I receive many questions by email and through this website, and attempt to publicly field some of the most intruiguing questions here. Most of the questions come from people that have a challenging case, just attended a live or recorded version of one of my webinars, or heard about me from a colleague. A recent question regarding managing rigidity in the PwPD that is hospitalized, was the latest to catch my attention. Here is my recommendation for how to best manage rigidity, including recommendations that I suggest will similarly serve for management of tone after craniotomy, stroke, TBI, and in some instances SCI.
1. Communicate patient and therapist expectations so that the patient can express their fears and preferences (here is how I get out of bed).
2. Reduce fear in attempts at bed mobility (height, rails, confidence, presence).
3. Positive Prediction Errors. Allow the patient to predict how much help they expect to need to get out of bed or up to stand or in gait. If they exceed their expectations, making an error in prediction, their alarm-based tone can reduce. Their reason for hospitalization should be considered here: pain, frailty, precautions.
4. Restorator cycle at the bedside or (more likely) at a recliner chair in the room.
5. (Specific to PwPD), investigate dopamine replacement timing, treat at optimal window.