Parkinson’s & Preventing Falls with Sutton Place Physical Therapy

Transcript

Gino:
Firstly, I just want to say thank you to anybody and everybody who took time out of the day to make today’s important webinar. Some of you I see on here probably been with the webinar series in the past that every fourth Thursday of the month we have created a wellness series. And really the intent is just to help some of our families in the community just with simple tips and techniques based on different wellness categories that can aid ’em. And I know Sunrise physically is not open now, but we have a great partners like LifeWorx and set in place aquatic physical therapy that the Stillman who’s going to be speaking today. And so today is just kind of bringing those resources together to help again some of our constituents in the community. So my name’s Gino Veso. I’m the director of community relations for Sunrise East 56. And as you guys know, we’re a luxury senior living right on the corner of East 56 in Lexington West slated, although the building’s finished and it’s beautiful, if I may say so myself, it’s slated to open in June towards the end of June. So we’re really excited about that and we’ll hope to see you in June. But every month we’ll have these webinars as well. So with no further ado, I would like to introduce our friend and colleague Gianna, who’s the director of Patient Services for LifeWorx

Giovanna:
Gino. Thank you so much here today guys, thank you so much for joining us here. We have Dr. Carol Telman and she is the physical therapist who is also the owner of Sutton Place Physical and Aquatic Therapy right here on 56 between second and third Avenue. And there they offer both land and water therapy, which is quite interesting. She’s also on the board of the NYC Arthritis Foundation and the chair of the Walk to Cure arthritis, which is coming up shortly. It’s Sunday, May 16th. So definitely everyone mark your calendars and her and team. They’re basically going to share with us why exercise and movement is very important, especially for clients or patients with Parkinson’s and share some fun ways to exercise with us. So everyone help me introduce Dr. Carol Stillman,

Dr. Carol Stillman:
Thank you Giovanna and Gino for inviting us. And we’re just going to switch over and share our screen. So I want to tell you to hold your questions till the if you can, and then we’ll have you put them in the chat and Giovanna will read them aloud. So there’ll be plenty of time. We left time for questions at the end. So today we’re going to be talking about movement and Parkinson’s. And Parkinson’s is very dear to my heart for two reasons. My stepfather, Herm Stern had Parkinson’s. And so when I was living in Florida, he lived in Florida. He had to put up with me always telling him he be exercising more and sitting less. And I actually got him to go to physical therapy and it made a big difference in his life as well as I learned a lot from him about how to prevent falls and what not to do. And so I’m going to share some of that. And then secondly, I’ve had my practice for 22 years and we have had many of our patients become diagnosed with Parkinson’s while they were coming to us for other things. So we were able to start very early on in their care and also we’re able to help them with their movement as well as learn a lot from those patients about what works best.

Today along with myself, we’re going to have two other of our physical therapists speak and Dr. Ben Musselman is our senior therapist and he has extensive experience in working with people with Parkinson’s as well as vestibular. And he is very passionate about Tai Chi. So he will be talking later on about how that ties in with Parkinson’s. And then Dr. Fannie Chan also has extensive experience in Parkinson’s and vestibular as well as she’s a certified LSVT therapist, which she will be talking about what in the world is LSVT? And then she’s also going to talk about boxing with Parkinson’s, but she is not a boxer, not yet.

So you may be thinking, who me? Exercise, all of you know that it’s a multifaceted approach for Parkinson’s. That medications as well as surgical treatments, deep brain stimulation for some people and exercise are all important components to be able to be what I call a Parkinson’s warrior, which is a journey. And today we’re going to talk about the range of choices to help you choose the best exercise that would help you based on where you are in your journey and what you enjoy. And we’re going to share the evidence, the research that shows how effective these are.

I’ve been a physical therapist a long time and one of the things I’ve seen is we have really improved over the past few decades in the research that has come out in the physical therapy community that we no longer just say, well, let’s try a little exercise and see if it helps. That we really have strong evidence about what is the best exercise, how long should it be done, how frequently, and that’s the kind of information that I wanted to share with you about Parkinson’s because it’s very different if someone comes to physical therapy and they fractured their hip or they had a total knee replacement, then your plan of care maybe three months and then you’re done and you may go back to your activity. Whereas with Parkinson’s, all the research is showing that you can really make a difference if you do regular physical exercise for a long, it’s part of your lifestyle.

And they took a group of people and had them exercise for up to five years and it was group exercises by a physical therapist. It was not one-on-one physical therapy. And this group of people, despite the progressive nature of Parkinson’s, improved in what was measured in the study was their mobility. So how much they walked, what their balance was like and what their grip strength was like. And then you may say, well, how long should I be exercising? I don’t have time for this. And another study showed that this is specific to people with Parkinson’s that if you exercise only two and a half hours a week, which is 30 minutes five days a week, so you get two days off that the cohort of people that did that amount of exercise had a smaller decline in mobility over a two year period. So there really is a difference.

All of you are very familiar with what are the common challenges for people with Parkinson’s and everyone’s different, but Parkinson’s as we know is a movement disorder. Movement is pretty much what we do during our day. So people are going to have trouble not just with walking but with how you make transitions. So how you get into the bathtub or how you stand up from a sofa, getting in and out of a car, all of those things, there are strategies to make them safe, but those are areas where you guys are going to have the challenges. And then some of you I’m sure are familiar with the freezing phenomenon in Parkinson’s. Not everyone has it, but that can occur either let’s say you’re walking and you try to initiate a step and all of a sudden it’s like there’s concrete in your feet and that can cause you to topple over if your head was planning on moving. There are some very good strategies to help with freezing as well. And then another common challenge that goes along with that is problems with balance and balance ties into fear of falling that people know intuitively, if you know have poor balance, you’re going to be and if you’ve fallen or even if not, you’re going to be afraid of falling, which is going to cause you to have more problems with your balance than some other symptoms or tremors, stiffness, especially in the morning and Brady Kinesia otherwise known as slow movements.

So not only is the motor system affected in Parkinson’s, but there’s also some other systems that people with Parkinson’s are at higher risk of osteoporosis and osteopenia as well as higher risk for cardiovascular diseases. And these are all things that prevention and that e word, again, exercise can help especially because if you know you’re higher risk, you want to work and jump ahead of this. Osteoporosis and osteopenia are very common findings in patients with Parkinson’s. And 91% of women with Parkinson’s have this 61% of men and it’s caused the same reason that we all, and I’m in that group too, start to get bone loss. But because of the mechanism of not having as strong of a contraction pulling on your muscle and less movement as in many neurological diseases, that’s what causes you to be at higher risk.

So physical therapists are probably the most passionate people about fall prevention because we see all the people that come in that have fallen and had injuries. And one of the things I mentioned, Herman, my stepfather and I’ll share a couple of his falls. One night he lived in Florida in Sarasota and he was a golfer and my parents lived on a golf course and Herman used to go out at night when everyone was gone and he had some kind of ball retriever and he would go to the ponds and get the balls out. So we had hundreds of balls in our garage and one night it was after it had rained and my mother told him not to go, but he went because he didn’t listen to her and he didn’t come back for a long time and she went out looking for him and he had fallen and couldn’t move and he had fractured his ankle.
And so those are the types of things that you just have to be aware to prevent because no one ever plans on a fall. I’ve had a couple of falls, I fell last week when my dog knocked me down at dog run. That falls happen, but there are certain things that you want to just know not to do to keep yourself safe. So I’m sharing with you some mistakes. He made another mistake and fractured his hip because he didn’t want to wait and he didn’t want to ask someone to help him go to the bathroom. He was using a walker then and so he went to the bathroom on his own and he froze when he was trying to get up and he fell and fractured his hip fractures are so painful and really can be such a pivot point with Parkinson’s that we really talk a lot about preventing falls.

I mentioned earlier because it was hard for me to wrap my head around fear of falling being a risk factor for falling, but the more I’ve worked with people, I realized that some of the most fearful people when they come in here, they hold themselves more rigid. And so therefore there are autonomic balance responses. If you lose your balance normally you don’t think about, oh, I’m going to assume vertical, you just catch yourself. So those are things that can cause problems. And then what happens is if you’re afraid of falling and your neighbor asked you to go out to dinner, this is before CO, so many of my patients became isolated because they did not want to fall and they didn’t feel comfortable going out to dinner and they didn’t maybe want to take their cane or walker. So then they became more isolated. So we really work with people and assess what their fear of falling is.

The balance training, as I mentioned, is a big thing that we work on and I’m always harping with people that you can strengthen balance the same thing as you can strengthen a muscle. Everyone knows you can strengthen muscle. You think about that, it’s easy. Well, balance is the same way. And just because you think you have bad balance, some people say to me, well, I’ve always had bad balance. Well, you can change your balance and when you go to a physical therapist, we measure your baseline and right here we’re doing what’s called single leg stance. And you can try this yourself as long as you’re in a corner or someone’s near you as you cross your hands in front of your chest so that your arms don’t help you balance and then you just stand on one foot and you should be able to do that based on your age for a certain amount of time. And we get your baseline when you come in and then we make sure that it’s improving. And then if you’ve fallen, if any of you have fallen, you want to make sure that balance is a part of your daily routine.

I wanted to talk a little bit about mobility equipment needs because that’s what physical and occupational therapists are also experts at. And I don’t know, I don’t know any of you in the group, but I’m sure you have a variety of assistive devices. And one point I wanted to make is, well, when do you need to have an expert help you choose or help you fit? And I’m going to give you an example of a patient that had a bad fall in the street a couple weeks ago. Well, she has a LS, so it’s just another neurogenerative disorder with balance issues. And the a LS support group has a donor closet of free equipment and someone had given her a rolling walker, she wasn’t quite ready for a walker, but anyways, she liked it but it was way too big for her. So she was out in the streets going up a ramp and it tipped over and she tipped in front of it and sustained a very bad concussion.

She’s fine now, but the point is that there is a way that equipment should be fit. There is a certain side that a cane should go on, there’s a specific height and I can’t tell you how many people I see in the grocery store with a cane on the wrong side or it’s not fitting correctly. I’ve stopped telling people because not everyone wants to hear. Sometimes I tell people, but anyways, it’s just important. And I saw someone a few weeks ago walking out of a walk-in clinic with a foot cast on and their cane was on the wrong side and I had to say something and he said, oh, they didn’t even tell me, they just handed me the cane. So don’t assume if you go somewhere like a medical clinic that they even know how to fit you with the equipment. That’s one thing that you want to have a physical therapist do. Home modifications are really important.

Most falls happen in the home and that’s because we spend a lot of time there and a lot of times you’re tired or you get up to go to the bathroom. So this is something that a physical or occupational therapist can help you with. And the cool thing is now we’ve all become experts at telehealth, so we can go into your home without having to actually go to your front door and you can show us what your challenges are. We can do an overview and tell you what we can make safer because there are some pretty simple adaptations that can be done for getting in and out of tubs in the shower and energy saving features for working in your kitchen that we can help you with.

And on the topic of telehealth, we have learned during covid that as physical therapists we thought we had to be with people to really help them. And because many people couldn’t come in here, we started to really get good at being able to help people work on their balance and their strengthening and their activity over zoom. And most physical therapy clinics do offer that now, and we realize that so much of what a good physical therapist does is education. We can work on your bed mobility posture, we can get the family involved. So those are all things just in the back of your head to know that you can do telehealth with physical therapists. And now I’m going to turn over the presentation to Dr. Fannie Chan and she is going to talk about what is LSVT and why should you be interested in this? So here she comes.

Dr. Fannie Chan:
Well, wow. So what is LSVT? So LSVT was originally developed as a speech therapy approach to Parkinson’s disease. LSVT actually stands for Lee Silverman’s voice treatment because it was to help a family member speak louder because her family just couldn’t hear what she was saying. She was mumbling, she was whispering a lot of the things that are very common in and then they found, but people with Parkinson’s have more than just speech limitations, so they applied the same concepts to physical and occupational therapy and those concepts are focused on amplitude high effort and calibration. So amplitude when you think, so Parkinson’s is when there’s a motor mismatch, your brain is not registering your movements the same way someone without Parkinson’s does. So it’s like you think you’re moving normally, but what other people can see is that you’re not moving enough. So you want to force amplitude.

So in LSBT treatments big is a very nice cue that they use to, you want to think big, you want to walk big. A lot of it is big movements because when you tell someone with Parkinson’s to move big, it creates more normalized movement, which helps with balance, it helps with strength and it helps with a lot of things in preventing falls and things like that. So LSVT is really good in there we go. Any stage of Parkinson’s, there has been really good research to even apply the treatment in early stages when you’re not having too many functional difficulties as a preventative measure. But the thing with Parkinson with LSVT is that you must have the commitment and you want to have the motivation. It’s very strenuous. There are one hour sessions, four sessions a week for four weeks, so it’s a total of 16 sections. There’s a lot of homework where you pick certain activities that you find it important for yourself so that you’re motivated to do them. The protocol does say you’re not allowed to take any breaks. So I would say if you have the motivation, it’s really good to have a lot of family support to keep you motivated. It’s really good for strength, endurance and balance.
And now we can move on to boxing for Parkinson’s. So as we said before, you want to encourage exercise even. So you don’t want to just exercise when you’re in physical therapy or even when someone’s just telling you to exercise, you want to make this a lifelong commitment and boxing is a really good way to do that. I’m going to grab my boxing gloves. So research says that exercise is really neuroprotective because when you do a lot of exercise, it gets the blood going and nerves are very blood thirsty. They like a lot of nutrients sent to them. So there’s that. The research just say that boxing is appropriate for early to middle disease progression. So I would say if it’s really for the more mobile of the bunch, unfortunately we don’t have a lot of research to see what happens when you’re in the more progressive stage of it, but that’s to be seen.

It’s really good for community participation, maybe not now because of covid. A lot of these exercise classes are individualized to maintain social distancing, but in normal times and when we get back to normal times, it’s a really fun way of kind of building a community. You’re usually in a group with other people who have similar experiences, similar limitations, and it’s really a good bonding experience. It’s good for strengthening and cardio fitness. Again, for the neuroprotective properties from exercise box study, boxing is a more commonly known about organization that offers classes specifically designed for people with Parkinson’s. They’re modified. You’re not actually contact boxing, it’s a lot of a series or you’re punching a punching bag and they’re really designed, depending on your mobility level, they have different levels depending on how well you function, what your needs are. Right now they offer virtual classes and they’re all over the city if you’re based in New York. And I think there’s not a lot of research based on rock study boxing, but when you think about it, the concepts that come over from LSVT do apply because when you’re punching, the person on the other side can tell you if you’re punching hard enough, you yourself can hear an audible pop when you’re, and that’s how you can register if you’re doing it correctly. So I think it’s a good way to stay active, be active, and maintain really good health.

Dr. Ben Musselman:
We’ve talked already about falling and if you think about falling at different points in our lives, falling makes some very contrasting transitions. As a child falling is viewed as normal as a learning tool. A fall is usually accompanied by an uhoh or a funny sound, and then that soothes the child to make light of it and we try and move on. Then later as an adult falling can be an awkward embarrassment. We blush try to act nonchalant and the act like the act never happened. But the frightening final evolution of falling in the later stages of our lives is one of a sinister event. Depending on our body’s fitness falling can change our lives forever. If we break a bone that results in needing surgery to stabilize that bone or replace a broken joint, that experience can be traumatizing, can create paranoia and obsessiveness. It can change the way that we relate to the world and a fall can even cause death.

But the good news is that falls are totally preventable and physical therapy helps prevent them because we always perform fall risk assessment and prevention in physical therapy, we take falling very seriously and we make avoiding them a priority. In our physical therapy evaluation, we assess how your joints are moving, the strength of your muscles, like Carol said, we use those balance assessment tools and functional tests to gauge whether you’re at risk for falling based on these data, we create a plan of care to address these deficits that we found. And in addition to strengthening what’s weak, stretching what’s tight, we work on your ability to stand on one leg, walk in different directions, walk on different surfaces, and negotiate different obstacles. In our balance training, one of the unique characteristics about a physical therapist is our accessibility. So especially in today’s healthcare environment, we get precious little time with the practitioner that we’re going to see about the condition that’s a concern in our life.

The nice thing about physical therapy, especially at a clinic here like Sutton Place, is that we spend 30 minutes one-on-one with our patients. So in addition to helping you achieve your goals, we’re also talking all the time about situations in your life. And quite frequently we have patients that might read something on the internet or get some kind of email or see a newspaper article and have some questions and they bring them to us and we try and answer them frequently. We get questions about articles that are in the New York Times and one of the authors that writes a lot about aging and wellness is Jane Brody and one of those articles she talked about a book called Falling is Not an Option, A Way to Lifelong Balance by George Locker. A few of my patients had mentioned this because they’re always interested in balance and we’re interested in balance Locker the author of this book who taught Tai Chi for most of his life and advocated the principles of Tai Chi training as a way to train and improve your balance and your posture.

He says in Tai Chi, we don’t move to achieve balance. First we balance, then we move the body’s own weight prompts, the postural muscles to balance the body and the key is creating downward force. This article and this book caught my attention as training balance is my business as a physical therapist, and I hadn’t heard of this unique perspective on balanced training before. I’m also very interested in the wisdom of ancient practices and their relevance to modern day wellness and health. Similar to like yoga, I decided to have a deeper look at Tai chi and the insight that it can give into improving our balance.

So what is Tai Chi? The full name is Tai Chi Wan and is frequently abbreviated Tai chi and it represents the most effective form and highest evolution of Chinese martial arts or otherwise known as kung fu Chi is life force of the body. Wan is fist fighting or martial arts, and tai chi means the grand ultimate or supreme pole. And it represents the theory of the universe, often described as yin and yang, a dynamic and changing universe where everything exists in opposition to and complimentary with one another. The tai chi form is a series of movements practiced very slowly linked smoothly together, each of which can be used in fighting either offensively or defensively. According to the situation, it is taught in long or short form with or without weapons. Most systems of Chinese martial arts can be classified as systems of either internal or external.

External systems rely on muscular force. Internal systems rely on the mind to conquer the body on quietness to conquer motion on softness to conquer hardness. Tai chi is considered the most effective of all internal systems. In Kungfu Tai chi form should be practiced very slowly. It opens the body so that the qi energy will bring nourishment to all its parts. Rejuvenation is an important concept in Tai chi. If one does the form slowly due to its emphasis on internal systems, it actually charges the body rather than deplete energy, as in other martial arts emphasizing external symptoms. Master CKQ of a Tai chi studio here in Times Square describes it as the feet, legs, hips, upper torso, arms, hands and legs all have at a given moment their specific spatial relation to each other and must always move as one unit. If the movements are done correctly, the energy will flow without obstruction.
This is how one’s Qi develops. So where did it come from? Chang sang Fang, a Taoist monk of the Chinese S dynasty that’s about a thousand years ago, live from 1127 to 1279 and was an expert in Chinese martial arts or kungfu. And he synthesized the Tai Chi during this period and his contribution was to establish its laws with these established parameters. It was passed down through generations, usually taught within upper middle class households and to immediate family members only then a peasant kung fu master by the name of Yang Luhan, who lived from about 1800 to 1872. He was from a peasant family and traveled from the countryside to the Chen household and noble men of the area he had heard was teaching Tai chi. He was refused this opportunity to be taught Tai chi as he was not family, but yang being a peasant stayed on to work as a servant in the household from a hiding place.

Yang observed Master Chen teaching Tai Chi to his students every night and he began to practice on his own. Then at one time, a few weeks later, yang had an occasion to fight one of Chen’s students and Chen won Master Chen called Yang to inquire where he had learned his art. And Yang confessed Master Chen appreciated yang’s perseverance, broke his rule of only teaching family members and officially began teaching Yang. Yang became Chen’s first best student of Tai Chi. And then everywhere yang went, he was challenged, but Yang defeated everybody. He fought his reputation, got him an invitation from a nobleman from P King. The gentry loved martial arts and had many experts employed in their courts and laughed at this short, plain looking peasant yang. But once again, yang demonstrated his art and defeated all his opponents. In P King. He became known as Invincible yang and opened a Tai chi school in becoming the first person to teach Tai chi publicly Yang sons and grandsons also taught Tai chi and the fame of the style spread. Yang style Tai chi became the most practiced in China and is still being practiced around the world today right here, even in Times Square.

So what are some of the benefits that make Tai Chi such a great option for people with movement diseases like Parkinson’s? Well, one, it emphasizes deep breathing. There’s been a lot of research on the health benefits of slow controlled breathing, which is emphasized throughout the Tai Chi form. Slow controlled breathing can help us manage our sympathetic nervous system, which means it can decrease the effects that stress has on our body and helps us to lower our blood pressure. It also has a lot of relaxation components as it circulates the chi in our body. As Fannie had mentioned, big body motions help to combat the symptoms of Parkinson’s and Tai chi form has these built in since it was designed as a system of interacting in combat. Limbs are taken through the full ranges of their motion. This helps to retrain and remind the brain of the body’s potential and combat stiffness and rigidity.
A third reason Tai chi is great is the calmness of the mind. Since the Tai chi form is practiced slowly, it forces the practitioner to be very mindful and intentional with their movements. The more focused you are on our movements, the more you are aware what your body is doing or not doing correctly. This helps you identify corrections that you need to make to keep your balance and move more efficiently. Tai Chi helps to promote this mindful movement due to its slow pace, removing momentum from the equation. And finally, it helps to tune our nervous system. Typically, we move in autopilot without consciously thinking about what needs to happen. When we do something like walking or reaching our brain sequences, the actions of our body, this automatic sequencing area in our brain stops functioning properly and Parkinson’s disease. So practicing coordination helps to retrain the brain. The repetitively practiced form of Tai chi, which involves simultaneous movements of arms, legs, and the trunk, help to develop and reinforce coordination in the brain.

As we mentioned, the most frightening result of poor balance and movement disorders is falling. Can Tai chi help prevent a person from Parkinson’s disease from falling? Well, that’s what a Chinese hospital had a look at. When it created a study in 2014, it found 76 persons with Parkinson’s disease and who had fallen in the last 12 months. They took half these subjects in the study and enrolled them in a Tai chi class three times a week for three months. The other half of the people in the study did nothing. They just went about their normal lives. Both of these groups of people were monitored for six months and it found out that the Tai Chi group, the people who had practiced Tai chi, were able to cut their number of falls in half compared to the control group. So this is really exciting stuff. This 1000 year old exercise routine has lasted the test of time for a reason. Tai Chi has been proven to contain the power to enhance the lives and safety of persons with Parkinson’s disease. This ancient physical therapy unlocks the healing potential of our bodies and our brains today. Thank you.

Dr. Carol Stillman:
Thank you Ben and Fannie. That was awesome. Alright, and the last fun idea we’re going to share is we are very lucky to have this large pool at the top of the high rise that my clinic is on. We have the only swimming pool in Manhattan and we have an aquatic physical therapy program that we’ve had now for three years. And the picture on the left is one of our patients that has a LS and she’s working, I don’t know if you can tell, but she’s kneeling on a board, so she’s working on her core as she’s lifting her arms. And that’s Fannie in there in the pool with Barbara. And then on the other side, Terry’s working on some flexibility and that’s Tony in the wetsuit who is our physical therapist from Italy who’s done 20 years of aquatic therapy in Rome. So if you speak Italian or you want to practice Tony’s the person to see.

So the water is so helpful for people with Parkinson’s because first of all, the warmth of the water, did I mention it’s a heated indoor pool. The warmth of the water helps to reduce the rigidity and the stiffness and oftentimes pain that you might have. But the really cool part of putting people in the water is what the buoyancy does because first of all, the buoyancy does two things. It gives you your body support that you may not have so that it’s easier for you to walk because it’s like wearing a giant spank when you’re in the pool. But it also weights. So if you’re in the water up to your chest, about 85% of your body weight’s removed. So for a lot of people that can’t walk on land very well, we put them in the pool and they can walk and really work on their gate speed and they don’t have the fear of falling. So there’s a lot less effort required in the water, which is important for people that may have some breathing problems. And of course the turbulence of the water. And we work on challenging your balance by making our own waterfalls. So we have a lot of fun in the pool and we have a lift as well. So for anyone that needs to use a lift to get in and out, we have that at our pool.
So just so that I can end this up, Ben did a good job of talking about, well, what would happen when you come into a physical therapist, and probably most of you have been to a physical therapist, so the types of things that we work on, but some of the issues that are important in Parkinson’s, if someone we check out, not just how you walk but also what your GA speed is, because there’s norms for what speed you can safely cross New York City Avenue. So that’s the type of information we would work on. We get your fall history assessment and find out where you have fallen and what’s going on so that we can drill down and prevent any more falls if it means some adaptations at home or better training of your caregivers or those are all really, really important things that we can help with.
And so basically the goals that we work on in physical therapy overall is to slow the disease progression. And we showed earlier that there’s evidence that that can be done with your participation and that to work on improving your overall function. We can’t talk about preventing falls too much. And also we see a lot of people with general neck and back pain because maybe their body mechanics and posture hasn’t been addressed. So we can help with that as well. We really love for the family to come in. We work with the caregivers and family because over the years I have seen partners that are helping with transfers and not doing it in a safe way and they’ve ended up both falling on the floor and oftentimes it’s the wife that has a fracture. So these are things that we really work with. So that does not.
And just to review, when would you want to speak to a physical therapist? If you’ve recently been diagnosed with Parkinson’s? It’s a good time. It’s always important to get started as soon as possible if you’ve had a recent fall so that we can, as I was saying, figure out what happened and how we can prevent that. Or if you’re not exercising at all and after hearing this lecture, then that’s something that you definitely want. If not us, contact a physical therapist of your choice. And over here is, so how do you pick which exercise? And I’m always of the thing, dare to try something new. Reach out of your comfort zone. You’re not going to exercise if it’s not fun for you. So think of something that’s fun and try it. You might like it, you might not. So what are some next steps that you can take after getting all this information?

Anyone that’s on this call, we have your email that we are offering a free 15 minute consult or a virtual visit with one of our physical therapists here. And we can talk about anything that physical therapists can offer or if you already know that you want to make an appointment, all you have to do is our numbers here. Or you can email and insurance covers all of this. And you don’t need a prescription unless, because in New York state you can go to a physical therapist without one, unless you use Medicare. And then federal guidelines are you need a prescription. But now I’m going to open this up for questions and the three of us will be here. So if you can put your questions in the chat box, we’ll take it from there.

Giovanna:
Yes, I opened up q and as. I just want to say thank you so much Dr. Stillman and your team. That was an amazing PowerPoint, very informative, especially to deliver quality care. We actually had a few questions that did come in. I’m going to read them off and then again, more questions are welcomed and I can read them off for everybody. So our first question came in, it says, how often would a bedbound patients need to perform physical therapy a week to be able to walk again?

Dr. Carol Stillman:
Well, so in order to answer that, I would have to ask a lot of questions to you. I would need to know why you’re bedbound and that doesn’t sound good at all, and then how long you have been bedbound. So that sounds like you’re not getting up and sitting. Those are all the questions and we would certainly be happy to address that on a Zoom or FaceTime or a phone call I would love because bedbound is not good from head to toe, your mental status, your bones, your muscles. So that is something that, but with more information I could answer more. Do you guys want to add anything? Oh yeah, Ben and Ben just added that. It sounds like you would be a great pool patient because just to get started in the water. Good point. That’s why I have a team.

Giovanna:
Yeah, excellent point actually. Great. The next one asks which a DL, this one’s very interesting. Which a DL would you say has the most risk of falling for a client if you were to categorize it?

Dr. Carol Stillman:
Well first that is a very good question because it’s not a simple answer that first of all, having no a DL can also be a reason why there’s a lot of falls. So it’s not a black and white answer because each person, we would have to assess how they’re walking and what their balance is as far as that because I’ve seen people come in without an assistive device or the wrong one and they have fallen because they’re using the wrong one. Or I remember once a patient came in with a rolling walker and he went flying in and it was because a rolling walker wasn’t the best tool for that person because he didn’t have any control how to stop. But a regular walker was good, but for some people a rolling walker because they’re really slow is good.

And Ben just added because the question was which is the most dangerous A DL? But that also to think about a lot of times in my mom because she had bladder problems and so she got up a lot during the night and was having trouble with falling, but got her a rolling walker to use one of those rollators just at night. She didn’t want a bedside commode, but she needed something but she didn’t need it during the day. So a lot depends on like as Ben said, when you’re using it.

Giovanna:
Interesting. That’s great. Wow. We have another one here. It says, what would be a safe exercise that a family member can do with their patients that is highly effective.

Dr. Ben Musselman:
So I like sit to stand because sitting to standing is something that we have to do every day, multiple times a day. And it is basically a supported squat. And a squat is one of the most efficient exercises you can do because you’re working some of the biggest muscles in your legs. And that’s a great one for family members to help with too because they can give a lot of assistance initially. And as the patient or as the family member gets better, they can give less and less and hopefully then that will also then take some of the stress out of transferring also. So I like helping the person with sitting to standing. So whether it’s getting them up or just holding their hands as they slowly lower back down into the seat, there’s lots of ways to do it, but for the most part, that’s one of my favorite.

Giovanna:
Nice. Very nice. There is another question. It says, can you briefly describe what isometric exercises are and how are they effective?

Dr. Ben Musselman:
So anytime our body basically works on the principle that you put demand on it and it responds. So whether that is muscle putting a demand on a muscle, the muscle then responds to that demand and gets stronger. Whether you put demand on a bone, the bone gets stronger by you putting weight through it. So muscles work in which they shorten and so they go from long to short and that is how a muscle contracts. But there is also a way that muscles work. Anytime you are active, those muscles kind of have a sense of tone so that they’re not totally shortening, but they’re on and active. So when that muscle is active but not shortening, that’s called isometric. And so concentric means it’s shortens, eccentric means it lengthens. Isometric means that it stays one length. But that could be simply that even though my elbow is not moving, I’m pushing into my hand here and my muscle is working and that’s an isometric contraction. So isometric can be a great way to start to strengthen a muscle because it is a form of strengthening because any demand on the muscle will make it stronger, but it’s only going to be strong at that one point. But I would say that’d be a good way to start strengthening a weak muscle is with an isometric contraction.

Giovanna:
Nice. Very nice. That’s awesome.

Dr. Fannie Chan:
I like the one where if you sit with your legs straight on the bed, you can put a towel underneath your knee. And I like the cue of try to squeeze the towel so your knees. So if you want to think of my elbow as your knee and the towel’s here, you want to push the back of your knee into the towel so your quad muscle is working, but it’s not lengthening, it’s not shortening. So that’s a good exercise. We give people the first question with that bedbound patient, he would be a good candidate for that exercise.

Giovanna:
Nice. And these are things that can be done at home also, or

Dr. Fannie Chan:
It can be done safely or if they choose to come in, we can teach ’em how to do it correctly. Nice. Interesting.

Gino:
Think I’m going to try those tonight. Strengthen my quads.

Giovanna:
I think we all should, honestly. Yeah, any other questions? You guys can type it in and I can say them for you. It’s still opens.

Gino:
Also, wasn’t there a few comments too? We had a couple of people express gratitude for today’s topic and today’s presentation saying how important tai chi is and how important it is to incorporate this into their lifestyle,

Dr. Fannie Chan:
This information. I think that’s the job of a physical therapist and if you guys are in the community, we want to share that knowledge.

Giovanna:
Definitely. Thank you so much.