Hello there. My name is and this is today. I'm here with Shelley and Shelley. It's going to talk with us a
little bit about physiotherapy for
Parkinson's disease patients. Hello, Shelley. Hi. Hi,
everyone. Thanks for having me. Thank you so much for being
here. We really appreciate you and all
the work that you do. Thank you
our patients. And uh I just gonna like start a
with a little bit of trying to
get to know um a little bit about
you and a little bit about what
you do for our patients. Um Can you take us through the
education and support services
provided by B CS into society? Yeah. Sure. So
there is a whole variety. Um So it sort of depends on what
kind of supports you're looking
for. Um But um we have a range of
services, for example, we have a information and
referral line where people can
call in or email um with questions in
relation to their Parkinson's
disease. Um and we can answer them from
there or give them other um
organizations to refer to. And um we also have various uh
printed resources like books, uh leaflets we've got online
resources as well, like help sheets on various
symptoms. And we also have uh lots of
programs. So um educational webinars, we
have online exercise classes, activity classes as well, such
as like drumming, singing, uh gardening clubs and things
like that. Um We have support
groups. We have a clinical counseling
program, um a virtual physiotherapy
program which is relatively new. Um And then also a health care
navigation program. So there's a whole lot of
resources out there for people
with Parkinson's. Um and, and not just for them,
but for their family and friends as well. Wow. And
you can find all that online. Yes, you can find all that
online on Parkinson dot BC dot C
A. Um Or if the person doesn't have
internet or they're not sure where to locate
these information, they can always give us a call
um or drop us an email and we can always direct
them to the right place. That's so great. Um Can you tell us what resources
are available uh specifically
for caregivers? Sure. Yeah. So we do have a
caregiving section um on our
website um where you go to the resource
section, there's um sort of a
list of help sheets. Um So there is a caregiving
section there and it's got a variety of
resources there. So we have, for example, a
caregiver booklet. Um It, it's, it's pretty compre
comprehensive. It's like a caregiver guide. Um
It's in printed form. And we do have uh caregiver
support groups as well. So, specifically for care
partners, um who may want to meet with
other care partners, either
online or in person uh to talk about their journeys
with caring for someone with
Parkinson's as well. So there are a lot of resources
for caregivers as well. And um if anybody has questions, they're always welcome to reach
out and we can always direct
them to the right place. Great. So uh can you tell us what uh
drove you to get to the path of
uh physiotherapy on the neural side
of things? Sure. Yeah. And so growing up, I was
actually a competitive dancer, I did a lot of ballet and uh
needless to say a lot of injuries. And so I saw quite a few
physiotherapists myself growing
up. And um I always thought, oh, this is kind of a cool
profession you get to um work in
exercise, which is something that I've
always loved. Um And then as I got a bit
older, um well, older, 18, when I was 18, I actually quit
competitive dancing. Um because it just got to the
point where um it, it was really tough on
your body when you're doing
competitive ballet. Like I was literally dancing
seven days a week um not having
a lot of breaks and it, it was very tough and, and I
kind of wanted something
different. And so at the time, I actually didn't
know what I wanted to do. So then I went to school to do,
um, a Bachelor's in
neuroscience, sort of like a psychology and
science mix. Um, just to see what it was like
because I remember really
enjoying, um neuro in, in high school when I did like a
P neuro and psych, I really
liked that. And so I tried it and then, um, I thought maybe that's what
I want to do. But then I
realized I, um, uh, the course I was doing the, the Bachelor's degree that I was
doing was on a path specific to
research, which I did like, but I don't, didn't think it was something
that I wanted to do forever. Um, because I'm someone who's
quite active and I don't like
sitting down, I don't like being by myself. I like talking to people and
meeting new people. And so I
kind of took that and thought about physiotherapy as a
career. And so I kind of followed that
at the time and it all kind of
came together um, at the right place at the right
time because, um, I also wanted to, one of my bucket list items was
actually to live abroad for a
bit and travel, um, while I was young. And so I
actually did my physio school in
London in England. So that was kind of my
opportunity to travel as well. So I kind of fell into that and
then following graduation I did residency um in all the
different areas to see what I
really liked. And then eventually I kind of
settled in Neo and I applied for my band six um
over there, which is my neural
specialty. And um yeah, became a specialist neurophysin and then um moved back in 2019. And yeah, that's what I've been doing
since. Um what is the role of
physiotherapy and the management
of Parkinson's disease? Sure, great question. So we know through research that
exercise is a huge, huge part of
living well, with Parkinson's not necessarily
just to help with, um, you know, certain motor symptoms and, and, and balance and preventing falls
and things like that. But if you do exercise at the right
time, sea level at the right frequency
and the right types of exercise, it actually has a role in
slowing down Parkinson's. And this is really exciting and
this is really important because in order to
live well with Parkinson's, you sort of need to incorporate
exercise and, and, and kind of have the
mentality of exercising for
life. And while for some people that
might be maybe easier if there's someone
who's always been active and they've always
enjoyed exercise. But if we're being totally
honest with ourselves, I don't think anybody wakes up
in the morning and is gonna feel gung ho about
exercising every day. It's very hard if we're being
honest. Right. Um, and so, and so with physiotherapy, I I, it's
nice to have someone where you
can maybe go through the specific
problems that you're having with your parking
sins and, um, find exercise that can be
specifically tailored for those
needs and, and set a exercise routine and, and even just know how to get
started with exercising for
life. What does that mean? What is the
frequency you need to do? What is the intensity you need
to do and all of those sort of
individual pieces that, that kind of help you, uh put together the exercise uh
program that you would do for
life. Um Even though it, of course
evolves over time depending on
your interest. Um Can you take us through the
assessments you do to evaluate
the needs of each patient? Ok. Yeah. Sure. Specifically
like P D patient. Sure. Yeah.
So, um when I do assessments on a
Parkinson's patient, it's very
much individualized. So, um what I mean by that is I'm
not going to be doing the same um assessment from one
person to the other because it
really depends on um a what they identify their
issues as b what they think
their goals are and maybe c some things that
I'm seeing during um our
conversation, the way that they're moving as
we're talking or the way that they're walking into
the room for the assessment. Um or uh just, just as we go
along our session, there might be some things that
I notice and think, oh, maybe that's something we wanna,
um, discuss a bit further or, or look into a little more. So, um, usually the assessment starts
with a conversation much like what me and you are doing right
now, um, where we talk a little bit
about what the person's main
issues may be right now. Um, um, what they're having
problems with, um, how is their
balance? Are they falling? Um, those sorts of things that, that they're kind of
experiencing on a day to day
basis. And, um, then following that, we might talk about some goals
that they might have set for
themselves. Like, what do they see from this
physio session? Why are they
here seeking physio? What do they want um, out of
these sessions? And then we, it kind of guides us through our
assessment depending on the things that we
talk about. And then in the physical portion
of the assessment after the talking would depend on the
stuff that we talked about. So, um, example, if someone says,
um, they're falling every day,
um, and, you know, we, we might then do dive a little
deeper into that. Ok. When you say you're falling
every day, what exactly is
happening? Is it when you are, um, uh,
walking through a doorway? Are
you freezing? Is that why you're falling? Are you finding that you're
falling whenever you're turning
around? Is it in a certain area of the
home all the time? Is it certain scenarios are you
always falling backwards or at those kind of
questions? Because um um the reason one person may have
balance problems compared to someone else as an example would
be very different, right? Not everyone's gonna have the
same underlying problem that might be causing
their falls. Um using falls as an example. So those would be the kind of
things we'd be talking about diving a little
bit deeper into that. And if someone is saying yes,
I'm freezing as I'm going
through a doorway or, or whatever it may be, then we
might look at that specifically. Ok. Let's have a look at you
walking through. Do I just to see what's going on
there or if they're falling
backwards a lot, we might be testing a lot of
those step strategies to see if they are able to shift
their weight and, and step in multiple different
directions and all sorts of
things like that. So, um it's a pretty vague answer
but it's um it's hard to answer because it
really depends on what the person is looking for
and that kind of directs uh where the
assessment would go, right? How long usually are those
assessments for? Yeah, great
question. So I usually budget for an hour
for the assessment, but it
depends on the person. So there are instances where
I've done an hour with someone, but maybe they need more time. So they might come back on
another day for another part of
the assessment. Um, this would be, um, especially if someone has maybe
some speech problems and it
takes a little bit of time for us to
discuss certain things. Um, maybe they have a care
partner come in and, um, the care partner also has
questions. Um, or if the person is, is
having quite a lot of fatigue, maybe not just physically but
cognitively as well where it's
difficult to, um, be mentally engaged for a
whole hour or something like
that, then it might be split into
smaller sessions into more time. But generally I, I do it in, in
about an hour. Can you explain some of the uh
techniques and exercises you do with uh uh
Parkinson's patients? Ok. Um Well, it depends on what their,
what their deficits are or what
their issues are. Um And we tailor the exercises
specifically for that. Um So for example, if someone is
um having balance issues like
agility, balance issues falls, then a lot
of the times we would do a lot of weight shifting type
exercises, multi directional
stepping exercises, pivoting, turning. Um Lots of things that involves
moving your weight from one
place to the other and trying to keep your center of
gravity on top of your moving
base of support. In this case, your feet. Um So it be things like that if
it was someone who um whose main issue may be
uh slowness and movements. So radio Kinesia then we might be doing
lots of large amplitude
exercises, lots of um reaching, twisting,
stretching, those kind of big movements that
really um uh encourages them to reach to
their, their limits of their range and
things like that. Um, if it was someone who is
maybe more tremor dominant, so their main issue is tremor, then we might be doing a lot of
um forced use high effort type
exercises like punching and kicking and those kind of
exercises. So, um, it sort of depends on
what, what their, what their
issues are, but we would tailor the
exercises specifically to those
issues. Um, and we often get people who
say, oh, I'm having a lot of problem with
my posture and, you know,
posture type exercises. Um, I tend to incorporate the
posture exercises into their
exercise program so that each exercise that
they're doing is not going to be
just for one thing, it's going to be, you know, targeting multiple different
issues that they may be having. Um, but for an example of
posture exercise, it would be a
lot of, um, uh, strengthening exercises through
the upper back through the last,
through the, it would be a lot of overhead
type of movements and things
like that. So, um, the exercise
prescription, um, very much
depends on what the person's,
um, issues are and what their goals
are. And we kind of tailor tailor the
exercises to that. And would that be different
between the ages. Like, if a
person is a bit older they will get, uh, maybe, uh, a different kinds of
exercises and compared with
somebody that's a bit younger. Great question. If we're talking about Parkinson
specifically, um, no, I would do
the exercises, um, uh, to the intensity level
that fits the person regardless
of the age because, um, the whole point of exercise and
Parkinson's, if we're
specifically talking, slowing down Parkinson's is that the exercises have got to be
intense, they have to be
challenging. Um, and they have to be done
frequently enough in order to slow down the Parkinson's
disease, but also change your brain in
terms of neuroplasticity to help you with
motor learning and, and being able to um improve on
your motor skills. So age is not necessarily a factor
when we're talking about trying to
prescribe intensive exercise, but it's more the person's
fitness level, it is more relevant. So,
depending on um, um how active the person was
before you might tailor it to
that. But generally, as a rule of
thumb, we would say the exercises will need to be
sort of at 80% of the person's
max um effort level, sort of, um, even though it's
very um subjective, of course, because it's sort of the
person's perceived exertion
levels, but we're aiming for about 80%
of the max um effort levels that
they can muster. So age is not necessarily a
factor. Um It's more the person's kind
of fitness, ability and tailoring the
exercise to what they can do now
and, and, and work towards the goal more
than, you know, boxing people into
ages. So, traditionally, um, when we talked about
physiotherapy for Parkinson's,
when I say traditionally, I mean, this is like many years
ago now. But, um, when you think about the types
of things you learn about exercise for
Parkinson's and physio school
or, or just many, many years ago,
the school of thinking at the
time was, oh, Parkinson's is, you know, neurodegenerative.
So there's nothing you can do. But maintenance, you can only
maintain someone's ability and, you know, all the exercise
prescription was ok, they're
stiff. So we're stretching, we're
stretching, we're stretching and it was all
sort of about passive stretching and, and,
and, um, and just maintaining, versus now
through research, we know that that's actually not doing anyone
any favors by doing ok. I'm doing a stretching program
every day and, you know, I'm just maintaining because now
we know actually even though Parkinson's is a
degenerative disease, there is a huge role for
neuroplasticity in the sense that the brain can make
new connections, you can actually improve on all
of the physical um abilities
that you have. You know, and it's not just
about maintenance anymore, it's about improving what you
can do, but also trying to slow down the
disease at the same time. So we're now getting away from the
old school of thinking what
we're doing, um, really passive exercises of
just stretching its neural. It's what we call neuro passive
exercises where, where you're doing it for
maintenance, arguably. And probably isn't
maintaining much anyway. But yes, you're doing it for
maintenance is neuro passive. And then we kind of got into the
neuroactive exercise where, ok,
we now know that, you know, exercises can't just
be, um, stretching every day and
that's it. But now we got to add in an
aerobic portion. We now got to do some strength
training and, and, and challenge
people's balance. So that's sort of the
neuroactive exercise that we move from. So we went from neurop passive
to neuroactive exercises where
we're now actively trying to make new connections in the
brain by challenging people in
their exercises. And then through even more research, we're now knowing that we can
actually get away from neuroactive exercise and
move on to neuroprotective
exercise where it's, it's a step up from the
neuroactive exercise in the
sense that, you know, not only are we
challenging people, but we're trying to do exercise
as a way of protecting brain
health and, and, and bettering brain health and,
and slowing down the disease. So then neuro protective exercise would
be an incorporation of all of these things that we
would be, you know, aerobic portion. There's a strength training
portion, there's a coordination
training portion, there's dual tasking portion, there's um choreography and the
exercise that you're doing. So it's challenging your
coordination, your balance,
your, your agility and, and all of these things kind of
incorporated together. And so now the ideal type of exercise you
should be doing is this neuro protective exercise versus, you know, the neurop passive
exercise or even the neuroactive
exercise. Although as a minimum
neuroactive exercise is, it's,
it's better than nothing. But, um, so, so that's sort of how
the school thinking, um, change. Um, well, we usually do that
via, um, uh, outcome measures. Um, which don't have to be
necessarily like formal outcome measures are
designed by someone. It could be something as simple
as, um, maybe you're tapping your foot
on a footstool to, to, um, you
know, for your ability and your weight
shifting and, and you're setting 20 seconds on
the clock and you're counting how many you can do and
you're maybe redoing that again several weeks later
to see whether that's changed from your agility type exercises
or it might be, um, you walking down a hallway,
maybe you walk a certain, uh, distance and then at the same
time you're saying out loud as
many, um, uh, boy names or girl names you can
think of from the letter A down
to Z and that dual task, you're, you're timing yourself doing
that by counting the amount of steps they're
doing during that task and then you retest it
again several weeks later to
see, you know, whether their exercise
program has been doing what's
intended for. So, outcome measure is sort of the
way that you would go about reassessing and seeing
whether someone's gotten better, um, or not. But of course, if someone
develops a new injury or, or something happens and you
need to modify the exercises that's sort of done on
an ongoing basis. So, it's not like we, um, give
an exercise program and then
that's it. See you later, we'll see you in,
you know, six weeks or whatever, but it's sort of an ongoing
process. So every, every time you see them and
you're going over exercises or you're
progressing or regressing
exercises, you're always kind of assessing
on the spot and you're seeing
what you're, what the person is doing and
you're changing or modifying your treatment
plans based on that. So, technically, reassessments
are ongoing all the time. You, you're doing all the time
whenever you're, you're seeing
that person. Um But if you're looking for
like a formal way to, to see whether someone's
improving or not, then outcome measures would be a
way to do that. I see. Usually do you meet in
person uh or do you guys do like
zoom? Yeah, great question. So, through the parking society, the virtual physiotherapy
service is virtual only. Uh well as the name implies is
virtual physiotherapy service.
But the reason is virtual is because
uh P S B BC is a provincial
organization and we need to um we need to have equitable
access to our services. So, regardless of where you live
in BC, you need to be able to
access the service. And so the best way to do that
is virtual, um because you could
be living, you know, in northern BC or on the island
or somewhere else, that's not
the lower mainland and still be able to have the
same service there. So, um luckily for, for Parkinson's, it's actually relatively easy to
do virtual sessions. Um Then maybe other types of
physiotherapy you might see with other conditions
because Parkinson's is exercise
based. So it is um relatively easy to
do virtual sessions where it's
kind of like you watch me and follow along and I
can see your movements and those
kind of things. Um But of course, there are some precautions we
would need to take because if you're not physically there with
the person person and then, you know, if they're a little wobbly or
there's someone you think might um uh is a frequent
follower, then you might be needing to get
them to have a care partner with them during
the session or you do lots of safeguarding things
like you need to find out their emergency contact if
there's someone who lives alone, um, make sure they have like
chairs set up or, or a table set up in a way where
they can grab hold of something
or if they were to fall backwards they
would just sit in the chair and
those kind of things. But through P S BC is all
virtual and how long usually those
virtual sessions are for. Yeah. So the initial session we
usually um give about an hour,
um, the 45 minutes to an hour. It sort of depends on the person
and, and what they're seeking
physiotherapy for and then the follow up sessions are 45
minutes. Um How do you stay up to date with
the latest research in P D
management? Yeah, great question. So there's lots of different ways
you can stay in touch with uh
the latest research, you can either read research. Um uh So subscriptions to um uh
servers that have uh research
articles. Um We also have lots of
educational webinars through P S
BC. So we're very lucky in that
sense because you can attend and the webinars that you host
and they're always held by um people who are doing research
in the field or um experts in the field of
Parkinson's. So through that you can also
learn a lot. Um There's conferences like the
Insight to Parkinson's
conference through, through P D Warrior that happens
every year, which has really, really great information
specific to health care
professionals. Um There is the uh W PC, the
World Parkinson's uh Congress,
which is of course coming. So those are all really
educational um things that you
can kind of seek out. But um basically it, it, in reality when you're
trying to stay up to date with
Parkinson's research, but you're also practicing at
the same time. It's really about allocating time throughout your
days or weeks or month dedicated specifically
to courses or, or attending these conferences
and, and education webinars and
things like that. Beauty. Can you share any fun stories or
like notable outcomes uh from,
you know, your work with, uh, a
Parkinson's patient or patient? Yeah. Sure. Oh, notable stories. Uh, fun
one. Yeah, I mean, I think for me it's very rare that I don't see
someone with Idiopathic Parkinson's get better if we do
an intensive exercise program and they do the program the way
it's intended to do. So, I, I
don't really have, um, stories where the person hasn't
succeeded unless there were
other complications or maybe it was
Parkinson's plus or something
else. Um, but I guess really fun story
was, um, I did have someone, uh, many years ago when I was still
working in England and, um, he had come into our
movement disorder clinic and,
um, he, he wanted a physio, he wanted rehab. And, um, the only goal he had, he
didn't have any goals. The only goal he had was his
daughter was getting married, um, in, in about nine months time and
his only goal was to be able to
walk her down the aisle. I know it was, um, yeah, it was
very inspirational. So that was his only goal and at
the time he was walking, um, but his endurance wasn't great
and he had a lot of freezing
problems and, um, especially when he's out in a
crowd, his freezing was worse. Um, because of, of just having
some anxiety with, with people
watching you and, and, you know, not wanting people to
think you're drunk or, or, or you're a strange man walking
down the street who's freezing
and things like that. So that was the only goal he had
was he wanted to be able to walk a certain distance
and the aisle distance was very
short. It wasn't very long, it was
maybe like 56 m, something like
that. So his goal was to be able to
walk 5 to 6 m without freezing
specific to the aisle. Um And um to be able to, without
having to use his walker. So that was a very, very, um um amazing goal that he had
because it's so personal. And I think a lot of the times
when the person has a very personal
goal, not just a goal like, um
you know, I want to improve my motor
abilities even though that's a
great goal as well. But when you have a goal that's
so specific and so personal, it actually makes it easier to do that in rehab because you
have something very measurable
and very specific. You got a time frame that you
can work towards. So with that we were starting
with freezing strategies of, you
know, if you did freeze, what could
you do? Could you weight shift a little
bit to try to increase your
movements? So your feet aren't stuck on the
spot. And also, of course, um the more
you mimic a freezing episode, the more you actually trigger a
freezing episode. So working a lot of high
stepping length of, of the
stepping, those kind of things, repetitive movements with stepping over things um um using like external cues
like, OK, if you did get stuck,
uh the floor is tile. So could you try to think about
stepping on the lines of the
tile? Um And then eventually, um after doing some of those
strategies we would create and I space in the gym where of
course, it's not the same, but we would
say, OK, so you said it's 56 m,
let's measure out 56 m, let's line up some chairs on the
side and pretend this is the aisle and then let's practice
walking down the aisle and
things like that. So, um that was what we worked on
and, and I thought that was a really
inspirational story because it's
just so personal and it's something that
this man wanted to do really
badly and, and it, it, it was amazing to
work with him on that. It was a privilege to work with
him on that. Wow, that's so
beautiful. Well, thank you so much,
Shelley. Of course. Thank you for having us and
thank you for helping all our P
D patients. I'm sure they really appreciate
you. I hope so. I hope they're not
like Shelley is so negative your salad. Thank you. Thank you for having
me. Thank you. Thank you guys.
See you next time. Got well done. You guys.
