Rehabilitative strategies

Physical Therapy

Individuals are referred to physical therapy at the VCU Parkinson’s and Movement Disorders Center for a comprehensive evaluation of your walking and balance. The role of a physical therapist is to evaluate, restore, maintain and promote optimal physical function and quality of life by preventing the progression of impairments, functional limitations and disabilities that result from a disease.

Why do I need to be evaluated?

To determine if your walking has changed: Disorders of walking (gait) and balance are common and significant causes of reduced quality of life and independence in individuals with movement disorders. Losses of balance and/or having a sense of unsteadiness are related to reduced walking speeds and decreased walking smoothness contributing to fall risk.
To determine if your confidence has changed: Changes to walking are common risk factors for falls and are not purely driven by disease. Development of a fear of falls, following either a fall or merely a loss of balance, can result in a person choosing to do less, which can also have a significant impact on independence. This can lead to disuse, further contributing to imbalance and more falls. If you are doing less, your balance will get worse. Unfortunately, most individuals are not evaluated by a physical therapist until loss of mobility becomes substantial or following an event such as a serious fall.
To determine fall risk and potential for fall reduction: It is well established that fall risk reduction is a multifactorial process, involving reviewing medications, balance and gait assessment, musculoskeletal assessment, reduction of home hazards and cardiovascular assessment.
To evaluate how you are walking now and measure changes over time: It becomes necessary to evaluate one’s gait and balance over the course of a disease to address these issues proactively.
To contribute to research: Identifying the natural changes to walking and balance associated with various movement disorders would allow clinicians to better understand the efficacy of interventions and ways to prolong levels of independence. We encourage you to register to be a part of our clinical database. Learn more about our research.

What should I expect at my visit?

A board-certified specialist in neurologic physical therapy will evaluate you. A neurologic physical therapist is a physical therapist who specializes in the evaluation and treatment of individuals with movement problems due to disease or injury of the nervous system. Visits are typically 90 minutes.

What will my evaluation include?

Pretesting questionnaires regarding confidence, activities of daily living, lifestyle and quality of life.
Clinical screening of your vital signs, visual system, range of motion, strength and sensation.
A comprehensive evaluation of your walking and balance using standardized measures of gait and balance that help to determine fall risk.
Computerized gait analysis to measure several characteristics of your walking, including speed, pace and steadiness. We will use this information to compare your walking to normal populations and to offer recommendations for improvement.
Computerized analysis of your balance and postural sway under various sensory conditions and of your reactive postural control using a Computerized Dynamic Posturography system. We will use this information to compare your steadiness and postural control to normal populations and to offer recommendations for improvement.
Recommendations for a comprehensive general wellness program including: stretching and mobility, aerobic training and strength training based upon current best evidence.
Recommendations for fall prevention and risk reduction.

What happens after my evaluation?

Following your appointment, the results and recommendations of your evaluation will be provided to you and anyone you would like to have included in your care. Should it be determined that you would benefit from ongoing physical therapy, we will send a referral from your physician, as well as a report of your evaluation to a local provider.

How should I prepare?

To prepare for your evaluation, we recommend you:

Get a good night’s rest.
Eat meals as you typically would.
Take all of your prescription medications as prescribed, unless otherwise instructed.
Dress comfortably in walking shoes.

Speech Language Pathology

People are referred to speech-language pathology at the VCU Parkinson’s Movement Disorders Center for assessment of voice, speech, language, cognition, and swallowing. The role of the speech-language pathologist is to assess, treat, and counsel individuals with impairments that may reduce quality of life, limit function, and restrict participation in activities that result from their underlying condition.

How to schedule with Speech Language Pathology

We require a referral from a physician and recent medical records. We strongly suggest that you obtain a formal diagnosis from a neurologist.

Why do I need to be evaluated?

To determine if your voice, speech, language, cognition, or swallowing has changed. Disorders of any of these functions may occur early with movement disorders. Not only may our findings help the doctor make a final diagnosis, but any of these impairments may significantly worsen your quality of life. The earlier we can treat these problems, the greater the likelihood that we can improve your function.
For people with Parkinson disease and Parkinson Plus conditions, starting therapy early will result in far better long-term outcomes. We offer LSVT LOUD® therapy with certified clinicians as well as the Speak Out! Therapy Program with licensed providers. Also, when indicated we offer EMST and PhoRTE therapies. Traditional speech therapy techniques will also be used as needed.
For our movement disorder patients who need augmentative or assistive communication devices, we can refer to VCU’s Health Assistive Technology Lab at Children’s Hospital of Richmond on Brook Road.
To determine the rate of change in a symptom. Whether symptoms progress slowly or rapidly treatment will be tailored to your needs. Our goal is to promote optimization of function: more successful communication, cognition, and swallowing.

What should I expect at my visit?

You will be seen by a speech-language pathologist specializing in neurologic disorders. The speech pathologist may recommend specialized tests for swallowing (the modified barium swallow and fiberoptic endoscopic evaluation of swallowing) which are conducted at different sites with the VCU system.

What will my evaluation include?

Questionnaires regarding how your symptoms affect you in your everyday life.
Depending on your complaints, a comprehensive evaluation of your voice, speech, language, cognition, and/or swallowing.
We will perform acoustic analysis of your voice if indicated.
If you are referred to the Assistive Technology Lab, the speech pathologists there will help you choose an appropriate technology.
If imaging of swallowing is required, we will refer you to Stony Point or the Main Hospital downtown for specialized assessments of your swallowing.
We will discuss therapy options, if they are indicated, and offer strategies that you can immediately initiate to help you improve.

What happens after my evaluation?

Following your appointment, the results and recommendations of your evaluation will be provided to you, your referring physician, and anyone you would like to have included in your care. Should it be determined that you would benefit from speech-language therapy, we will help you schedule an appointment or facilitate a referral to a closer local provider.

How should I prepare?

To prepare for your evaluation, we recommend you:

Get a good night’s rest.
Eat meals as you typically would.
Take all of your prescription medications as prescribed, unless otherwise instructed.