Erica Pitsch, DPTEditor’s Note: These are brief notes from Elizabeth Wong about what she got out of the presentation and what she learned from the Q&A:
Physical therapists are licensed healthcare professionals that specialize in movement. In simple terms, Physical therapists work with individuals to get them from point A to point B. Physical therapy is used to prevent injuries (such as from falling), compensate for loss of ability to do something by using a device or strategy, and in a progressive neurodegenerative disease, it is used to lessen the slope of decline in function.
For someone with MSA, your physical therapists will use your strengths to help support your movement.
When someone is referred to rehab, you can expect an individualized assessment, standardized testing, assessment of fall risks, individualized exercises to be prescribed, teaching habits for everyday movement, and the trialing of assistive devices if needed. The exercises learned from physical therapy should become a habit to be used in everyday life, not just during rehab sessions.
Some universal truths include: everyone needs cardiovascular exercise and everyone loses strength as we age. Sarcopenia is the loss of muscle as we age. We all have to fight to prevent the loss of muscle mass. When we exercise, we need to practice specifically what we need to do. For example, if you have a hard time getting up from sitting position and walking, the exercise will focus on the mechanics, movements, and muscles to achieve that action. Exercise and rehab should be challenging, doing things that are easy is NOT helpful, easy will not help us get better.
Individuals with MSA often ask how physical therapists can assist with orthostatic hypotension (significant drop in blood pressure after changing positions). There is not a whole lot of published research, but there are two things that physical therapists will teach people based on clinical experience. First, make it a habit to slow down and pause between changing positions. Second, try exercises that raise blood pressure, such as clenching toes, thighs, buttocks, abdominal muscles all at once in a rhythmic fashion, do this while pressing arms up and down above the head (raising the roof), don't forget to keep breathing, and keep moving. Presumably, more exercise and strength training will lead to more muscle mass to pump your blood back to your heart.
There are some particular exercises to use for individuals with MSA-Parkinsonism (MSA-P). There has been a lot of research on parkinsonism. Rhythmic auditory cueing can help get those steps going, and can help with initiation. Any kind of music can be helpful, 80-100 beats/minute is a good stepping beat, such as “Staying Alive” by the Bee Gees. Stretching cannot make rigidity go away, but it can help manage. A person who has rigidity still has muscle, connective tissue that needs mobility. It is important to try to preserve your skeleton while your brain is fighting against it.
MSA-Cerebellar (MSA-C) is challenging because balance issues are hard and rehabilitation outcomes are not as good. Therefore, she recommends focusing on function not frustration. From her clinical experience with movement disorders, when there is too much energy going into trying to do something, sometimes it tends to add gas to a fire, and so she asks people to go slow and smooth, and then they may just be able to achieve their goal.
Specific strategies can be used to overcome barriers to exercising with MSA. The important take-away is to start where you are, move more, and sit less. Some ideas include: move and stretch before getting out of bed, stand up and sit down 10x between Netflix episodes, take a lap or two in the house after getting up to use the bathroom, stand tall and clench your legs every second while using the microwave, play tug or war with dog while sitting, or throwing bean bags at a jug of water. There are a lot of options for group classes: in-person and online group classes, group classes at senior centers, videos on YouTube (for example the “Sit and Be Fit” YouTube channel https://www.youtube.com/SitandBeFitTVshow), and there are Parkinson’s specific exercise programs. Step trackers and apps such as the iPhone Health app that comes on the iPhone can also be helpful. Find an exercise program that works for you. Get outside help to continue with a program after PT.
Lastly, Dr. Pitsch advocated for a dental model for physical therapy. This would be making a plan with PT at the end of your official sessions to have a telephone check-up in six months to make sure you have not declined and see if there is anything the PT can fix/adjust. At the check-up you can discuss if the exercises are too easy or too hard, if you are having near falls or falling more often, or need further evaluation.
Editor’s Note: These are more detailed notes, in case you are interested in reading further! The author is also Elizabeth Wong.
Physical therapists can assist people with MSA improve their balance, coordination, and strength. Physical therapists use a variety of strategies to help people with MSA.
There are a few things people with MSA can do to stay safe and active. These include:
- Participating in regular physical therapy.
- Doing exercises that are tailored to their individual needs and abilities.
- Pacing themselves and avoiding overdoing it.
- Using assistive devices when needed.
- Being aware of their surroundings and avoiding falls.
Physical therapists can work with people with MSA to:
- Prevent falls: Falls are a major concern for people with MSA because falls can lead to serious injuries. Physical therapists can teach people with MSA how to improve their balance and coordination, and how to use assistive devices safely.
- Compensate for limitations: MSA can cause a variety of movement problems, such as difficulty walking, standing, and getting dressed. Physical therapists can work with people with MSA to find ways to do these activities safely and independently. This may involve using assistive devices or learning new techniques.
- Strengthen muscles: MSA can cause muscle weakness. Physical therapists can work with people with MSA to strengthen their muscles, which can improve their balance, coordination, and overall function.
- Improve cardiovascular health: Exercise is important for everyone, but it is especially important for people with MSA. Physical therapists can work with people with MSA to find safe and effective ways to exercise, which can improve their cardiovascular health and overall well-being.
Habit is really important especially when it comes to physical therapy. Dr. Pitsch emphasizes that people and those with MSA tend to forget the exercise they learned during therapy sessions and go back to their old ways. So the key is to make the exercise a habit.
Here are two tips for creating a habit of doing physical therapy exercises:
- Do the exercise every time you perform the activity it will be used for. For example, if you learned a sit-to-stand exercise in physical therapy, then every time you stand up from a chair, try to perform the exercise you learned.
- Make it simple and achievable. Don't overwhelm yourself with too many exercises. It's better to focus on a few important exercises and make sure you can do them correctly.
Physical therapy can assist with orthostatic hypotension in two ways, but there is not a lot of scientific literature on the topic.
- Pause in between transitions. Waiting a moment before standing up from a seated position can help. This allows your blood pressure to catch up and reduces the risk of dizziness.
- Clench muscles. In theory, clenching muscles throughout your body, from your toes to your buttocks, can help push blood back up to your head. Raise your arms over your head and clench your muscles.
- Exercise could help you build more muscle, so you have more muscle mass to push the blood back up.
Here are some general exercise recommendations for people with MSA:
- Focus on activities that are specific to daily needs, such as getting out of a chair.
- Prioritize exercises that challenge you but are still safe to perform. You should experience an 80% success rate.
- It is important to keep moving and avoid staying sedentary.
- MSA-P
- Use rhythm/music for walking tempo, 80-100 beats/minutes.
- Rigidity- stretching is sustenance.
- MSA-C
- Focus on function.
- Less effort not more.
- Go slow and smooth.
Remember to move more and sit less. You can start anywhere, you can even exercise by clenching your legs while waiting.
- Tai Chi is good for postural awareness and weight shifting.
- Boxing is good cardio and has good use of an external focus by having the person thinking outside their body.
- Dancing is great for balance training.
- Group classes are great options for activity, the Bay Area Outreach and Recreation Program, www.borp.org, is a great resource for sports, exercise and recreation programming for people with physical disabilities.
- Research supports applying a dental model with physical therapy.
- A physical therapist can’t see you forever, but it’s good to have a plan with your physical therapist to check in after you finish your treatment and build a long term relationship with the therapist.
- You can go to Choosept.com to find a neurologic clinical specialist.
Question-and- Answer
Q: Are there any tips for preparing to stand and avoid dizziness?
A: Pre-movement exercises such as toe taps and ankle pumps can help improve blood flow. Work on forward lean when getting up slowly.
Q: Does physical therapy help with Pisa Syndrome?
A: There is no cure for Pisa Syndrome, but physical therapy can help by using sensory cues, weighted vests, or mirrors to retrain the brain.
Q: What is the current thinking on "use it or lose it" in terms of exercise?
A: This principle applies, but it is important to prioritize activities and avoid overexertion.
Q: How can someone with MSA safely exercise when they also have orthostatic hypotension (low blood pressure) and a high heart rate?
A: Recumbent exercise equipment such as a recumbent stepper or bike is a safe option for cardio because it allows you to exercise while sitting down.