Your “Next Level” practice for PwPD and the Parkinsonisms

Are you ready to take your practice to the next level? Now is the time for PTs and OTs to improve their clinical acumen and become recognized as a critical component in the workup for and management of persons with Parkinson disease (PwPD) and the parkinsonisms, conditions that cause a combination of the movement abnormalities typically associated with PD.

Don’t be intimidated by the multitude of acronyms associated with Parkinson’s disease and the parkinsonisms, such as PwPD, PSP, MSA, and CBGD. Similarly, don’t be inhibited by movement disorder subtypes, neurophysiology, or prognosis.

People with these conditions need help, and we are the most well-positioned practitioners to offer that help.

Why Rehab Practitioners? Why Now?

What makes rehabilitation clinicians so crucial to helping PwPD?

  • Therapists are often able to provide longer appointment times.
  • Therapists observe functional movement, which may reveal tremor, freezing, or dual task intolerance—something that often cannot be achieved in a 15-minute visit with a primary care provider who is focused on a multitude of other issues.
  • Thanks to longer appointment times and focused care, therapists can often establish a stronger relationship with patients and have the time to decipher the clues in clinical puzzles.
  • Patients vary across the course of weeks and days, allowing therapists to gain a more comprehensive perspective.
  • Therapists can see patients as a part of a medication trial in diagnostic workup, which means they can be a in a good position to assess a patient’s response to dopamine replacement.

As if these five points are not enough, keep in mind that there is currently a shortage of neurologists—and an even greater wait time to get in to see a movement disorders specialist. For a person with undiagnosed progressive supranuclear palsy (PSP) who might be falling as frequently as six times per week, being seen sooner can make a huge difference.

Additionally, telemedicine is here to stay, and the knowledge is there now for you to consume and apply either in person or via video to help with diagnosis and management. A listening ear and watchful eye can be conveyed by video as well.

During your appointments, there are several key differential diagnostic features to watch out for. Here are four easy features to observe, ask about, and consider:

  1. Rate of progression or decline—A higher rate may indicate a parkinsonism.
  2. Fall frequency—Again, a higher rate is more indicative of parkinsonism.
  3. A large collection of non-motor signs—Cognitive, psychiatric, autonomic, and GI signs can help guide your diagnosis.
  4. Unilateral vs. bilateral onset and the type or presence of tremor

Four more pointers for your practice:

  1. Dual-task screening can serve as an early detector for PD (prodromal).
  2. There are two distinct subtypes (phenotypes) of PD in adult onset, and their neurophysiology, response to dopamine replacement, and rehabilitation needs are quite different.
  3. Tremor-dominant (TD) and posture impairment gait disturbance (PIGD) offer some organization to our PD approach.
  4. Not all parkinsonisms are progressive. A person can have a single stroke, leaving them with a static lesion that imitates the presentation of PD, which is a non-progressive parkinsonism.