"It's a lot more complicated than it seems": physiotherapists' experiences of using compensation strategies in people with Parkinson's

Background

Gait disturbances often result in functional limitations in daily activities and negatively impact the quality of life in people with Parkinson's disease. Physiotherapists often employ compensation strategies in an attempt to improve patients' walking. However, little is known about physiotherapists' experiences in this regard. We evaluated how physiotherapists adopt compensation strategies and what they draw on to inform their clinical decision-making.

Methods

We carried out semi-structured online interviews with 13 physiotherapists with current or recent experience working with people with Parkinson's disease in the United Kingdom. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was utilized.

Results

Two main themes were developed from the data. The first theme, optimizing compensation strategies through personalized care, shows how physiotherapists accounted for the individual needs and characteristics of people with Parkinson's, which resulted in them individually tailoring compensation strategies. The second theme, delivering compensation strategies effectively, considers the available support and perceived challenges with work settings and experience that impact physiotherapists' ability to deliver compensation strategies.

Discussion

Although physiotherapists strived to optimize compensation strategies, there was a lack of formal training in this area, and their knowledge was primarily acquired from peers. Furthermore, a lack of specific knowledge on Parkinson's can impact physiotherapists' confidence in maintaining person-centered rehabilitation. However, the question that remains to be answered is what accessible training could address the knowledge-practice gap to contribute to the delivery of better-personalized care for people with Parkinson's.

Perceptions of Compensation Strategies for Gait Impairments in Parkinson's Disease: A Survey Among 320 Healthcare Professionals

Compensation strategies are an essential part of managing gait impairments in people with Parkinson’s disease (PD). We conducted an online survey among 320 healthcare professionals with specific expertise in PD management, to evaluate their knowledge of compensation strategies for gait impairments in people with PD, and whether they applied these in daily practice. Only 35% of professionals was aware of all categories of compensation strategies. Importantly, just 23% actually applied all seven available categories of strategies when treating people with PD in clinical practice. We discuss the clinical implications, and provide recommendations to overcome this knowledge gap.

Why People With Parkinson's Disease Experience Near-Drowning-and How to Prevent It

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Differences in EMG-moment relationships between ACL-injured and uninjured adults during a weight-bearing multidirectional force control task

Anterior cruciate ligament injury (ACLi) reduces mechanical knee joint stability. Differences in muscle activation patterns are commonly identified between ACLi individuals and uninjured controls (CON); however, how and which of these differences are adaptations to protect the knee or adversely increase risk of joint instability remain unclear. Since the neuromuscular system integrates activity of all muscles crossing the knee to create a moment-of-force that opposes an external load, this study sought to quantify differences in individual muscle electromyography (EMG)-moment relationships between ACLi and CON. Participants isometrically modulated ground reaction forces during a standing force matching protocol to elicit combinations of sagittal, frontal and transverse plane moments. Partial least squares regressions determined which internal joint moment(s) predicted activation of 10 leg muscles for each group. Compared to CON, ACLi demonstrated greater contribution of rectus femoris to knee extension, semitendinosus and gastrocnemii to knee flexion, and lateral gastrocnemii to knee external rotation moments. ACLi also showed lower contributions of biceps femoris to knee flexion, medial gastrocnemius to internal rotation, and varied hip muscle contributions to frontal plane hip moments. Between group differences in EMG-moment relationships during static conditions suggest neuromuscular contributions to sagittal plane stability increases after ACL injury, while knee stability during knee abduction and external rotation is reduced. Clinical Significance: Clinical assessments of ACLi should account for deficits in frontal and rotational plane stability by including tasks that elicit such loads. Improving hamstring muscle balance, hip abductor and gastrocnemius function may benefit ACLi rehabilitation interventions and should be studied further. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Hip Dysfunction in Patients with Femoroacetabular Impingement

This paper summarizes hip disorders caused by femoroacetabular impingement. This pathomechanical process, which is associated with bone deformity, is one of the most commonly diagnosed causes of pain and dysfunction of the hip. It also often leads to decrease in the quality of life and osteoarthritis. Patients with hip joint impingement exhibit a restricted range of motion, thickening of the hip capsule, muscle weakness and compensatory changes in loading patterns, which affects the biomechanics of the entire lower extremity. Therefore, treatment of femoroacetabular impingement should not only involve surgical correction of the deformity, but also physiotherapy serving to eliminate soft tissue restrictions and pathological movement patterns.

Where do golf driver swings go wrong? Factors influencing driver swing consistency

One of the challenging skills in golfing is the driver swing. There have been a large number of studies characterizing golf swings, yielding insightful instructions on how to swing well. As a result, achieving a sub-18 handicap is no longer the top problem for golfers. Instead, players are now most troubled by a lack of consistency during swing execution. The goal of this study was to determine how to consistently execute good golf swings. Using 3D motion capture and full-body biomechanical modeling, 22 experienced golfers were analysed. For characterizing both successful and failed swings, 19 selected parameters (13 angles, 4 time parameters, and 2 distances) were used. The results showed that 14 parameters are highly sensitive and/or prone to motor control variations. These parameters sensitized five distinct areas of swing to variation: (a) ball positioning, (b) transverse club angle, (c) transition, (d) wrist control, and (e) posture migration between takeaway and impact. Suggestions were provided for how to address these five distinct problem areas. We hope our findings on how to achieve consistency in golf swings will benefit all levels of golf pedagogy and help maintain/develop interests to involve more golf/physical activity for a healthy lifestyle.