Tom,

I refer my patients to their surgeon for activity restrictions
immediately following surgery. I typically take a conservative
approach of re-evaluating the person following DBS and pretty much
looking at it as a new start because hopefully in many cases, the
person will present differently.  The other point worth mentioning,
most people are still on the same dosage and oral meds following DBS.
There is a period where people hopefully titrate down on their oral
meds and go through a programing period so there is pretty much a
constant change which you need to take into account that may make
exercise easier or more challenging.  Having said this, there
typically is a point where things are not so dynamic and most people
can return to a more active life style with little restrictions.

Much Aloha,

Kevin
www.ohanapacificrehab.com
www. parkinsonsmoveit.com

On Tue, Nov 17, 2009 at 2:19 AM, Tom Clift <[log in to unmask]> wrote:
> Kevin,
>
> Could you include some cautionary comments as to how the PWP with DBS should
> modify the exercise routine.  I am aware of several PWP's with DBS who have
> damaged the leads and electrode placement via both accidental and deliberate
> vigorous physical activity.  Being mindful of the care of those items
> generally does not occur until damage has been done, but one might be able
> to avoid further damage to that treatment modality if one is mindful of the
> location and placement of the various parts and avoiding stress or strain on
> those specific areas.
>
> Thanks for your valuable contribution to this site.
>
>
> ----- Original Message ----- From: "Kevin Lockette"
> <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, November 16, 2009 7:34 PM
> Subject: Re: Home Exercises for PD
>
>
>> The key to an effective exercise program with PD is to focus on
>> posture and purposeful movement.  The postural muscles are important
>> to maintaining ROM in the shoulders for ADLS, key to balance and gait
>> by keeping your center gravity over your base of support and to assist
>> in fatigue.  The main antigravity and postural muscles are your
>> scapular muscles/upper back, back/hip extensors and your quadriceps.
>> The stronger that your postural muscles are, the better equipped you
>> will be to battle “forward posturing” which is the tendency to being
>> pulled or stooped forward.  There many ways to exercise these key
>> muscle groups.
>>
>> BASIC TRAINING PRINCIPLES AND CONSIDERATIONS
>>
>> Progressive Resistive Exercise (PRE)
>> As a muscle adapts to applied stresses, resistance must gradually be
>> increased for further positive changes to occur- thus the term
>> progressive resistive exercise.  Large increases in resistance should
>> be avoided; if the stress is too great, you could injure your muscle,
>> tendons.  If your increase in resistance results in poor technique,
>> then it is too much weight.
>>
>> Muscle Balance
>> Proper muscle balance is an important goal in all exercise routines
>> because it is essential for maintaining good posture and avoiding
>> over-use injuries.
>>
>> Muscle Imbalances:  Most rotator cuff injuries are due to muscle
>> imbalances of the shoulder.  Shoulder strength and muscular length/ROM
>> imbalance can cause impingement of the soft tissue structures of the
>> acromiohumeral space.  Wheelchair users are even more susceptible  to
>> muscle imbalances.  Nearly every motion and all repetitive motions are
>> anterior working the pecs, shoulder internal rotators, anterior
>> deltoid, etc.  These anterior muscles become tight and shortened while
>> the upper back muscles become weak and elongated.  You can see these
>> imbalances in the postures of chronic wheelchair users.  A typical
>> posture is rounded shoulders with mild thoracic kyphosis and forward
>> head.  This posture is even more accentuated by non-supportive
>> wheelchair back that is stretched out accommodating this poor posture.
>>
>> Sets and Repetitions
>> With use of the appropriate training load, the number of sets and
>> repetitions govern the goal and outcome of the exercise program.  Sets
>> and repetitions can be set up for muscular endurance, muscular
>> strength, and muscular power routines.  Core muscles such as the
>> scapular and pelvic girdle musculature are best trained via a muscular
>> endurance routine since they are more endurance and postural muscles.
>>
>> GOAL/ROUTINE Volume (reps/sets) Intensity (training load)
>> Muscular Endurance 8-20 reps/3-5 sets Low to Medium
>>
>> When in doubt, consult your MD or PT.
>>
>> Much aloha,
>>
>> Kevin Lockette PT
>> www.parkinsonsmoveit.com
>> www.ohanapacificrehab.com
>>
>> On Sat, Nov 14, 2009 at 4:07 PM, rayilynlee <[log in to unmask]> wrote:
>>>
>>> Types of Home Exercises for Parkinson's Disease
>>>
>>> Certain types of exercises may help, such as :
>>>
>>> a.. Stretching . Simple stretches can be done anywhere and help to keep
>>> the body flexible and mobile. They should be done throughout the day, each
>>> exercise repeated three times, and holding the stretch for three to five
>>> full breaths.
>>> b.. Strength training exercises with light weights can be done at home.
>>> They help to improve balance and co-ordination by strengthening muscles, and
>>> also increase resistance to fractures by strengthening bones.
>>> c.. Aerobic exercises such as walking, cycling, dancing, or swimming help
>>> to maintain general health and well being of the patient. While walking, the
>>> patient should practice heel to toe placement of the feet, longer strides
>>> for walking and short steps with feet apart while turning, and swinging the
>>> arms by the side.
>>> d.. Aquatic exercises performed in a warm pool give excellent results
>>> regarding improvement in muscle tone, increasing range of motion, and
>>> helping to reduce pain and stiffness. The buoyancy of the water helps to
>>> improve balance and posture without the risk of falling.
>>> e.. Exercises to involve movement of the limbs in full range improve
>>> flexibility and mobility.
>>> f.. Singing loudly, reading aloud, making faces in the mirror, or chewing
>>> help to strengthen the facial and jaw muscles.
>>> g.. Yawning helps by opening the throat and helps with swallowing
>>> problems as well as clear speech.
>>> h.. Practicing Tai chi and yoga exercises can help to improve strength,
>>> balance, and flexibility, as well as reduce stress and joint pains.
>>> Exercises should be stopped at any point if you are feeling unwell or if
>>> in pain and further exercises should only be resumed after consulting with
>>> your doctor.
>>>
>>>
>>>
>>> Rayilyn Brown
>>> Director AZNPF
>>> Arizona Chapter National Parkinson Foundation
>>> [log in to unmask]
>>>
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>>
>>
>>
>> --
>> Kevin Lockette PT
>> www.ohanapacificrehab.com
>> www.parkinsonsmoveit.com
>> Kailua Clinic 808 262-1118
>> Honolulu Clinic 808 593- 2610
>> Cell Phone 808 228-0340
>>
>>
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>> If you have received this communication in error, please notify us
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-- 
Kevin Lockette PT
www.ohanapacificrehab.com
www.parkinsonsmoveit.com
Kailua Clinic 808 262-1118
Honolulu Clinic 808 593- 2610
Cell Phone 808 228-0340


SPECIAL NOTE:  This communication is intended solely for the
individual or the entity to which it is addressed and may contain
information that is privileged, confidential, and/or prohibited from
disclosure.  If the reader of this communication is not the intended
recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly prohibited.
 If you have received this communication in error, please notify us
immediately at the above telephone number provided and return the
original message to us at the above address via the U.S. Postal
Service.  Your cooperation is greatly appreciated.  Thank you.

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