PTH 745-Therapeutic Interventions II-Practical 2: Part 1

ICF MODEL

Impairments Activity Limitations Participation/Restrictions

- Right hand - Can’t hold onto - Can’t play with her
tremor
- Slowed speech
objects due to kids on the floor,
and quite voice poor grip since struggles to
- Decreased Gait strength get up from it
speed
- Forward head
- Can’t pick up - Limited at work
posture kids due to since struggles to sit
- Reduction of arm decreased for long periods of
swing on the
right more, but
strength and time
lacking in both trunk support - Can’t ambulate
- Decreased - Struggles to get around her
bilateral step
length
off the floor community like she
- Decreased trunk - Has a hard time used to
mobility in all concentrating
directions
- Decreased grip
at work
strength in right
hand
- Decreased
strength in R UE,
R LE and trunk
- Impaired
coordination with
floor to stand
transfers
- Increased # of
steps on turns
- Narrow base of
support
- Back pain
- Fatigue
PTH 745-Therapeutic Interventions II-Practical 2: Part 1

- Decreased stride
length
PTH 745-Therapeutic Interventions II-Practical 2: Part 1

Plan of Care
Intervention: Strength Circuit Training (One, 3-activity circuit)
Discuss what you are emphasizing for this circuit (strength, coordination, balance, gait, etc).
- Strength and balance are being assessed mainly in this circuit, in order to work on her
impaired balance and decreased strength throughout her body. This combination is essential
in order to help improve the patients ability in order to ambulate her community safely and to
be able to do everyday transfers as well.

Activity 1: Sit to stands with 3lb weight (feet shoulder width apart) to Sally up but only on the ups
controlling her descend until the next sally up (1 minutes) working on strength and endurance with
chair to sitting https://www.youtube.com/watch?v=bql6sIU2A7k
 Progression: Sit to stands with chair, doing squats to the sally up and sally down.
 Regression: Sit to stands no weight with a chair as support, otherwise same as before.
 Rationale: This activity will be utilized for improving strength in the patients lower extremity
specifically her right side since it tends to be weaker than the left. This activity will be important in
order to be able to get up and down at work when helping clients out at her job. Endurance will
also be tested in this activity because the patient will have to complete numerous sit to stands
throughout the song.

Activity 2: Pool noodle/half foam roller smacks in standing from above head to ground counting up by
1s (5 powerful smacks x 3 sets)
 Progression: Pool noodle/half foam roller smacks to ground in standing alternating smacks from
the right to the left side, counting up by 1s with each rep.
 Regression: Pool noodle/half foam roller smacks to ground sitting in chair, with smacks only in the
forward directions
 Rationale: This activity works on strengthening the upper and lower extremity through powerful
movements. Trunk extension and flexion are also being utilized in order to start and end the
movement. This activity is salient for the patient because they can work on strengthening,
improving their trunk mobility in order to be able to be able to do yardwork around her home.
She will also be working on being loud by counting with each rep that they do in order to improve
her expressions.

Activity 3: Boxing with feet should width apart with therapist giving cues of right hit, left hit, right
cross, left cross (10 hits total x 3 sets) Cueing the patient to make sure they are hitting the target hard
while also counting up by 1s after each rep is completed.
 Progression: Boxing while walking with cues of right and left punches given by the therapist.
 Regression: Boxing in standing with only right punches (30 seconds), and then only left punches
(30 seconds)
 Rationale: This activity works on weight shifting in the lower extremity with each direction, upper
extremity coordination to hit the target, and dynamic balance in order to be able to stay standing
when punching into the pad. This activity is salient for this patient in order to be able to work on
coordination and to be able to install trunk rotation into her everyday task when reaching for a
glass out of a cupboard.
Intervention: Gait Training (3 activities)
One of the activities must have a dual task associated with it. Highlight what activity included the dual
task and what type of dual task you included (physical + physical or physical + cognitive).
Activity 1: Reciprocal exaggerated arm swings with forward high marching with walking poles in each
PTH 745-Therapeutic Interventions II-Practical 2: Part 1

hand on a tile surface counting backwards from 20 by 1’s when doing this activity (for 2 minutes x 2
sets) (cognitive + physical)
 Progression: Backward walking reciprocal arm swing with walking poles in each hand, counting up
by 1s after each rep
 Regression: Walking polls in each hand with therapist behind patient, initiating reciprocal arm
swing through the use of polls while the patient walks counting down from 20 after each rep.
 Rationale: This activity works on improving the patients reciprocal arm swing, gait, trunk rotation
and extension when using the walking poles. This is ideal for this patient in order to be able to
improve her gait speed and also to get more trunk movement from her as well. The patient will be
counting backwards from 20 with each step that she takes in order to initial some cognitive
thinking into this task as well. This activity is salient for this patient in order for her to be able to
step over toys at home as well as improving her gait, which will help her to be able to go on walks
again with her friends and husband without fatiguing as quickly.
Activity 2: Walking forward at the patients comfortable speed making wide turns around 2 cones that
are place 30 ft away from each other on a tile surface. While the patient is turning around the cones,
the patient is going to take wide steps around 3 dots, while not touching the dots on the ground. (3
laps x 3 sets)
 Progression: Patient is then asked to pick up gait speed and walk faster around the cones, making
the same wide turns.
 Regression: Patient walks around cones making wide turns as before but with only 2 dots to
maneuver around.
 Rationale: Patient will benefit from this exercise in order to improve her gait speed, turns, and
also her ability to walk on a smooth surface around her home. This is salient for her to be able to
keep up with her grandchildren when they come over to play, to be able to ambulate her house
and at work by decreasing her risk of falls.

Activity 3: Walking forward on tile while reciting as may states as she can (Physical + cognitive) (1
minute x 3 sets)
 Progression: Walking forward while walking on carpet, stating all the vegetables that are green
 Regression: Walking forward on tile, stating the ABC’s in order
 Rationale: This activity will help the patient with her gait while also tying in a cognitive component
into it. This is important so that she will be able to have a conversation when she is walking and
can help with memory/cognition which is something that patients struggles with currently. She
will be working on improving her cognition, balance, overground gait training with the changing of
surfaces from tile to carpet, as well as coordination through this dual task activity. This is
beneficial for her because she wants to be able to go on walks again with her friends and husband
like she used to.
Intervention: Balance Training (3 activities)
One of the activities must have a dual task associated with it. Highlight what activity included the dual
task and what type of dual task you included (physical + physical or physical + cognitive).
Activity 1: Power Rock and Reach in standing: Rocking weight side to side in standing facing a wall
with boom whackers in each hand, reaching towards the ceiling with reciprocal arm. Patient is asked
to follow her reach by turning her head to look at the point she is reaching for with the boomwhacker
(1 minute x 3 sets)
 Progression: Weight shifting side to side to a metronome, touching boom whackers to the wall as
above.
 Regression: Rocking/weight shifting side to side in standing position, keeping both feet on the
PTH 745-Therapeutic Interventions II-Practical 2: Part 1

floor and touching boom whackers to the wall as before.

 Rationale: Patient will be working on weight shifting from side to side, improving her balance. This
will be salient for the patient since she will be working on UE and LE limb coordination in order to
be able to grab items out of the cupboard at home.

Activity 2: 4-point position on floor, combination of power moves: working on power ups into tall
knee then into a power step up move. (3 to demo power up and power step, then combination of the
two (45 seconds, as many as they can) Patient will count each rep out loud by 1’s
 Progression: same as above, just with knees on foam pad to challenge stability on cushioned
carpet
 Regression: working on only power up moves from 4-point position to tall knee, and then only
work on tall kneel step up moves
 Rationale: This task will be beneficial at improving her ability to get off the floor, work on weight
shifting, coordination with the sequencing of getting off the floor. She will benefit from these
power moves in order to get short boosts of energy while balancing on all fours in order to be
able to play with her grandkids on the floor and also be able to feel more confident getting off the
floor. The patient will be counting each rep out loud in order to work on improving her thinking
and also her ability to be speak louder.

Activity 3: Sitting on cushioned mat on the floor with trunk unsupported playing connect 4, alternating
each arm every move. (4 minute game) (physical +physical)
 Progression: Patient is going to be play connect 4 on the floor as above and will try to complete
the game in 3 minutes.
 Regression: Patient is going to be sitting unsupported on the mat as above and will only reach
with her right hand in order to grasp the game chips.
 Rationale: This activity works on dual tasking such as grip strength/fine motor dexterity as well as
working on her anticipatory balance reaching for a game chip in the box. Trunk control and
mobility will also be challenged during this activity when she is flexing and reaching forward in
order to grab the chip pieces. She will benefit from this activity in order to be able to pick up coins
at her banking job, as well as being able to play on the floor with her grandkids.
Intervention: Aerobic Training (1 activity)
You must include your desired intensity and how you plan to monitor your patient.
Activity 1: Cha Cha slide with modifications to some of the moves below in standing. (3 minutes in
duration/whole song- 50-70% HRmax since first time doing activity) explain moves to patient in
beginning. Demonstrating modifications such as hopping is going to be changed to a standing bilateral
power reach keeping feet on the floor, crisscross in the song is going to be crossing the left foot over
the right foot each time to weight bear over the right leg since weaker, and cha-cha’ing is dancing it
out while turning to the right. https://www.youtube.com/watch?v=I1gMUbEAUFw
 Progression: Shouting out the direction to which you are stepping as you do it, and doing the song
another time.
 Regression: Patient is able to do half the song.
 Rationale: This activity will work on endurance, weight-shifting in standing, lateral shuffling,
balance and also being able to follow directions to a cue. This will be essential in order to help the
patient with her cognitive thinking and endurance so that she is able to move around at work and
at home with some agility when she is being asked to play with his grandkids and to do her ADL’s
at home. This activity will also help engage her in some more vibrant and expressive motions
since it is to a beat that she likes to do when she goes to weddings and dances. I plan to monitor
PTH 745-Therapeutic Interventions II-Practical 2: Part 1

her by asking her how they are doing throughout the activity, asking her how she rates herself on
an RPE scale, noticing signs of fatigue, and also looking for any freezing of gait during the activity.
Intervention: Specific UE/hand (2 activities)

Activity/Intervention 1: Standing and reaching to touch wall behind them with boom whackers in each
hand (1 minute x 3 sets with 30 second breaks in between)
 Progression: Reaching across body touching poles or tables to work on trunk rotation and trunk
flexion while taking a step.
 Regression: Sitting and reaching to touch wall behind them with boom whackers in each hand.
 Rationale: This exercise will work on coordination in the UE and trunk rotation as well, while also
improving on trunk mobility in all directions. This activity helps improve her standing balance,
which will be beneficial for her in order to be able to play with her grand kids and to be able to
help her with ADL’s when getting bowls out cabinets in the island behind her when making dinner.

Activity/intervention 2: Sitting in chair without armrests feet in wide stance, patient makes fists
bilaterally with elbows flexed then reaches out in front of her and then extends fingers; this is also
completed bilaterally in out to the side as well. (6 reps in each direction x 3 sets with 30 second
breaks in between set)
 Progression: Patient will be asked to repeat the same task but in standing position.
 Regression: Patient will have paper money and coins in front of her only, otherwise same as
before following cues by therapist as to how much to get.
 Rationale: This activity incorporates UE limb coordination and works on grip strength as well. The
patient will benefit from this exercise in order to be able to pick up objects without dropping
them and to be able to hold onto objects as well. Moving in both the forward and lateral direction
improves her reaching capabilities and also works on finger flexibility while working on really
extending those fingers as she reaches out. This activity is helpful for this patient in order to
incorporate big motions, along with lateral and forward reaching which will be essential when she
is trying to play with her grandkids on the couch and when reaching for notepad at her desk at
work.
Intervention: FES/orthoses
Discuss if FES or an orthosis is indicated in your case and why. What is your rationale for your
decision? If you are considering an orthosis, what kind and why. If you are considering FES or e-stim,
discuss the implementation including settings and activities.

An FES or an orthosis is not recommended for my case since the patient has early-stage Parkinson’s
disease and the gait imbalance occurs internally through the basal ganglia, so orthoses for shoes I feel
like won’t be beneficial for her at this point in her recovery. She has some unsteady gait at times
when making turns and some impaired balance during certain tasks but I feel like she is not meant to
have FES or an orthotic at this specific point in time. Her joints articulate pretty well as they are right
now and she doesn’t have restrictions to ROM in any of the lower extremities so I feel like she would
not be suitable for a device or orthotic.
Section 8: Resources. Provide at least 2 resources you’d give to your client and family to
assist them in the recovery process. Give a web link and brief description of why you are
recommending this resource
1.https://davisphinneyfoundation.org/resources/
This is a good resource in order to find out more information about Parkinson’s disease, finding out
what others have written about their experience living with the disease as well as being part of a
PTH 745-Therapeutic Interventions II-Practical 2: Part 1

foundation that supports those that have the disease as well. There are webinars and podcasts
included on this website that provide helpful information and real life experiences of those that are
living with Parkinson’s disease and their journey.
2. https://www.parkinsonsmi.org/contact/26-programssupport-groups/184-exercise-movement-
activities
This is a great resource in order to find local Parkinson’s classes around throughout the state of
Michigan. I am recommending this resource because it is essential for Parkinson’s patient to exercise,
but also is important for them to have some friends that are going through some of the similar things
that they are so they can feel like they aren’t alone in this process. This is a great way to be social and
get some physical activity in, in a more structured setting so that they don’t have to exercise alone.
Intervention: Patient/Caregiver/HEP Education
Provide 2 activities for an HEP with rationale. Provide two topics on patient education
pertinent to your client’s diagnosis & discuss why that topic is important.
HEP:
1. Sitting Power Up exercise in chair without armrests = push hands out in front of you,
then bring them down to floor, then bring them up towards the ceiling and that is one
rep (10 reps of 2 sets, counting after each rep out loud doing 5 times a week). This
works on trunk mobility in flexion and extension, UE limb coordination with keeping
arms in sync, and also working on balance in sitting.
2. Sitting Power twist exercise in chair without armrests (10 reps of 2 sets, 5 times a
week) = This exercise works on weight shifting, balance, coordination and also works
on improving mobility in the trunk. This exercise can be done at home and can also be
easily replicated by the patient.

Image link: https://www.parkinson.bc.ca/media/253561/pwr-moves-

pd-specific-skill-acquisition-3-page-2020.pdf
Patient Education Topics:
1. Importance of big moves/exercise
- This topic is important because people that have Parkinson’s disease tend to start
confining their movements closer to their trunk, which decreases their ability to
produce more distal movements outside of their base of support. Therefore, the
importance of big moves is to reach for objects, using trunk rotation and weight
shifting exercises in order to create more mobility for the person with Parkinson’s
disease. Exercising anywhere from 4-6 days a week will decrease the progression of
the disease, so it doesn’t have to be a crazy high intensity workout each and every
day, but a couple of days would be ideal. Continuing to do exercise and big moves
throughout their day will be essential in order to keep those nerve endings intact and
to slow down the progression of Parkinson’s disease.

2. Importance of PT for Parkinson’s patients

- Physical therapy is important in order to be able to start slowing down on the
PTH 745-Therapeutic Interventions II-Practical 2: Part 1

progression of the disease. Physical therapy can help people with Parkinson’s find
community programs, help them increase their strength, teach them moves that they
can do every day, and can also help to educate them on the disease and their road to
recovery. PT is more than just coming in for a workout, it also helps develop a bond
between therapist and patient in order to help the patient get better and slow the
progression of the disease down.
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