REPOSTED from Times Leader | Wilkes Barre by Matt Mattei on AUGUST 29TH, 2016

PWR program improves motion, mobility

WILKES-BARRE TWP. — A little bit of rhythm goes a long way at Allied Services’ John Heinz Rehab Center, where drumming is one of several exercises utilized in a physical therapy program that helps patients with Parkinson’s disease deal with debilitating symptoms.

Kristina Dorkoski, staff physical therapist at Heinz Rehab, leads the Parkinson’s program, using the PWR! (Parkinson Wellness Recovery) treatment program in the form of engaging activities that can improve movement and slow degeneration in patients.

Drumming on exercise balls with tubes that produce tones along the C-diametric scale mimics a motor activity and is both physically and cognitively demanding. Combining the musical effort with PWR! “up” movements aids a patient’s posture while exercising the brain by keeping in time with “beats per minute.”

Physical therapist Kristina Dorkoski is trained in the PWR! treatment program, which she puts into action helping patients with Parkinson’s disease improve motion and slow deterioration at the John Heinz Rehab Center in Wilkes-Barre Township.
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Kristina Dorkoski, lead therapist for Parkinson’s patients at the John Heinz Rehab Center, demonstrates one of the activities she employs with patients. Drumming is physically and cognitively demanding and mimics a motor activity.
Kristina Dorkoski references the PWR! Moves program, which targets four symptoms of Parkinson’s disease.
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Physical therapist Kristina Dorkoski uses Nordic walking as an engaging exercise to treat Parkinson’s patients. The exercise, combined with bounding and side-stepping embellishments, can help improve posture, balance and ability to change direction.

According to the Parkinson’s Disease Foundation website, more than 10 million people live with Parkinson’s worldwide, and approximately 60,000 Americans are diagnosed each year. Symptoms of the disease include tremors of the hands, arms, legs, jaw and face; bradykinesia, or slowness of movement; rigidity, or stiffness of the limbs and trunk; and postural instability, or impaired balance and coordination.

The PWR! program, created by Dr. Becky Farley, focuses on four major areas of movement and stability: posture, weight shifting, trunk rotation and transition.

Repeated upward movements promote posture, helping patients get out of the “stooped” position. Rocking movements can improve weight shifting and allow patients to experience less “freezing,” which commonly occurs in Parkinson’s cases. Twisting movements improve trunk rotation and lessen rigidity, and exaggerated steps promote transition from one body position to another.

Farley is also the mind behind LSVT BIG, which she developed to combat bradykinesia specifically. Heinz Rehab has used LSVT BIG since 2008 and continues to have success with the program, but Dorkoski sees merit in PWR! for its flexibility and its success with more than one symptom.

“LSVT BIG is a regimented program, so it’s four times a week for four weeks,” Dorkoski said. “Some folks don’t want to come four times a week, or their insurance doesn’t alot that.”

Further personalizing the program is the use of fun or attention-keeping activities to carry out the prescribed movements.

“That will allow therapists who have a special talent — I’m certified in professional yoga and mat Pilates — to add in those things if it interests their patients.”

Dorkoski uses the structures of dancing, drumming, non-contact boxing and Nordic walking to facilitate different PWR! movements.

“Emotional engagement is one of the key features of what you want to add to a program,” the PWR! trained therapist said. “Neuroplasticity research has shown us the patient needs to be cognitively engaged, and the activity needs to be salient to them.”

In other words, if a patient is repeating a motion of lifting his or her leg from the sitting position, it is important for the patient to know that exercise is to improve his or her ability to enter and exit a vehicle.

A patient engaged in Nordic walking with ski poles can improve posture by standing up straight during the exercise but can also work on balance and changing direction by side-stepping and bounding during the activity.

“We know, from a large study of almost 3,000 patients that was conducted last year, that we get improved quality of life in patients who exercise, across all phases of the disease,” Dorkoski said.

Dorkoski said she works with five to seven Parkinson’s patients yearly, and in her estimation, every patient has been or is being helped to some extent.

The work can be daunting, but Dorkoski said when a person is willing to do the work, there is a positive outcome.

“What’s been shown to work is a lot of repetition while they’re engaged in the activity,” Dorkoski said. “They need a lot of positive feedback from the therapist, and that’s what we provide here.”

Reach Matt Mattei at 570-991-6651 or Twitter @TLArts