The Effects of LSVT BIG Home Exercises and T’ai Chi on Balance and Gait in an Individual with Parkinson’s Disease: A Case Study

Background: Parkinson’s Disease can lead to deficits that impair quality of life. Common impairments include freezing of gait, balance deficits, and slowed gait speed. There has been limited research done involving the effects of the Lee Silverman Voice Treatment (LSVT) BIG home exercise program (HEP) and T’ai Chi Exercises on an individual with late stage Parkinson’s Disease. The purpose of this case study was to determine the effectiveness of T’ai Chi and the LSVT BIG HEP in improving gait and balance deficits in a subject with Parkinson’s Disease. Methods: The subject was an 82-year-old woman with Parkinson’s Disease who was classified as Stage 4 on the Hoehn and Yahr scale. She used a power wheelchair independently, and a walker with supervision. The subject participated in an 18-week study with three phases of 6 weeks. Phase A incorporated the LSVT BIG HEP; phase B included a T’ai Chi video program; and Phase C included a combination of both programs. Gait and balance were assessed every six weeks, and after 12 weeks of no intervention. Results: Walking velocity and step length increased slightly following the first two phases of treatment, and then declined in the follow-up phase. The subject’s Berg Balance score improved from the beginning of the study to the end of Phase B. The subject declined only slightly after twelve weeks without intervention. Conclusion: This subject with Stage 4 PD demonstrated improvements in balance and gait with supervised exercise that included the LSVT BIG HEP and T’ai Chi exercises. Without intervention, there was a slight decline beyond baseline status. These results indicate a need for more research looking at how exercise affects subjects who are functioning at Hoehn and Yahr Stage 4. Continued supervised exercise may help maintain or improve function in the later stages of Parkinson’s disease

Effects of Quadruped Movement in an Individual with Chronic Stroke: A Case Study

Background/Purpose: Neuromuscular dysfunction encompasses a wide variety of conditions that impact proper muscle functioning. One common condition resulting in neuromuscular dysfunction is a cerebrovascular accident (CVA) which can disrupt sensory, motor, visual and language systems. The resulting combination of impairments can cause limitations in activity performance and restrict participation across domains. In addition, muscle weakness is widely recognized as a major contributing factor to decline in function. Literature is showing that rehabilitation programs focusing on development of core strength with emphasis on repetition, intensity and novelty are critical for recovery of motor function. The purpose of this research was to develop a modified quadruped-based exercise program appropriate for an individual with chronic stroke that utilizes the principles of repetition, intensity and novelty. The goal of intervention was to improve core muscle strength and function across gait, endurance, and subjective assessment of quality of life. Case Description: Patient is a 57 year old Caucasian male with an 11 year history of left middle cerebral artery CVA. Prior to initiation of the study, the patient presented with impaired endurance, abnormalities of gait and posture secondary to muscle weakness in right lower extremity, impaired right upper extremity function secondary to presence of synergy pattern. The patient has received treatment at this clinic since 2014 with interventions focused on gait and strength training as well as improving upper extremity function. Methods: Hour-long intervention sessions were conducted twice per week for eight weeks. Sessions consisted of a warm-up, wrist mobility exercises, core and shoulder muscle activations, quadruped-based stretches and traveling movements. As the individual progressed through the program, movements began to be connected into flows, and circuit training was introduced. Results: Data was analyzed through calculation of percent change from pre-intervention to post-intervention. Notable improvements were seen in timed crawl forwards (+41.8%), timed crawl backwards (+24.82%), left grip strength (+19.5%), 6 Minute Walk Test (+3.35%), and posture (53.9% decrease in effective head weight). Improvements were also seen throughout various parameters of gait specifically pertaining to improved weight bearing through the affected side (gait velocity, step length ratio, percent single limb support ratio, integrated pressure ratio). Conclusion: A modified quadruped-based exercise program was an effective intervention for individuals following a CVA. Therefore, the intervention provided would be advantageous to incorporate into physical therapy practice. Clinical Relevance: Quadruped based movement would be a beneficial intervention for a variety of diagnoses. Patient modifications, to accommodate patient impairments and limitations, should be utilized to ensure safety and ability to participate in intervention.https://digitalcommons.misericordia.edu/research_posters2022/1042/thumbnail.jp

Leadership Development of Rehabilitation Professionals in a Low-Resource Country: A Transformational Leadership, Project-Based Model

Background and rationale: This paper presents an overview of the activities and outcomes of the Leadership Institute (LI), a short-term leadership development professional development course offered to physiotherapists in a low-resource country. Previous studies have provided examples of the benefits of such programs in medicine and nursing, but this has yet to be documented in the rehabilitation literature. The prototype of leadership development presented may provide guidance for similar trainings in other low-resource countries and offer the rehabilitation community an opportunity to build on the model to construct a research agenda around rehabilitation leadership development. Pedagogy: The course used a constructivist approach to integrate participants’ experiences, background, beliefs, and prior knowledge into the content. Transformational leadership development theory was emphasized with the generation of active learning projects, a key component of the training. Outcomes: Positive changes after the course included an increase in the number of community outreach activities completed by participants and increased involvement with their professional organization. Thirteen leadership projects were proposed and presented. Discussion: The LI provided present and future leaders throughout Rwanda with exposure to transformative leadership concepts and offered them the opportunity to work together on projects that enhanced their profession and met the needs of underserved communities. Constraints and challenges: Challenges included limited funding for physiotherapy positions allocated to hospitals in Rwanda, particularly in the rural areas. Participants experienced difficulties in carrying out leadership projects without additional funding to support them. Lessons learned: While the emphasis on group projects to foster local advocacy and community education is highly recommended, the projects would benefit from a strong long-term mentorship program and further budgeting considerations. Conclusion: The LI can serve as a model to develop leadership skills and spur professional growth in low-resource settings. Leadership development is necessary to address worldwide inequities in health care. The LI model presents a method to cultivate transformational leadership and work toward improvements in health care and delivery of service