Casus 6: Parkinson Patiënt
This case is intended to show how Bugnet posture therapy seems to positively contribute to the treatment of Parkinson patients.
Housewife, 68 years of age, diagnosed by neurologist with M.Parkinson 4 years ago; first symptoms before diagnosis were pain and stiffness in the cervical spinal column, dizziness and tripping over obstacles, especially on the street.
- neurologist: medication and check-ups twice a year
- physiotherapist: once or twice a week
Examination and research:
Remark: this concerns an interim examination before the introduction of exercises according to the Bugnet method.
Examination and research found among other things: Complete flexion posture with considerable protracted position of the shoulder girdle, rigidity in left half of body (hemi-Parkinson often occurs in the first years), scoliotic posture, centre of gravity of body towards ventral and right, balance problems, slight propulsion and tendency to fall to right during movement, left half of body left-behind and reduced trunk rotation in ADL, slight active flexion contraction of left hand, left elbow and hips.
In addition: active woman, hobbies: handwork and walking, daily activities without aids, Cox arthritis right.
The treatment started in accordance with the guidelines for Parkinson's disease from the KNGF (Royal Dutch Society for Physiotherapy).
This patient's posture and her sense of posture showed a rapid decline after three years of therapy despite adaptation of the medication by the neurologist.
Since posture correction was one of the aims of the treatment, Bugnet Posture Resistance Therapy was used to supplement the therapy.
The exercises according to this method
- fit in well with the home exercise schedule.
- offer the patient the opportunity to vigorously and actively practise and apply posture and posture sense in daily life
- give the patients a better sense of posture and movement.
- offer Parkinson patients “cues”( see KNGF guidelines for Parkinson 2005), which can help the patient in daily movement.
- can train the extension chains to combat the general flexion contracture tendency.
- offer the opportunity of training the muscles that are becoming weaker, often on the rigid side and/or through inactivity, in functional muscle chains, which are necessary for maintaining daily posture and movement. For instance one of the Bugnet exercises could help the loss of function of the dorsal flexors in the feet of this patient. “Shuffling and almost falling over” can reduce the pleasure of walking and movement and also forms a big risk because of complications such as fractures. Comment: weakening for instance of the m. tibialis anterior is seen more often in older patients. Also the accent can be put on function maintenance of the m.erector truncti, the vertebral part and the adductions and depressors of the scapula in the same exercise to combat the increasing posture problems of Parkinson patients.
Course of treatment:
The patient starts with an exercise to improve the extension strength and lifting of the feet, lying prone with a roll under the knees, a small, light elevation under the thoracic vertebral column, under the pelvis and with the head slightly elevated. The exercise is a combination of exercises from the general section: to extend the contractures of the hip (A.8), to strengthen extensor function of the thoracic vertebral column and adductors of the scapula (A.9) and to strengthen the m. tibialis anterior (E.6). See Bugnet exercise 1.
- The starting position should be as symmetrical as possible.
- The basic rules for all Bugnet exercises apply here, the central build up with use of stomach and buttock musculature etc. Resistance is applied to the lower legs, at home the patient pushes against a roll, placed against a wall.
Owing to problems with symmetry the trunk is then subjected to an exercise for scoliosis/ scoliotic position (see book pages 45/59): asymmetric resistances are offered and asymmetric flexing. Within a short period the patient develops a better posture sense in the trunk: she can now feel when she is sitting crookedly or sinking down in a chair. Pushing off with the feet on the ground seems to be a good “cue” for adopting a stronger and straighter posture. The exercise lying on the back remains in the exercise schedule, the seated exercise is applied now and again during daily life. After a number of weeks the exercises are extended to include an upright exercise to see if the palsy tendency can be reduced. The patient has problems with this especially while walking. The woman loves to walk a lot but she has not been on a bicycle for a long time. Her tendency to “drift across the pavement and not be able to keep in a straight line" is already less. When the upright exercises were introduced these tendencies decreased even more. And after a while almost tripping over was a thing of the past. The woman could walk on the treadmill without support from her arms after a few weeks. Movement of the left arm while walking did have to be consciously introduced.
When the patient began to experience slight symptoms of incontinency, the exercise was adapted and expanded to include learning to flex the pelvic floor musculature in the total chains. The stomach and hip muscles were once again fully involved in the exercise. It must be said that incontinence symptoms can also occur on the basis of central neurological pathology (in which case the exercises offer no guarantee of recovery). This patient has profited from the exercises to date, also with the pelvic floor problematic. Feedback to the neurologist goes without saying.
The patient has a very motivated, active and positive attitude. She found the additions described above to the existing exercise schemes for Parkinson's disease challenging. Much to our and her amazement the application of several exercises according to the Bugnet method appear to have a very favourable affect to date. The posture and movement problematic resulting from the scoliotic posture and the difficulty with the sense of posture seem to be well trainable with the posture resistance exercises.
Although it does involve a central neurological progressive illness, we saw progress with these patients in the points mentioned. Similar patients, who were trained according to the guidelines for the treatment of M. Parkinson without the addition of the abovementioned exercises, seemed to make less headway in the points mentioned.