I guess we have to define cognition....there are certainly the treatment interventions that put emphasis on the spinal and brainstem level conmponents of gait, yet, if one is to initiate gait for a reason, then, yes, need cognition (or emotional investment to walk).
David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 [EMAIL PROTECTED] -----Original Message----- From: Ron Carson [mailto:[EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 11:12 AM To: Lehman, David Subject: Re[4]: [OTnow] Parkinson's disease / Alzheimer's Hello David: thanks for taking time to write and explain. you've created another area of interest. is it really possible to facilitate gait without cognition. in all my dumbness, this just doesn't seem possible. Ron ================================================= Tuesday, December 2, 2003, 11:29:36 AM, you wrote: LD> I agree that either disease can manifest itsel throughout areas for LD> movement control (PD = basal ganglia, AD = pre-motor cortex?), and yes I LD> agree that memory deficits can eventually lead one to "not remember" how LD> to move.......just be careful using terms like remembering, for gait can LD> be facilitated at a level of the CNS that is not cognitive, whereas a LD> more complex skill may require cognition.......I guess what I am trying LD> to say is that the neuroanatomical areas are different, yet, yes, some LD> functional decline may be similar between the 2 pathologies.....BUT, I LD> am not so sure that means you can refer to your first question about LD> treating based on diagnosis and now say, since PD and AD show similar LD> deficits, then we can trEAT THEM ONE IN THE SAME LD> ?????? LD> David A. Lehman, PhD, PT LD> Associate Professor LD> Tennessee State University LD> Department of Physical Therapy LD> 3500 John A. Merritt Blvd. LD> Nashville, TN 37209 LD> 615-963-5946 LD> [EMAIL PROTECTED] LD> -----Original Message----- LD> From: Ron Carson [mailto:[EMAIL PROTECTED] LD> Sent: Tuesday, December 02, 2003 10:02 AM LD> To: Lehman, David LD> Subject: Re[2]: [OTnow] Parkinson's disease / Alzheimer's LD> Hey D: LD> I think the memory problem is where I get confused. For example, I evaluated LD> a woman yesterday with advance Alz. He son, the caregiver, reports a recent LD> and significant decline in his Mom's ability to ambulate, transfer, assist LD> with toileting and bathtub transfers. (these are what I was referring to as LD> 'functional symptoms') LD> Now, the question becomes is this a memory disorder or a movement disorder? LD> And can't a memory disorder manifest itself as a movement disorder. In other LD> words, can't a person forget how to move? Finally, doesn't PD eventually LD> effect one's cognition, including memory? IF so, wouldn't PD them become a LD> memory disorder. LD> It seems that while etiology of PD and Alz may differ, the results of the LD> diseases are similar. LD> Ron LD> ================================================= LD> Tuesday, December 2, 2003, 10:31:02 AM, you wrote: LD>> FUNCTIONAL SYMPTOMS? not sure what you mean here...but, for the LD>> most part in PD there is a brain versus movement disorder and in AD it LD>> is more of a memory issue LD>> I think I answered your second question in my first LD>> response.....no, I would not treat the same LD>> My approach would be to assess the impairments that I feel LD>> contribute to the functional deficit and attempt to offer intervention LD>> that would improve the impairment thus function (i.e. weight training LD>> to improve balance). The person with AD would not be able to understand LD>> the weight training....so, I might use something more familiar to LD>> improve balance (like dance moves) LD>> So, did I answer your questions? LD>> David A. Lehman, PhD, PT LD>> Associate Professor LD>> Tennessee State University LD>> Department of Physical Therapy LD>> 3500 John A. Merritt Blvd. LD>> Nashville, TN 37209 LD>> 615-963-5946 LD>> [EMAIL PROTECTED] LD>> -----Original Message----- LD>> From: Ron Carson [mailto:[EMAIL PROTECTED] LD>> Sent: Tuesday, December 02, 2003 9:06 AM LD>> To: Lehman, David LD>> Subject: Re: [OTnow] Parkinson's disease / Alzheimer's LD>> Hello David: LD>> In your experience, are the 'functional' symptoms of PD and Alz similiar? LD>> And if so is your treatment the same or would you treat a client with PD LD>> different than a client with Alz? Granted ALL clients are individuals LD>> requiring individual care but are their general treatment differences based LD>> on the client's diagnoses? LD>> Ron LD>> ================================================= LD>> Tuesday, December 2, 2003, 9:25:18 AM, you wrote: LD>>> My understanding and experience of the mental changes/dementia due LD>>> to PD are related to the decrease in dopamine within the LD>>> nigro-striatal-cortical connections to the frontal lobe. The mental LD>>> changes occur as the disease progresses. It seems to cause a decreased LD>>> emotional investment in the movement I may be assessing (i.e. gait). LD>>> Therefore, this has been discussed as being one of the reasons for the LD>>> lack of initiation in P w/ PD. LD>>> Also, long-term use of L-Dopa can lead to schizzophrenic type dementia. LD>>> My approach to EVERY person with AD or PD is individualized and LD>>> never based soley on the diagnosis....certainly establishing where the LD>>> person is in regards to mental status is the start, for this will let me LD>>> know if I should use cerebral or primitive mechanisms in my approach to LD>>> treating the movement deficit. LD>>> Seems like most of the people with AD that I have treated were in LD>>> LTC facilities and were at the later stages. I would use very LD>>> common/familiar tasks (i.e. bicyle/dance/walk) for mobility training. LD>>> The person with PD may not respond as well given the side effects of LD>>> meds and the freezing issues associated with movement in the later LD>>> stages. However, in early stages, I can use cueing and strength LD>>> training to improve balance and gait. LD>>> David A. Lehman, PhD, PT LD>>> Associate Professor LD>>> Tennessee State University LD>>> Department of Physical Therapy LD>>> 3500 John A. Merritt Blvd. LD>>> Nashville, TN 37209 LD>>> 615-963-5946 LD>>> [EMAIL PROTECTED] LD>>> Hello: LD>>> What differences if any do you all see in the way that Alzheimer's versus LD>>> Parkinson's diseases manifest themselves in your clients? LD>>> Are your treatment approaches different based solely on the disease? LD>>> Thanks, LD>>> Ron LD>>> _______________________________________________ LD>>> To unsubscribe, visit: LD>>> http://otnow.com/mailman/listinfo/otlist_otnow.com LD>>> The OTnow Mail Archive: LD>>> www.mail-archive.com/[EMAIL PROTECTED] LD>> _______________________________________________ LD>> To unsubscribe, visit: LD>> http://otnow.com/mailman/listinfo/otlist_otnow.com LD>> The OTnow Mail Archive: LD>> www.mail-archive.com/[EMAIL PROTECTED] LD>> =============================================== LD>> _______________________________________________ LD>> To unsubscribe, visit: LD>> http://otnow.com/mailman/listinfo/otlist_otnow.com LD>> The OTnow Mail Archive: LD>> www.mail-archive.com/[EMAIL PROTECTED] LD> _______________________________________________ LD> To unsubscribe, visit: LD> http://otnow.com/mailman/listinfo/otlist_otnow.com LD> The OTnow Mail Archive: LD> www.mail-archive.com/[EMAIL PROTECTED] LD> =============================================== LD> _______________________________________________ LD> To unsubscribe, visit: LD> http://otnow.com/mailman/listinfo/otlist_otnow.com LD> The OTnow Mail Archive: LD> www.mail-archive.com/[EMAIL PROTECTED] _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] =============================================== _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ==============================================
