Retropulsion treatment idea using 3 items you already have in your rehab gym. Let's help our patients with Parkinson's work on being able to transfer better and not fall backward | SeniorsFlourish.com #geriatricOT #OT

Retropulsion Treatment Idea Using 3 Items You Already Have in the Clinic

Mandy Chamberlain MOTR/L Education & Tips for Independent Living 37 Comments

Retropulsion treatment idea using 3 items you already have in your rehab gym. Let's help our patients with Parkinson's work on being able to transfer better and not fall backward | SeniorsFlourish.com #geriatricOT #OTRetropulsion has been a teensy-weensy thorn in my side.

As in, "I am not exactly sure how to train or what types of treatment ideas" are there for my patients pushing back or losing their balance backwards when I am specifically working on functional transfers.

It is a big factor in falls with my patients that have Parkinson's Disease and limits transfer performance.

So I set out to figure out some new techniques (check out the video of a technique I came up with at the bottom of this article!).

So I did some research... Google searches... Pinterest... AOTA...

How do I make them more safe?

Besides adaptive equipment, can I even work on this effectively?

How can I instruct them to compensate for their limited ability to shift weight forward or maximize their strengths to accomplish this?

Besides verbal cuing of "nose over toes" with perfect body positioning, is there anything else I could try?

The only thing I could come up and have tried is using a large ball to cue forward weight shift for sit to stands. Click here to see an article explaining the technique.

This technique does work great, but I have found that working in long term care, most of my patients are too advanced in their disease to be able to try this technique without the use of armrests or a stable surface to hold on to for safety.

Here is a modified technique that I am using that is really working well for my patients with Parkinson's disease who tend to fall backward when transfering:

What techniques have you used to help treat your patients that have difficulty with functional transfers due to retropulsion?

Are you looking for more information on treating patients with Parkinson's Disease? Here is a really good course from OccupationalTherapy.com called "A Practical Approach to Treating Individuals with Parkinson’s Disease." Definitely worth a look.

 

Looking for more OT treatment ideas, education videos, clinical resources, patient handouts, assessments and support? Check out the Learning Lab membership and join today!

 

Comments 37

  1. I’m a S/OTA in my last academic semester. At 53, I’m old enough to be a mother to all of my classmates, but they have not dropped me into that lane. I’m totally in love with the promise of OT. I’m doing one of my papers/presentations on PD and need to do an intervention or ADL technique for the presentation, I think this dangling-band cue is Just Right! and will be helpful during portion of my upcoming fieldwork in a SNF. My only question is regarding length of the therapy rope/band, how long do you suggest it be?

  2. That is a good exercise strategy. The mistake a good amount of clinicians make when trying to correct retropulsion during transfers is just treating with balance exercises. But the problem is more of an aversion to orienting the weight forward over midline. Some may have more pronounced retropulsion and would need set up exercises to work up to the transfer exercise with the elastic tubing. A good basic setup exercise would be putting an item on the patient’s walker or a chair just beyond reach so the patient has to orient their shoulders forward over their knees to reach the item.

      1. Thank you so much. I do not have Parkinson’s but I fractured my t-7 vertebra this fall. Resulting in significant kuphosis and balance problems. PT has been helpful and we have done the lean forward on the big ball. But I don’t have a big ball at home The big pillow was a great idea. I always tended to walk on my heels. But with the kuphosis I have occasional incidents of retropulsion which are frightening. I am coming to the end of my annual 18 sessions of PT under medicare. So I am delighted there is so much great PT stuff on line to reinforce what I have learned in clinic. Your patients are lucky to have you. Your clarity, caring, and professional competence shine through. Merci mille fois!

  3. Hi Mandy!
    Thanks for the tip. It worked so well with my patient today. I work in home health and despite all the cueing I was giving him, he just could not sit to stand without mod-max assist. He was getting frustrated and then I remembered this technique and tried it and voila, he was able to sit to stand with contact guarding! He was overjoyed as was I.

    Thanks for the tip!

    1. This makes me so happy! I love when something just “works” with my patients – I am so glad it worked for him (and you!) too.

  4. To break up the reflex patterns have the client turn their head to look tobthe left and then to the right. Repeat up to 3 x’s if needed then transfer.

    1. Oh, good, Colette! You can obviously use it with other populations as well – anyone that needs the extra input to weight shift. It is also a great tool to help educate caregivers that are helping transfer to fully understand how much a patient has to lean forward – “nose over toes!”

  5. I recently evaled a patient with retropulsion and it’s been knocking me for a loop so far. This will help– thank you!!

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  6. Thanks for the article, Mandy. I’m a new COTA and work in a SNF. After reading the article, I tried this technique with a PD pt I have for about 2-3 days and pt found it helpful. I’ve also cued her with counting prior to standing. I’m wondering though what the “retention” rate is knowing the progressive nature of the disease? Do I need to incorporate it into treatment every time I see the pt while she is here? For how many days? I’ve noticed some improvement with decreased retropulsion since using the technique. Thanks for your expertise.

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      Hi Fran! Great question – in addition to exercise/aerobic exercises, learning based exercises, such as the retropulsion tech, are best for people with Parkinson’s. I have found that if I do it initally for a few tx sessions (so they get the hang of it), then progress with increasing demands during functional tasks and increase spaced practice to promote learning. Because Parkinson’s is a progressive disease, we still need to teach techniques and provide compensatory strategies to help them engage in their occupations, PLUS these strategies with aerobic exercise can be integrated together (activities that simulate a variety of movements such as getting up to stand to move to music or Wii games). Let me know if I can clarify things further or if you have any other questions

  7. Awesome idea Mandy!! There are a few patients I am currently working with that have this issue. I’m def trying this!!

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  8. Thank you for sharing this technique and for this site! I am a new grad (Dec 2015) and just landed my first FT job in a SNF which I will start soon. I am so happy to have this site as a resource/community! You are a blessing!

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  9. Thank you for this technique. I actually have a patient that although he does not have Parkinson’s tends to lean backwards every time we go from sit to stand. This makes it harder for him and myself when assisting. I hope to try this tomorrow! 🙂

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  10. Great great idea!! I am gonna try it with my patient!!
    I used self-cueing/self-speech technique to treat retropulsion with one of my patients who has Parkinson’s disease. There are couple of articles available to read. This technique can really improve their functional transfer performance as well as functional reaching. The title of the article I used is: Enhancement of reaching performance via self-speech in people with Parkinson’s disease
    Check it out and try this technique with you patient with retropulsion. You will be amazed.

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