 앞으로기울인상태에서걷기점점빨라지는보행 ( 속도증가 ) 낙상

39 02 Stage 1,2,3,4 Stage 1 Stage 2 Stage 3 Stage 4 Pain management Pain management Pain management Pain management Simple isometric ex. Simple isometric ex. Flexibility exercise Flexibility exercise Flexibility exercise (Rom 위주로 ) Aerobic exercise Flexibility exercise (Rom 위주로 ) Aerobic exercise Strength exercise Aerobic exercise Strength exercise Gait training Aerobic exercise Strength exercise Gait training Gait training

40 02 Therapeutic exercise Aerobic exercise warm up Strength exercise Balance Gait training Flexibility exercise cool down

41 02 Pain management + Medication acetaminophen hydrocodone [ Ultrasound ]

42 02 Aerobic exercise warm up 3 times a week 15minute a day

44 02 Strength exercise

47 02 Balance training [Tetrax] [Education of using cane]

49 02 Gait training 팔다리흔들기 treadmill parkinson s exercise program

51 02 Flexibility exercise cool down Exercises for Parkinson's: Flexibility Exercises

52 02 Group exercise 그룹치료의운동효과 - 우울증예방 music start

54 02 Diet 식이섬유섭취, ( 콩, 곡물, 과일, 야채 ) 물을많이섭취해야함 8 잔이상

55 02 What is dysphagia? 정의 : 인후두의기계적인협착, 또는입술, 혀, 구개, 인후두에관계하는운동성뇌신경핵 ( 안면, 미주 설하신경 ) 의장애 ( 가성구마비 ) 에의해연하가곤란하게되는것. 호흡훈련흉식호흡 풍선흡입구강호흡 - 촛불끄기, 비눗방울불기, 풍선불기 능동적인자극법입술훈련 - 입의개폐운동 이 발음하기볼훈련 - 혀내밀기, 혀들어올리기

56 3 CONCLUSION

57 Summary

58 03 Refernece 1. categoryno=0&currentpage=1&sorttype=recent&isfromsearch=true 2. 질환별물리치료 1,2 민경옥, 김순희 / 도서출판대학서림 3. 신경계질환별물리치료 - 윤범철외 8 / 현문사 4. 신경계질환별물리치료 - 박지환외공저 / 현문사 5. Allied health care interventions and comlementary therapies in Parkinson's disease 6. 물작메 ; 물리치료사의작은메모장 7. Hip fracture-diagnosis, Treatment, and Secondary Prevention 8. Gachon univ. 'Clinical decision making' Lecture1, Lecture The effects of treatment with a TETRAX on balance and mobility in acute sto rke patients 11. Music therapy interventions in Parkinson s disease: the state-of-the-art.

59 ANY QUESTION? 감사합니다

61 Critical ThinkingQuestions 1. How would you document your treatment in the SOAP or Patient Management format? 2. If the treatment goes as expected, what will you do for the next treatment? 3. How would you expect this patient to progress over time? 4. If the patient does not progress as expected, what might be some reasons for a lack of progress? 5. What signs or symptoms, if observed or reported by the patient, would cause you to hold treatment and check with the nursing staff, MD?

62 Critical ThinkingQuestions After reviewing the continuum of care for this patient, consider the following: 1. How did the patient s problems change over the months after his fracture? 2. How did this affect the goals and the interventions that the PT included in the POC? 3. How were the same interventions modified over time to progress the patient according to his changing needs?

63 Implications of Pathology for PT 1. What are the patient s risk factors for falls and how might the PT incorporate fall reduction education and techniques throughout the interventions in the different settings? 2. How might the timing of Parkinson disease medications affect the physical therapy interventions? 3. How would cognitive impairment, as is common with later stages of Parkinson disease, affect your approach during the physical therapy interventions? 4. What should the PT be aware of when working with patients with the following Spinal fracture Lower extremity fracture Upper extremity fractures

Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie

Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie Volume 12, Number 1, 92~102, An Intervention Study of Pain Reduction during IV Therapy in Hospitalized Children Myo-Jin Kim 1), Joung-Hae Bak 1), Won-Seok Seo 2) Mi-Young Kim 3), Sun-Kyoung Park 3), Jai-Soung