The Exercise Files: How to Choose a Physical Therapist for PD

Posting for Dr. Hackney this month is Cameron Jadali, PT, DPT, a physical therapist working at Emory University where he teaches in their doctorate of physical therapy program, conducts PD research with Dr. Lucas McKay, treats PD patients in the Movement Disorders Clinic, and receives specialty training to become a Neurologic Clinical Specialist.

I would like to start by thanking PD Gladiators for giving me the opportunity to speak on this issue, and for continuing to combat PD on all fronts.

When people think of physical therapy (PT), they often think of the cliché image of a person being stretched and massaged on a table. However, in the PD population, finding the right therapist is paramount in prolonging functional mobility, optimizing movement, and preventing falls/injury. But how do I choose the right therapist?

Madeleine E. Hackney, PhD The Exercise Files blogFirst and foremost, you want to make sure your PT has either extensive experience with or training in treating PD patients. To understand the nuances of Parkinson’s Disease and provide the best treatment possible, this experience is key. Here are a few things that a neurologic or Parkinson’s specialist can offer:

• Knowledge of the most current PD treatment and exercise research (many of us are involved in this research) to know which treatments work, and which do not
• Personal relationships with referring PD neurologists to better coordinate care
• Knowledge about the effects of your medications, and how they may be affecting your movement and symptoms
• Certifications in special treatments such as LVST BIG, PWR, boxing, tai chi, tango, and other therapies designed to target parkinsonian symptoms
• Experience with patients in all stages of the disease and with varied presentations. This lets the therapist create an individualized treatment plan tailored to your needs
• Local connections with different PD support groups, opportunities to be a part clinical research trials, fitness venues, and social events
• The ability to provide “One and Done” evaluations and programs for patients who are not geographically close to specialist centers (often times communicating your plan of care to a PT/exercise specialist/class instructor in your area)

In a world where insurances often limit the amount of therapy visits you receive, all of the aforementioned qualities of a PD specialized therapist help ensure that you get the most bang for your buck. That being said, I want to stress the importance of beginning, maintaining, and advancing your exercise program. We are discovering that exercise can improve many of the symptoms of PD, not just those associated with movement[1]. These recent discoveries only solidify PD Gladiators’ mission to combat PD through vigorous exercise! I also would like to stress the importance of discussing your exercise plan with a PT, even if they are not a specialist. PTs of all backgrounds can help you continue your exercise program and active lifestyle with maximum results!

When looking at skilled PT interventions combined with an exercise program, PT is shown to be effective at increasing walking speed, functional independence, and UPDRS score[2]. Furthermore, recent studies have found motor and non-motor PD symptom improvement with advanced treatments such as treadmill training[3], advanced cuing[4-6], tai chi[7], and other techniques[8,9]. Just think of the potential benefits of tag teaming with a therapist who has all of these tools at their disposal. I hope that this blog was educational and helped create more informed health care consumers who are in control of their care, and ultimately more in control of their disease.

References: CLICK HERE to view complete references to published research cited above.

Dr. Madeleine E. Hackney, Ph.D, is a Research Health Scientist at the Atlanta VA Center for Visual and Neurocognitive Rehabilitation and an Assistant professor of Medicine in the division of General Medicine and Geriatrics at the Emory School of Medicine. She holds a Ph.D. in Movement Science from Washington University and a BFA in Dance from NYU, Tisch School of the Arts and has also been an American Council on Exercise certified personal trainer since 2000. Dr. Hackney’s extensive research interests include inquiry into challenging exercise programs–traditional exercise, Tai Chi and partnered tango classes–designed to improve physical function and quality of life in people with PD, older adults and those with serious mental illness. In 2014, she co-founded MDT Education Solutions, which has trained dozens of fitness and allied health professionals how to develop and lead safe, evidence-based exercise programs for people with PD at all stages of the disease, including almost all instructors in the PD Gladiators Metro Atlanta Fitness Network (including the YMCA of Metro Atlanta). She is currently the Research Advisor to PD Gladiators.

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