Enablers to Exercise Participation in Progressive Supranuclear Palsy: Health Professional Perspectives

Physiotherapy case reports on three people with progressive supranuclear palsy

Introduction

Progressive supranuclear palsy (PSP) is a neurodegenerative brain disease that affects patient's functionality and quality of life. Physiotherapy should be recommended at the time of diagnosis to slow the progression of disability and enhance the quality of life of these patients.

Clinical presentation

Here, we describe three cases of patients with PSP, outlining their motor and non-motor symptoms and examining their clinical progression with physiotherapy intervention. During the initial intervention years, a reduction in the number of falls was achieved, along with improvements in gait and balance.

Conclusion

Exercise and physiotherapy appear to be beneficial for patients with PSP by enhancing their functionality and quality of life. Controlling or reducing the number of falls should be the primary goal of any intervention for patients with PSP.

Prevention of Falls in Parkinson's Disease: Guidelines and Gaps

Background

People living with Parkinson's disease (PD) have a high risk for falls.

Objective

To examine gaps in falls prevention targeting people with PD as part of the Task Force on Global Guidelines for Falls in Older Adults.

Methods

A Delphi consensus process was used to identify specific recommendations for falls in PD. The current narrative review was conducted as educational background with a view to identifying gaps in fall prevention.

Results

A recent Cochrane review recommended exercises and structured physical activities for PD; however, the types of exercises and activities to recommend and PD subgroups likely to benefit require further consideration. Freezing of gait, reduced gait speed, and a prior history of falls are risk factors for falls in PD and should be incorporated in assessments to identify fall risk and target interventions. Multimodal and multi-domain fall prevention interventions may be beneficial. With advanced or complex PD, balance and strength training should be administered under supervision. Medications, particularly cholinesterase inhibitors, show promise for falls prevention. Identifying how to engage people with PD, their families, and health professionals in falls education and implementation remains a challenge. Barriers to the prevention of falls occur at individual, environmental, policy, and health system levels.

Conclusion

Effective mitigation of fall risk requires specific targeting and strategies to reduce this debilitating and common problem in PD. While exercise is recommended, the types and modalities of exercise and how to combine them as interventions for different PD subgroups (cognitive impairment, freezing, advanced disease) need further study.

Increasing awareness of rare PSP-F, where rehabilitation is the primary treatment: A case report

BACKGROUND

Progressive Supranuclear Palsy (PSP) is an incurable neurodegenerative disorder. One variant of PSP is a frontal lobe cognitive or behavioral presentation (PSP-F). Currently, the primary management of this disease is rooted in neurological rehabilitation, therefore, early, and accurate diagnosis is key.

CASE REPORT

Here we present a 60-year-old man with a 2-3-year history of functional decline and behavioral changes. He was misdiagnosed with a late-onset psychiatric disorder. During his second inpatient admission, a full workup for neurodegenerative diseases was performed, and the patient was ultimately diagnosed with probable PSP-F. We describe his neurological rehabilitation plan, examining recommendations before and after diagnosis.

RESULTS

After the neurodegenerative disorder diagnosis, the neurological rehabilitation plan, particularly PT and OT, changed drastically despite no change in clinical presentation emphasizing the value of an appropriate and early diagnosis. Furthermore, in an OT session, the patient demonstrated longitudinal improvement, emphasizing the importance of rehabilitation in these patient's lives.

CONCLUSION

Increased recognition of PSP variants amongst healthcare providers will allow more patients to receive early and appropriate diagnoses, so that they can benefit maximally from their neurological rehabilitation plans, maintain quality of life and experience longer periods of functioning. Furthermore, developing PSP-specific rehabilitation guidelines are crucial for improved outcomes. Correct diagnosis will also reduce the use of inappropriate and potentially harmful medications in these populations.