Cognitive and Neurological – 4 Articles
ScienceDaily (June 1, 2012) — Exercise helps to alleviate pain related to nerve damage (neuropathic pain) by reducing levels of certain inflammation-promoting factors, suggests an experimental study in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).
The results support exercise as a potentially useful nondrug treatment for neuropathic pain, and suggest that it may work by reducing inflammation-promoting substances called cytokines. The lead author was Yu-Wen Chen, PhD, of China Medical University, Taichung, Taiwan.
Exercise Reduces Nerve Pain and Cytokine Expression in Rats Neuropathic pain is a common and difficult-to-treat type of pain caused by nerve damage, seen in patients with trauma, diabetes, and other conditions. Phantom limb pain after amputation is an example of neuropathic pain.
Dr Chen and colleagues examined the effects of exercise on neuropathic pain induced by sciatic nerve injury in rats. After nerve injury, some animals performed progressive exercise — either swimming or treadmill running — over a few weeks. The researchers assessed the effects of exercise on neuropathic pain severity by monitoring observable pain behaviors.
The results suggested significant reductions in neuropathic pain in rats assigned to swimming or treadmill running. Exercise reduced abnormal responses to temperature and pressure — both characteristic of neuropathic pain.
Exercise also led to reduced expression of inflammation-promoting cytokines in sciatic nerve tissue — specifically, tumor necrosis factor-alpha and interleukin-1-beta. That was consistent with previous studies suggesting that inflammation and pro-inflammatory cytokines play a role in the development of neuropathic pain in response to nerve injury.
Exercise also led to increased expression of a protein, called heat shock protein-27, which may have contributed to the reductions in cytokine expression.
Neuropathic pain causes burning pain and numbness that is not controlled by conventional pain medications. Antidepressant and antiepileptic drugs may be helpful, but have significant side effects. Exercise is commonly recommended for patients with various types of chronic pain, but there are conflicting data as to whether it is helpful in neuropathic pain.
The new results support the benefits of exercise in reducing neuropathic pain, though not eliminating it completely. In the experiments, exercise reduced abnormal pain responses by 30 to 50 percent.
The study also adds new evidence that inflammation contributes to the development of neuropathic pain, including the possible roles of pro-inflammatory cytokines. The results provide support for exercise as a helpful, nondrug therapy for neuropathic pain — potentially reducing the need for medications and resulting side effects.
Exercise for Parkinson’s Patients
(With adept application, many human interventions may be crossed over to non-human animal functional rehab 
)
Becky G. Farley, PhD, PT, MS, knows that exercise is about more than fitness-it is a physiological tool that encourages the body’s own endogenous brain repair mechanisms.
“Exercise promotes brain health and, thereby, may protect the remaining ‘viable’ dopamine neurons, called neuroprotection,” she said.
It also optimizes brain function through activity-dependent plasticity mechanisms that can restore function to damaged pathways, normalize interference from inefficient signaling and increase reliance on undamaged systems.
In July 2010, Dr. Farley founded NeuroFit NetWorks, a non-profit program dedicated to developing and expanding access to research-based exercise programming that is proactive, optimizes brain health/function, and changes the lives of individuals living with a neurodegenerative disease.
Exercise, she said, may at the very least slow motor deterioration in patients with Parkinson’s disease, and, if started early enough, may be able to modify disease progression.
Research, Advocacy & Education
While at the University of Arizona, Dept. of Physiology, Dr. Farley researched muscle activation mechanisms that underlie one of the primary symptoms in patients with Parkinson’s disease. This research led to the development of an exercise program called LSVT BIG™ to target bradykinesia (a slowness of movement) and an NIH-funded randomized clinical trial.
After training more than 5,000 physical and occupational therapists around the world in how to instruct people with Parkinson’s disease in LSVT BIG™ methods, Dr. Farley realized that basic and clinical science research about exercise and Parkinson’s disease is not being translated to real-world application.
“For example, continuous access to proactive neuroplasticity-principled programs that have been shown in animals to slow disease progression.are not available,” she explained. “As it stands now, patients with Parkinson’s disease rarely go to therapy, and when they do, it is usually only after they lose function and start to fall. And those that do go are rarely seen by PD-exercise experts.”
Even if they do find therapists that understand Parkinson’s disease, most patients are not implementing approaches that adhere to the principles of practice that are required to promote learning and plasticity. Instead, outdated guidelines are implemented that promote using strategies or working on secondary impairments like weakness and flexibility.
“No doubt these things help make life better for patients with Parkinson’s disease, but they don’t target the problems that got them to that level of disability. So, ultimately nothing is changed,” said Dr. Farley.
NeuroFit NetWorks plans to change that. The non-profit is advocating for translation of this research now. They have started a national Parkinson Exercise Revolution to help people get better and stay better with exercise. Dr. Farley is conducting training workshops nationally for therapists and fitness professionals to become Parkinson’s disease exercise experts and to work together in their local communities to implement early intervention and continuous access to PD-specific exercise for life.
A model neuro-fitness center in Tucson, AZ, is currently being developed to show how rehab can be accessible and integrated with community fitness programming to optimize learning and function.
“This is the infrastructure that we think offers promise to delay disease onset, slow disease progression, restore motor function, and increase longevity and quality of life for people with neurodegenerative or neurological conditions, and for those individuals at risk for these conditions,” Dr. Farley noted.
It will take advocacy; education of the medical, fitness community and lay public; and working with health care systems to change existing paradigms, demonstrate health care cost savings, and document slowing of motor deterioration.
Research-Based Exercise Programs
All exercise programs at NeuroFit NetWorks are implemented within the context of the Exercise4BrainChange™ (E4BC) model that requires therapists and fitness professionals to incorporate instructions, feedback, and research techniques that promote four essential learning constructs: prepare, activate, reflect, motivate.
These constructs can accommodate multiple exercise approaches and be customized to address a disease’s specific physical/cognitive/emotional deficits. The depth of the content can be modified to allow for a system of communication with a similar language across a variety of therapeutic disciplines and exercise professionals. This is the first time that these essential principles have been described in a manner that can help clinicians implement these concepts immediately with their patients.
“We believe to effect disease modification, proactive models of health care continuums must embrace research-based exercise approaches that are guided by the essential principles of learning and neuroplasticity,” said Dr. Farley. “We call these essential elements “Exercise4BrainChange™ principles” and we have developed a model that integrates all these elements in a way that can promote optimal brain function and skill acquisition.”
Every staff member has undergone training to learn about Parkinson’ disease and exercise and how to modify their instruction/programming to make it PD-specific and optimize the potential for learning and plasticity.
The following programs are offered at the Parkinson Wellness Recovery (PWR!) Gym:
Rehabilitation – 1:1 Exercise4BrainChange. This is where an individual comes to the gym to get a ‘PWR! PLAN.’ They work one-on-one with a therapist that is a PD-exercise expert who educates them about the research on exercise and helps them develop a proactive PD-specific “Use It Or Lose It” program that includes ongoing coaching and tune-ups for life.
Other 1:1 rehabilitation treatments address and target specific problems, such as freezing or postural instability, to “use it and improve it.”
“We integrate research techniques to target bradykinesia/rigidity/coordination/postural instability/posture, such as the training of activated large amplitude whole-body movements; focused practice on axial rotation and extension exercises; paced, rhythmical movements to augmented sensory proprioceptive feedback; rhythmical; treadmill activities for endurance, coordination for gait and balance, and more,” Dr. Farley explained. Clients are progressively challenged to work harder than then self-select. Language and cognitive activities are integrated to increase difficulty, and emotional deficits are targeted through empowerment/education/affirmations to retrain their emotional brain about what they CAN do.
Community – Group E4BC Programming. This program offers PWR! MOVES; PWR! Circuit and specialty classes (agility, strengthening, stretching) that target PD-specific symptoms; and cardio programs for brain health and to prepare the brain to learn! (mobilize neurotransmitters, cell survival and growth factors, boost the immune system, reduce inflammation).
Other enrichment programming to optimize brain health and restoration includes nutrition, stress reduction, brain fitness, and other social or general group exercise activities (drumming, dance, tai chi, etc.).
Retraining the Brain
It is not enough to simply exercise when one has a neurodegenerative disease, noted Dr. Farley.
“It is important to target the anticipated and existing problems with intensive, repetitive practice while receiving certain types of feedback to help you learn and pay attention to critical aspects of the practice,” she explained.
It is also vital that a person is ready to learn and able to manage stress, anxiety and fear to optimize the conditions for learning. That’s why NeuroFit NetWorks has specially trained therapists and fitness professionals that understand how to implement programming to optimize brain health and function for people with different types of conditions.
“Our movements and ability to learn new skills requires active engagement. So, dysfunction in emotional or cognitive systems that interferes with planning, intrinsic motivation, self-monitoring, confidence, etc., interferes with learning,” explained Dr. Farley.
The cognitive deficits in Parkinson’s disease are in the area of executive functioning and attention. These cognitive components are essential for the planning and production of complex whole-body movements; ability to adapt movements/postures to changes in the environment, and automaticity (ability to divide or focus attention for multitasking).
In addition, the loss of dopamine contributes to emotional dysfunction, such as loss of motivation, self-efficacy, anxiety, fear and learned helplessness.
“Evidence suggests that physical exercise improves not only the sensorimotor deficits, but cognitive and emotional deficits as well,” Dr. Farley stated.
She noted that NeuroFit NetWorks is helping people with Parkinson’s disease get better and stay better with exercise, enrichment, education and empowerment.
“We want to have the infrastructure in place when the definitive research emerges that exercise that begins early and is continuous in nature slows disease progression,” she said. “It requires that we advocate for change to existing rehab/health care paradigms that don’t ever see people with Parkinson’s disease until they start to fall; years after the diagnosis.”
A window of opportunity has been lost to begin proactive and disease modifying exercise programs founded in research, said Dr. Farley. It will be years before clinical trials demonstrate the best exercise and the best dosage.
“In the meantime, we are going to implement the best of the best and incorporate new information as it becomes available,” she concluded. “There are studies showing that exercise augments the response to Parkinson’s disease medications in the short term and long term, yet people are rarely empowered after they are diagnosed, and so instead they go home and withdraw.”
Resistance Training and the Older Adult
From the American College of Sports Medicine
Comments and Position Statements
(and, yes, most of the ideas outlined here may be adapted, and have been by me, for functional animal rehab–RehabDeb)
“The health benefits of appropriately prescribed long-term (more than 12 weeks) resistance training in older adults–ages 65 and older–are well known. They include improvements in muscle strength and endurance; other possible health benefits include increase in muscle mass, which translates into improvements in functional capacity. In addition, increased weight bearing with resistance training is considered beneficial in improving bone density and combating the effects of osteoporosis.
Achieving appropriate levels of function is very important for older adults so they are able to carry out most of the daily living skills necessary to lead independent lives. Due to the fact that muscle wasting (sarcopenia) and weakness, exacerbated by physical inactivity, is prevalent in the aging population, more emphasis has been placed on developing resistance-training programs for older adults. When developing resistance-training programs for this group, important components to consider are the various training-related variables: frequency, duration, exercises, sets, intensity, repetitions, and progression.
Older adults often have orthopedic issues that contraindicate resistance training of the affected joint(s). Older adults are also at a higher risk of cardiovascular disease, and in many cases have even been diagnosed with it. Therefore, it is critical that the older adult receive prior approval from their physician before participating in resistance training. It should be noted that proper supervision of the individual’s resistance-training program, including any testing procedures, by an appropriately trained exercise professional, is highly recommended. It should also be noted that performing maximum strength testing in many older adults is not recommended. Therefore, when strength testing is appropriate, sub-maximum testing protocols for estimating maximum strength are recommended.
Frequency refers to the number of exercise sessions per week. The traditional recommendation for frequency is to engage in three training sessions per week for individuals primarily seeking improvement in their overall health and fitness capacity. Even though some individuals may be motivated to train more frequently, resistance-training studies with the elderly have indicated a range of two to four days per week to be effective and adequate in improving strength. So the recommendation is that the older individual train at least two days per week but no more than four, suggesting an average training frequency of three days per week. Also, the frequency of exercise should be structured so that there is at least 48 hours between training sessions. An individual could satisfy this requirement with a “total body” routine, meaning that they would exercise all of the chosen muscle groups during each training session two or three days per week. Another approach could be a “split” routine where some of the chosen muscle groups are exercised on one or two days a week while the remaining are exercised on a separate one or two days. This “split” routine approach may not be appropriate for those older individuals who are just beginning their program.
Duration describes the length of each training session. In reference to training duration, longer training sessions are not necessarily more effective. If one has an appropriately designed program based on sound training variables, lengthy training sessions are not necessary. In fact, older adults should avoid lengthy training sessions, because they may increase the risk of injury, manifested by extreme fatigue. Present guidelines for resistance training in older adults recommend a range of approximately 20-45 minutes per session. In other words, one should attempt to train for at least 20 but no longer than 45 minutes. This range suggests an approximate average duration of 30 minutes per session.
Exercise may be categorized as either multi-joint, meaning more than one joint is dynamically involved to perform the exercise (e.g., bench press, shoulder press, leg press), or uni-joint, meaning only one joint is dynamically involved (e.g., bicep curls, triceps extensions, leg extensions). In the older adult, the resistance-training program should focus primarily on multi-joint exercises. Uni-joint exercises are not discouraged entirely but should not make up the majority of exercises within the training program.
Additionally, machines are recommended over free weights (i.e., barbells and dumbbells) due to skill-related and safety factors. As the individual progresses, they can use free-weight exercises appropriate for their level of skill, training status and functional capacity.
Traditionally, muscle groups are classified as the following: 1) chest, 2) shoulders, 3) arms, 4) back, 5) abdomen, and 6) legs. Specifically, the chest group contains the pectoral muscles, the shoulder group contains the deltoid, rotator cuff, scapular stabilizers and trapezius muscles, the arm group contains the biceps, triceps, and forearm muscles, the back group contains the latissimus dorsi of the upper back and the erector muscles of the lower back, the abdomen group contains the rectus abdominis, oblique, and intercostals muscles, and the leg group contains the hip (gluteals), thigh (quadriceps), and hamstring muscles. In the older adult, it is important to attempt to incorporate all six of these muscle groups into the comprehensive resistance-training program.
It has been recommended that one to two exercises per muscle group is normally adequate. Noteworthy here is to understand that by employing primarily multi-joint exercises in the resistance training program one may actually exercise more than one muscle group or specific muscle per exercise. For example, in performing the leg press exercise the quadriceps, hamstrings, and gluteal muscles are all involved and, in many cases, this could eliminate the need to perform any uni-joint exercises for those particular muscles.
If a person is performing both multi-joint and uni-joint exercises for a particular muscle group, it is recommended that the multi-joint exercise(s) be performed before the uni-joint exercise. Additionally, within each resistance-training workout, larger muscle groups (i.e., legs, back, and chest) should be worked before smaller muscle groups (i.e., arms and shoulders).
Studies have shown improvements in muscle strength employing ranges of one to three sets of each exercise during the training program. Based on current guidelines, it would be recommended that the individual start with one set of each exercise and, depending on individual need, possibly progress up to no more than three sets when the fitness professional deems it appropriate. It should be noted, however, that an average of two sets of each exercise would be beneficial for most individuals. To avoid excess fatigue, a two-to-three minute rest period between sets and exercises is recommended.
Intensity refers to the amount of weight being lifted, and is a critical component of the resistance-training program, considered by many fitness professionals to be the most important training-related variable for inducing improvements in muscle strength and function. In other words, the more weight lifted, the more strength gained. Even though this may not always be the case, the importance of intensity in facilitating strength improvements is well documented. Intensity is often expressed as a percentage of the maximum amount of weight that can be lifted for a given exercise (1RM). For example, if someone who has a maximum effort of 100 pounds on the bench press exercise performs a set with 80 pounds, they would be training at 1RM of 80%. Studies have suggested that older individuals are able to tolerate higher intensities of exercise, up to 85%.
However, research has also shown intensities ranging from 65%-75% of maximum to significantly increase muscle strength. Therefore, in order to increase strength while simultaneously decreasing the risk of musculoskeletal injury that often accompanies higher intensities of resistance training, a low-intensity to moderate-intensity range of 65%-75% is recommended.
Repetitions (reps) refer to the number of times an individual performs a complete movement of a given exercise. There is an inverse relationship between intensity and repetitions, indicating that as the intensity increases the repetitions should decrease. Based on previous research, a rep continuum has been established that demonstrates the number of repetitions possible at a given relative intensity. For example, an intensity of 60% relates to 16-20 reps, 65% = 14-15 reps, 70% = 12-13 reps, 75% = 10-11 reps, 80% = 8-9 reps, 85% = 6-7 reps, 90% = 4-5 reps, 95% = 2-3 reps, and 100% = 1 rep. In view of the previously mentioned recommendations for an intensity of 65%-75% of maximum, this would suggest that for each training exercise the individual perform an adequate amount of weight that would allow for 10-15 reps. In the event that no initial strength testing was performed, simply through trial-and-error an individual could determine appropriate training loads that would allow them to perform only 10-15 reps. They could then be sure of training at 65%-75% of maximum effort.
In order to continually enjoy improvements in strength and functional capacity, it is important to consistently incorporate progression and variation into the resistance-training program. Progressing and varying one’s program commonly involves incorporating the overload principle. The overload principle involves making adjustments to the training variables of the resistance-training program such as frequency, duration, exercises for each muscle group, number of exercise for each muscle group, sets and repetitions. In terms of adjustment, normally the overload principle involves making increases to these variables. For example, making progressive increases in intensity has been shown to be important in increasing muscle strength. In terms of the rate of progression, one should consider attempting to progress their resistance-training program on a monthly basis. However, it should be noted that increasing the intensity in some older adults may be contraindicated due to orthopedic and/or other medical limitations. As a result, making adjustments in other training variables would be recommended.”
Written for the American College of Sports Medicine by Darryn S. Willoughby, Ph.D., CSCS, FACSM
Fighting Foot Drop
From Advance Journal for Human Physical Therapy
My (RehabDeb) Comment:
“Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.”
Employing these techniques in animal-other-than-human rehab is what I do and is highly successful here, as well–proprioceptive training that can also build nerve strength For dogs and cats, I utilize Orthovet footbed splints and Thera-Paws Dorsi-Flex Assist boots on a case-by-case basis.
The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen
Posted on: December 20, 2012
Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.
A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.
Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.
Gaining Control
The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.
“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.
Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.
“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?”
Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. “If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared.
According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.
“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”
“We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.”
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Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.
“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.
The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.
Enter the AFO
If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.
The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.
“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”
Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.
The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”
In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.
Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.
The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.
Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.
“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”
The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements. “If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and a passive AFO system will have to be used,” Thomas shared.
If the patient’s spinal cord has been interrupted in any way, then retraining the muscles would be a very difficult-and maybe even impossible-endeavor.
An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments that interfere with operation of a foot drop system.
Complying at Home
For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, however, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”
Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and I go through the exercises the first day and then send them home with illustrations. I say I will quiz them during the beginning of the next session and will ask them to demonstrate the exercises I assigned.”
With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”
When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”
Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier. “There was a lot less I could do for her compared with what I could have done right after her stroke,” he said. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”
Rebecca Mayer Knutsen is senior regional editor of ADVANCE and can be reached atrmayer@advanceweb.com.
Filed under: RESEARCH CITATIONS (NOT EXHAUSTIVE :))
