Premiers Programmes de training intensif Education du pas de rattrapage

Programme :$•  Tirer et pousser vers l’arrière, la droite et la gauche

•  2 semaines d’entraînement de 20 minutes deux fois par jour (une fois le matin et une fois le soir), durée totale de 10 jours ;

•  durant les 20 minutes d’une séance sont appliquées de 180 à 230 tractions et poussées.

Résultats$:$•  augmentation de la longueur du pas ;

•  diminution du temps mis pour réagir à une poussée ;

•  augmentation de la vitesse de marche.

• Jöbges M, Heuschkel G, Pretzel C, et coll. Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease J. Neurol. Neurosurg. Psychiatry, Dec 2004; 75: 1682 - 1687.

Influence de la force musculaire sur l’équilibre

•  «$Maintaining$func7onal$ability$and$preven7ng$falls$in$old$age$are$determined,$in$part,$by$maintaining$some$op7mal$level$of$body$strength.$»$(1)$

U7lisa7on$d’haltères$légères$

•  Renforcement$des$muscles$des$membres$inférieurs$et$du$tronc$

•  «$ac7vités$spor7ves$»$comme$le$Tai$Chi,$la$gymnas7que$douce$aérobie$(tango,$marche$nordique)(2)$

1-Hirsch MA et al. Arch Phys Med rehabil 2003

2-Hackney M, Earhart G. Tai Chi improves balance and mobility in people with mild to moderately severe Parkinson disease. Gait & Posture 2008

* Les Chutes

* Elles annoncent le déclin et la perte de l’autonomie dans les déplacements * Elles peuvent avoir des

conséquences lourdes traumatiques et psychiques * Causes variables * Grands principes de prévention :

• Rééducation à la marche

• Apprendre à se relever du sol

• Aménager l’habitat / systèmes sonores

Mais avant!!, prévention

* LSVT BIG is standard exercise prescription that adheres to principles of practice promoting strength, motor learning, and changes in brain function. * LSVT BIG is:

>16 individual therapy sessions >4x/week for 4 weeks >1-hour/day * LSVT BIG is:

>High Effort >Progressive >Continuous Activity >Motivating

The LSVT-BIG (Big Steps)

The LSVT-BIG (Big Steps)

La!rééduca4on!par!mouvement!de!grande!amplitude!:!@  La$répé77on$intensive$@  $Des$paZern$simples$@  $Auto$rééduca7on

Applica7on$pra7que$:!!!Parcourir la même distance avec le moins de pas possible. Si plus de progrès, doubler la distance

Fox CM, Farley B, Ramig LO, McFarland DH. An integrated rehabilitation approach to Parkinson’s disease : learning big and loud. Movements Disorders 2005;20 (suppl. 10) : S 127

Actuellement trois thérapeutes sont certifiés en Suisse : Suzanne Brühlmann, (clinique Hélios, Zihlschlacht), Jorina Janssens (clinique Bethesda, Tschugg) et Klaartje Malfroid (cabinet Robellaz, Köniz).

• Research Article: Comparing Exercise in Parkinson’s

Disease:The Berlin LSVT BIG Study.

• Subjects: 60 patients with mild to moderate PD • Methods: Patients were randomly assigned to receive either

one-to-one training (BIG), group training of nordic walking (WALK), or unsupervised home exercises (HOME). Each group was assigned to a specific training program and was reassessed after 16 weeks. The primary efficacy of measure was the Unified Parkinson’s Disease Rating Scale (UPDRS-III) score between tx groups after week 16. Secondary outcome variables included differences in quality of life (PDQ-39), Timed up and Go (TUG), and 10 meter walk test. All tests were performed w/ medications.

* 

Begin!siBng!in!a!chair!with!palms!in!lap.!Reach!arms!as!far!forward!as!you!can.!Then!reach!towards!the!floor.!Next!reach!as!high!above!you!as!you!can.!Last,!bring!arms!down!to!reach!as!far!behind!you!as!you!can.!Bring!palms!back!to!!lap!and!repeat_____4mes.!

* 

Lean!forward!with!both!feet!underneath!you.!Push!up!from!where!you!are!siBng!to!stand!up.!As!you!come!to!a!stand!reach!up!with!your!arms!as!high!as!you!can.!Repeat!_____4mes.!!

* 

Begin!with!both!feet!flat!on!ground.!Take!a!BIG!step!forward!with!right!foot!so!that!legs!are!scissored!and!spread!far!apart.!Alternate!swinging!arms!as!high!as!you!can!with!right!arm!foward!while!shiQing!your!weight!onto!right!foot!to!liQ!leQ!heel.!ShiQ!your!weight!back!onto!leQ!foot!to!liQ!right!toes!off!ground!while!swinging!!leQ!arm!forward!and!right!arm!back.!Repeat!_____4mes,!and!then!repeat!with!leQ!foot!forward.!!!

* 

Begin!standing!with!feet!shoulder!width!apart.!Take!a!BIG!step!forward!with!right!leg!while!spreading!arms!apart!wide!and!behind!you!to!open!up!chest.!Bring!right!foot!back!to!star4ng!point!and!palms!to!front!of!thighs,!then!step!with!the!leQ!w/!same!arm!movement.!Alternate!stepping!_____4mes.!!

* 

Begin!siBng!with!palms!in!lap,!knees!bent!w/!feet!flat!on!floor!and!legs!spread!open.!Reach!arm!as!far!to!the!right!as!you!can!to!rotate!trunk.!Keep!arm!flexed!to!90°.!Next!rotate!trunk!to!the!leQ!to!reach!with!right!arm!to!the!opposite!side.!Slide!right!foot!outward!as!you!turn!so!that!you!may!reach!further.!Bring!palms!back!to!thighs!then!repeat!with!leQ!arm.!Repeat!_____4mes.!This!exercise!may!also!be!performed!in!standing.!