Dementia is a group of conditions that affect the brain, causing problems with memory, thinking, communication, and behavior. Dementia has many forms, including Alzheimer’s disease, vascular dementia, Lewy body dementia, and more. It's a big deal. According to the WHO, it's the seventh leading cause of death worldwide and one of the major causes of disability among older people. While there is no cure for dementia, there are ways to manage the symptoms and improve the quality of life for people living with this condition.

Physical activity is one common recommendation. While exercise is certainly beneficial to everyone, the evidence for exercise's effect on dementia symptoms is mixed. Most studies do show that exercise can help delay or reduce symptoms like depression, or apathy. Some studies also show a benefit in delaying or reducing cognitive declines. If you're familiar with the benefits of exercise, this all makes sense. We know exercise has a positive effect on mood and depression. When your heart pumps harder during exercise, it increases blood flow throughout your body, including to your brain. 


Does Any Type of Exercise Work?

For people with dementia, it doesn't appear as simple as "exercise and symptoms improve." Studies have shown that the type of exercise, duration, and frequency all make a difference. For example, one study showed that people with dementia who engaged in dance movement therapy had less depression and better physical function. A second group who performed other types of exercise at the same intensity did not see those benefits. This is where a physical therapist can be incredibly beneficial. 

Physical therapy for dementia is tailored to each individual’s needs, goals, abilities, and preferences. The physical therapist will conduct a thorough evaluation of the person’s medical history, physical condition, cognitive status, functional level, and personal interests. Based on this information, the physical therapist will design a personalized treatment plan that includes specific exercises and activities that target the areas that need improvement.

The treatment plan may include:

• Aerobic exercises to improve cardiovascular health, oxygen delivery to the brain, mood, energy levels, and cognitive function.
• Strength exercises to build muscle strength and power.
• Balance exercises to challenge the person's ability to maintain equilibrium and prevent falls.
• Functional exercises that mimic or practice daily activities that are important or meaningful to the person, such as climbing stairs, getting in and out of bed or a car, or using utensils.
• Coordination exercises or more complex movements like dance or tai chi. Evidence shows more complex movements like these have larger effects on more dementia symptoms than a simpler exercise like riding a stationary bike. 
• Dual - task or cognitive exercises like combining walking with doing math out loud, or solving puzzles while on a stationary bike or treadmill. Again, research shows that combining physical and cognitive challenges can have an effect on dementia symptoms. 

The physical therapist will monitor the person’s progress and adjust the treatment plan as needed. They'll also provide feedback and encouragement. The physical therapist will also educate and advise the person and their family or caregivers on how to continue or incorporate physical activity into their daily routine and lifestyle.

Physical therapy is a safe and effective way to help people with dementia improve their physical and mental health, as well as their quality of life. Physical therapy can also provide support and guidance to people with dementia and their caregivers, helping them cope and adapt to the changes and challenges that come with this condition.

References:

• The effect of physical activity on dementia - https://pubmed.ncbi.nlm.nih.gov/31425142/
• Low & High Intensity exercise for people with dementia - https://pubmed.ncbi.nlm.nih.gov/32192537/
• Dance movement & exercise with dementia - https://pubmed.ncbi.nlm.nih.gov/30496547/
• Physical Therapy as Treatment for Cognitive Decline
• Physical Therapy for Dementia: How and Why It Helps Patients
• Exploring the Benefits of Physical Therapy for Dementia Patients
• Dementia and Physical Therapy - In Motion O.C. 
• How Patients With Dementia Benefit From Physical Therapy - FOXRehab

With the changing of the seasons, it's natural to want to soak up every last minute of summer. We all know how vital it is to take time to fill up your cup; whether it be enjoying an evening sunset bike ride, squeezing in a weekend road trip before the kids return to school, or doing some end of season gardening to prepare for the first freeze, it's important to remember to take care of your body. Taking care of your body can keep you doing the things you love and enjoy for days, weeks, and years to come! 

We have asked our skilled team of physical therapists to pull together some quick tips and tricks to keep you healthy while living your best life in these final days of summer. Please read these tips and be mindful of what your body is telling you. As always, if you have any questions, concerns, or lingering issues, contact PT Plus so one of our therapists can take care of you and make sure you are on your path to recovery! 

​Elm Grove Construction
The Interstate 94 and Moorland Road interchange will be under construction until late fall. Here is a link to the WI DOT Project Overview detailing what the project is for and how traffic will be impacted. We apologize for the inconvenience, we just wanted to make you aware of the detours so you can allow for extra time getting to our Elm Grove clinic.

Parkinson's disease (PD) is a progressive neurological disorder that affects movement, balance, posture, and coordination. It can also cause non-motor symptoms such as pain, fatigue, mood changes and cognitive impairment. While there is no cure for PD, there are treatments that can help manage the symptoms and improve the quality of life of people living with PD.
 
Physical therapy is one of these treatments. PT can help restore or maintain physical function, mobility, and independence. Physical therapists are trained professionals who can assess, diagnose, and treat movement problems related to PD. They can also provide education, advice, and support to people with PD and their caregivers.

Benefits of Physical Therapy for People with PDPhysical therapy can help people with PD in many ways, such as:

Improving muscle strength and endurance. Both age and PD can weaken and decondition muscles. A physical therapist will prescribe exercises using light weights or resistance bands to improve strength. More strength helps with balance and mobility.

Enhancing amplitude of movement PD can cause people to reduce the size and speed of movements. This can affect walking, speech, facial expressions, and gestures. Physical therapy can help increase the amplitude of movement by teaching overexaggerated physical movements, such as high steps and arm swings. This is a way to retrain the muscles and brain to compensate for the reduced movement that Parkinson's can cause. The LSVT BIG program is a specific set of exercises and activities that has been shown to improve mobility and quality of life.

Reinforcing reciprocal patterns. Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. PD can affect these patterns, which makes walking slow and unstable. Physical therapy can help to reinforce reciprocal patterns by using machines like a recumbent bicycle or elliptical machine. Practicing walking with arm swings is another activity that can help restore reciprocal movements. This can improve coordination, rhythm, and fluidity of movement for people with Parkinson's. Dance and tai chi are other activities that involve reciprocal patterns.

Improving balance and posture. PD commonly impairs balance. Your brain uses a complex mix of what you see, your inner ear and sensations from your feet and joints to maintain balance. Physical therapy can help to improve balance using exercises that challenge stability, such as standing on one leg or walking on uneven surfaces. PT will also focus on specific components of the balance system by doing things like having a person close their eyes to focus on the sensations from the feet and joints. Physical therapy can also improve posture by correcting any muscle tightness or weakness that may cause stooping or learning sideways.

Increasing flexibility and range of motion. PD also often causes muscle stiffness and rigidity. Physical therapy can help increase flexibility and range of motion with stretching exercises that target specific muscles. Common areas of issue are the hip flexors, hamstrings, and calves. Stretching regularly can also help to reduce pain and spasm.

Providing education and self-management advice. Physical therapy can help people learn more about PD and how it affects their movement. A physical therapist can provide tips on how to maintain safety when exercising, how to cope with fatigue or pain, how to use assistive devices if needed, and how to prevent or manage complications such as falls or freezing.

Sounds Great. Is There Proof?Yes. Research backs up all these claims. One meta-study (a study that combines the results of many other studies) that covered 1827 participants found that when compared to no intervention, PT significantly improved:

• gait speed
• two- and six-minute walk test scores
• Freezing of Gait questionnaire
• the Timed Up & Go test
• Functional Reach Test
• and the Berg Balance Scale

These results indicate improvements in mobility, endurance, strength, and balance. Gait speed is an especially important measurement. Physical therapists often consider gait speed a "vital sign." This is because low gait speed has been linked to:

• declines in functional mobility
• higher rates of hospitalization
• higher fall rates
• cognitive decline
• increased disability
• and higher risk of death

 
A larger meta study that included 191 studies with 7998 participants found that PT significantly improved motor symptoms, gait, and quality of life. Specifically:

• Resistance and treadmill training improved gait.
• Strategy training improved balance and gait.
• Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.

ConclusionPhysical therapy is a valuable treatment option for people with PD, as it can help to improve or maintain their physical function, mobility, and independence. Physical therapy can also enhance their quality of life, confidence, and well-being. If you have PD or know someone who does, consult with a physical therapist who specializes in PD to see how they can help you.

References

1. Physical Therapy for Parkinson’s Disease - Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/physical-therapy-for-parkinsons-disease.
2. Physical Therapy and PD | Parkinson's Foundation. https://www.parkinson.org/library/fact-sheets/physical-therapy.
3. Physical and Occupational Therapy for Parkinson's: What to Expect. https://bing.com/search?q=physical+therapy+for+parkinson%27s+disease.
4. Parkinson’s Disease Treatment Physical Therapy. https://www.parkinsonsdaily.com/parkinsons-disease-treatment-physical-therapy/.
5. Physical, Occupational & Speech Therapies | Parkinson's Foundation. https://www.parkinson.org/living-with-parkinsons/treatment/physical-occupational-speech-therapies.
6. Physiotherapy in Parkinson's Disease: A Meta-Analysis of Present Treatment Modalities - https://pubmed.ncbi.nlm.nih.gov/32917125/
7. Physiotherapy versus placebo or no intervention in Parkinson's disease - https://pubmed.ncbi.nlm.nih.gov/24018704/

Physical Therapy With Play-Dough  
Summer break is here, and on rainy days, it's great to have an activity to keep the little ones busy. Last weekend we attended the Port Festival of the Arts, and we brought along play-dough for the kiddos, with a recipe on how to make more at home. Read our most recent blog post for information about using hands-on-activates like playing with play dough to help hand intrinsic strength and coordination.
​
Hand intrinsic strength and coordination are essential for everyday tasks. These muscles help define the arch of the hands, bend the knuckles, and perform opposition of the thumb and fingers. This helps us perform tasks Read More...

Stroke is a serious medical condition that occurs when the blood supply to a part of the brain is interrupted, causing brain cells to die. Stroke can cause a variety of symptoms like weakness, paralysis, speech difficulties, memory loss, cognitive problems and emotional changes.
 
Physical therapy is an important part of recovery from a stroke that aims to help stroke survivors regain their functional mobility and independence. PT helps stroke survivors stimulate damaged nerves and muscles, promote circulation to affected areas of the brain to promote healing, learn to move and use their affected body parts as much as possible, regain mobility and strength, as well as to prevent or reduce complications such as muscle stiffness, spasticity, pain and falls.

Physical Therapy After Stroke

Physical therapy usually begins as soon as possible after the stroke, ideally within two days. The duration and intensity of PT depend on the severity and type of stroke, the medical status of the patient, as well as the individual's goals and needs.
 
Stroke recovery doesn’t just involve a physical therapist, though. It takes a team of professionals, including a physiatrist (a doctor who specializes in rehabilitation), a neurologist (a doctor who specializes in brain and nervous system disorders), nurses, an occupational therapist, a speech-language pathologist, a dietician, a social worker, a neuropsychologist and a case manager.
 
The physical therapist will assess strength, balance, coordination, range of motion, sensation, pain and functional abilities. Based on the assessment and the individual's goals, the physical therapist will design a personalized treatment plan that may include interventions like:

• Exercises to improve muscle strength, endurance, and flexibility
• Activities to improve balance, posture, gait and mobility
• Training to use assistive devices such as walkers, canes or wheelchairs
• Education on how to prevent falls and injuries
• Manual therapy to relieve pain and spasm
• Electrical stimulation to activate muscles and nerves
• Biofeedback to enhance awareness and control of muscle activity
• Hydrotherapy to use water resistance and buoyancy for exercise
• Constraint-induced movement therapy to encourage use of the affected limb by restricting the unaffected one
• Mirror therapy to use visual feedback to stimulate movement of the affected limb

Physical therapy after stroke can take place in different settings. It usually starts in a hospital. The survivor may then move thought a subacute care unit and/or an inpatient rehabilitation unit before being discharged home. The person will then usually receive home health therapy or continue treatment in an outpatient clinic depending on their level of function and needs. The physical therapist will work closely with the stroke survivor and their family to determine the best path for their rehabilitation, and to ensure continuity of care.

The Benefits of Physical Therapy After Stroke

Physical therapy has lots of benefits for stroke survivors, such as:

• Improving functional mobility and independence
• Enhancing quality of life and well-being
• Reducing disability and dependence on others
• Increasing self-confidence and motivation
• Preventing or minimizing complications such as contractures, pressure sores or infections
• Reducing the risk of recurrent stroke or other cardiovascular events

 
Physical therapy after stroke can also have positive effects on the brain itself. Research has shown that physical activity can stimulate the growth of new brain cells, formation of new connections between brain cells and growth of new blood vessels in the brain. These processes can help with healing and recovery after stroke.
 
Physical therapy after stroke is not a one-size-fits-all approach. It requires individualized assessment, planning and evaluation. It also requires active participation and collaboration from the stroke survivor, their family and their caregivers. Stroke recover is a long-term process that requires patience, perseverance and dedication.
 
However, physical therapy can be rewarding and empowering for stroke survivors. It can help them regain their functional mobility and independence, improve their quality of life and well-being, prevent or reduce complications and make the most of their recovery.

References

1. Rehab Therapy After a Stroke | American Stroke Association. https://www.stroke.org/en/life-after-stroke/stroke-rehab/rehab-therapy-after-a-stroke.
2. Physiotherapy after stroke | Stroke Association. https://www.stroke.org.uk/what-is-stroke/physiotherapy-after-stroke.
3. Stroke rehabilitation: What to expect as you recover. https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/stroke-rehabilitation/art-20045172.
4. A Simplified Guide To Physical Therapy For Stroke Patients - Saebo. https://www.saebo.com/blog/a-simplified-guide-to-physical-therapy-for-strokes/.
5. Home-Care Physical Therapy for Stroke - Verywell Health. https://www.verywellhealth.com/home-physical-therapy-after-stroke-4587362.
6. PT working gait after stroke | https://pubmed.ncbi.nlm.nih.gov/19588381/
7. PT working gait with cognitive impairment | https://pubmed.ncbi.nlm.nih.gov/33204533/
8. Physical Fitness for Stroke Patients | https://pubmed.ncbi.nlm.nih.gov/32196635/
9. Physical rehab for stroke patients in low income countries | https://pubmed.ncbi.nlm.nih.gov/30508495/
10. Evidence in PT poststroke | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913786/
11. Encompass Health  Stroke Rehab | https://encompasshealth.com/locations/harmarvillerehab/our-programs/stroke?gclid=CjwKCAjwuqiiBhBtEiwATgvixC72lg7PEmPp6djOG1qWQfUt_vU4kRkmqK8EBO6T1gWU78QjkHze0BoCYvoQAvD_BwE
12. Physiopedia - Stroke Rehab | https://www.physio-pedia.com/Stroke:_Physiotherapy_Treatment_Approaches
13. APTA - PT Guide for Strokes | https://www.choosept.com/guide/physical-therapy-guide-stroke

Hand intrinsic strength and coordination are essential for everyday tasks. These muscles help define the arch of the hands, bend the knuckles, and perform opposition of the thumb and fingers. This helps us perform tasks like holding a pencil, manipulating scissor, eating with utensils, brushing our teeth, and writing.
 
One important intrinsic muscle is the lumbricals which have the job of bending our knuckles and extending the smallest joints at the end of our fingers. For example, you may use these muscles to make a hand puppet or to hold a plate. The lumbricals are also used in handwriting to advance the pencil or pen in an upward motion. Our hands need the strength and endurance to be able to correctly perform the upstroke and re-tracing of letters which are required to write the letters a, d, g, h, m, n ,p , q, r, u, v,  and w.
 
Most of these motions are developed and perfected as we are younger, but there are many things we can do to help these muscles develop and stay strong. Using hands-on-activates like playing with play dough can help. Rolling the play dough into a ball with one hand, or squeezing play dough with tongs is a great way to strengthen the lumbricals.
 
Another very important group of hand intrinsic muscles are the abductors, flexor pollicis brevis, and the opponens pollicis. These muscles help to rotate the thumb and bring our fingers together for opposition which is used for picking up small items. To work with these muscles we can practice by rolling the play dough into a long log or snake.
 
Hand intrinsic strength is also needed to develop hand eye coordination, cognitive, and sight perception. Being able to position loose part into and over surfaces, cutting the correct piece, and inserting or threading items all use hand eye coordination and sight perception. These skills help us sense our environment, interpret what we are seeing, organize information, and create a visual memory. Play dough can be used to develop hand eye coordination and sight perception when we cut the play dough with scissors, create figures, form letters, or recreate scenes.
 
There are many great ways to encourage the development of the hand intrinsic muscles and play dough is a great tool. Use the recipe below to make you own play dough and make the next playtime a purposeful playtime!

Ingredients:

• 8 tbsp flour
  
• 2 tsp salt
  
• 1/4 C. water
  
• 1 tbsp vegetable oil
  
• food coloring
  

​Mix the flour and salt in a large bowl. In a separate bowl mix together the water, a few drops of food coloring and the oil. Pour the colored water into the flour mix and bring together with a spoon. Knead together to form a smooth, pliable dough.

Welcome Anna Grassman
Anna joined PT Plus in April and has been covering the Racine and Third Ward clinics. Anna loves Milwaukee and wants to integrate her profession into the community. A self-proclaimed foodie, Anna loves cooking for her friends and family or checking out a new Milwaukee restaurant. ​

​Bay View – Brookfield – Cedarburg – Elm Grove
Greenfield – Third Ward – Racine – West Bend

May is national arthritis month. Arthritis may seem relatively benign - everyone knows someone who has arthritis. But here are some numbers that help put the problem of arthritis into perspective:

• Arthritis is the leading cause of disability.
• Arthritis affects 1 in 5 adults and 300,000 children
• 1/3 of working-age people with arthritis have some kind of limitation in their ability to work
• Arthritis costs $156 billion each year in medical expenses and lost wages
• Nearly 1 million hospitalizations happen each year due to arthritis

It's a serious condition, and a serious problem. The good news is that physical therapy is one of the most effective treatments for arthritis.

The Benefits of Physical Therapy for Managing Arthritis Symptoms
Arthritis comes in 2 forms: osteoarthritis and rheumatoid arthritis. Osteoarthritis occurs because of wear and tear on the joints over time. Rheumatoid arthritis is an inflammatory, autoimmune disease. It occurs because of the immune system attacking the joint lining. Physical therapy can reduce joint pain, improve mobility, and help to prevent further damage to the joints. Using individualized exercises, physical therapists help people manage their condition and reduce discomfort. Physical therapists often combine advice on lifestyle modifications with exercise to maximize improvement. Let's look at the types of exercise that can help manage arthritis symptoms next.

Range of Motion Exercises
These gently move affected joints through their entire range of motion. This can help reduce stiffness and improve mobility. Examples would include things like gentle stretching, tai chi, or gentle yoga. 

Aerobic Exercise
Aerobic exercise creates repeated motion, moving the synovial fluid in the joints. It also increases blood flow and releases endorphins which reduce pain. Aerobic exercise also helps to control weight. Weight loss is proven to reduce the stress on your joints, which can reduce pain. Aerobic exercise for people with arthritis should be low impact. This would include things like walking, cycling, or swimming.

Strength Training
Strength training is an important part of managing arthritis. It decreases pain, improves strength, and function. Stronger muscles around the affected joints provide better support and protection. 

Aquatic Exercise
Exercising in a therapeutic pool can be a great way for people with arthritis to get started. The buoyancy of the water helps to relieve some of the body's pressure on the joints. The water pressure also provides compression on the joints. This offers some stability and pain relief. The movement of your body through the water creates resistance for your muscles. This allows them to get stronger in a protective environment.

Education
Besides designing a custom exercise program, a physical therapist will educate people with arthritis on lifestyle modifications to help mange their symptoms. Some suggestions might include weight loss, getting enough sleep, eating a healthy diet, and managing stress. A PT can also modify daily activities to help protect joints affected by arthritis. This can slow down or prevent progression of symptoms. Physical therapy is a safe and effective treatment for arthritis. Current clinical guidelines for treating arthritis include strong recommendations for exercise and other physical therapy treatments. If you're one of the 53 million Americans with arthritis, give your PT a call. They're a great provider to help you reduce pain, manage your symptoms, and move better.

References:

1. Research (peer-reviewed)
   1. ​Knee osteoarthritis: key treatments and implications for physical therapy- https://www.sciencedirect.com/science/article/abs/pii/S1413355520302434 
   2. ​Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation - https://www.aafp.org/pubs/afp/issues/2021/0115/p120.html
   3. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice - https://sport-physiotherapie-halle41.ch/wp-content/uploads/2021/03/9-Physical-therapy-for-patients-with-knee-and-hip-osteoarthritis-2019.pdf
2. Articles and Content
   1. May Is National Arthritis Awareness Month - News
   2. Benefits of Exercise for Osteoarthritis | Arthritis FoundationHow Can Physical Therapy Help to Avoid Surgery? - Tucson Orthopaedic Institute