Move BIG for Parkinson's disease and other Neurological Disorders

 In a previous article, I had presented an abstract of a research study looking to improve the quality of life in patients suffering from Parkinson’s disease.  This program is generally referred to as “Think BIG to Move BIG.”  I look to follow that article up with some specific exercise examples my colleagues and I have implemented with several patients.  Not all of these patients have had PD, but have suffered from some other neurological impairment such as brain tumor, stroke, or head injury.

A review of the symptoms and functional limitations patients with PD exhibit are involuntary tremors, muscle stiffness, shuffling gait, decreased to absent reciprocal arm swing, and impaired balance and coordination.  These symptoms are often seen in other neurological populations, which is likely a reason why there has been success across the neurological field using this program.  Implementing BIG exercises and programs then seeks to improve strength, decrease stiffness, and improve balance and gait while decreasing fall risk.

There are three treatment approaches I have so far utilized.  The first is an aerobic approach that involves use of trekking poles to improve reciprocal arm swing.  This assist from the therapist to swing the arms in sequence with gait helps to improve step length, energy conservation via momentum, decrease rigidity through larger steps and amplified movements, and an improvement in overall balance.  The therapist can use the poles as the balance aid while improving the reciprocal arm swings of the patient.  Gradually increasing step lengths and distance as appropriate for the patient’s endurance will allow the therapist to attain the above benefits.

One of the hallmarks of PD is bradykinesia.  This slowed movement further exacerbates the above listed impairments increasing the patient’s debility. Use of BIG can help the patient to attain faster and more efficient mobility.  As move BIG is designed to increase size/amplitude of movements, encouraging patients to make large, exaggerated movements with gait, transfers, etc works to smooth the motor learning and improve overall performance of gait and ADL’s.  Using cues like “big right, big left” for gait or “lean way far forward and big push up” for transfers can allow the patient to achieve improved movement over the usual small steps and poor posture through transfers.  Another popular tool is to encourage the patient to walk tall with his/her chest out to achieve an improved posture that is so often found lacking in patients with PD.

As I stated, many of the functional limitations the Move BIG works to remedy are seen not only in patients with PD, but in many neurological patient populations.  Remembering the cues to give and proper sequencing when working with one of these patients can be yet another valuable asset for the therapist’s bag of tools.