In honor of Parkinson’s Awareness Month this April, we’re pleased to feature some of the talented clinicians who provide outstanding care for individuals with Parkinson’s disease at our Klein Family Parkinson’s Rehabilitation Center multidisciplinary clinic. Physical therapy is one of the clinical specialties represented at the Center, and we’re pleased to introduce you to Michele Aguado, PT, a physical therapist who has been working at the Center since its inception. In this interview, she shares more about her career and her work.
Can you tell us more about your background and how you decided to pursue physical therapy?
Initially, I planned to pursue a career in nursing, but during freshman year at Holy Family University, I learned about physical therapy and did volunteer work at a physical therapy clinic. My experiences led me to change majors, and I transferred to Temple University. I have been a physical therapist for over 37 years. The majority of my career has been at Jefferson Moss-Magee Rehabilitation at both the Tabor Road and Elkins Park campuses, with experience in both inpatient rehabilitation and outpatient rehabilitation. I have had a focus on Parkinson’s disease since approximately 2014 when I became LSVT BIG certified. LSVT BIG is an evidenced-based treatment program for people with Parkinson’s disease.
What are your roles and responsibilities within the Klein Family Parkinson’s Rehabilitation Center?
As one of the founding physical therapists within The Klein Family Parkinson’s Rehabilitation Center, I provide a physical therapy screen of the patients. During the screening, I assess safety with sit-to-stand transfers, examine safety with ambulation, screen for balance impairments, and evaluate whether patients have orthostatic hypotension (blood pressure drop and dizziness with positional changes). I provide education to the patients and caregivers regarding strategies to improve safety with mobility. The interdisciplinary team meets and discusses the patient status, and then we all meet with the patient and caregiver to provide recommendations. For example, I may recommend that the patient should attend skilled outpatient physical therapy or join a community maintenance group exercise program.
In addition, I lead maintenance exercise groups for People with Parkinson’s disease. I also lead a Parkinson’s Special Interest group. The group meets virtually once a month to provide education to therapists on topics related to Parkinson’s disease.
What has it been like for you to work with individuals with Parkinson’s disease and their families and caregivers?
I have had the pleasure of treating individuals with Parkinson’s disease and working with their families and caregivers for over 10 years. It has been rewarding to see their progress with therapeutic interventions. I have developed rapport with patients and their families/care partners, and have treated some patients on and off for over 5-10 years. Upon discharge from skilled outpatient physical therapy, some patients join the maintenance group exercise program. This has enabled me to follow the patients and refer them back to a neurologist or skilled therapy when indicated. When a patient is in skilled physical therapy, I can screen for the need for other services and make referrals to speech therapy, occupational therapy, social work, and neurology. I provide education related to strategies to manage freezing of gait (when a person’s feet feel stuck to floor, making taking a step difficult), transfers, floor recovery (transitioning from the floor to standing, e.g., in the event of a fall), gait, and balance. The goals are to improve safety, reduce falls risk, and improve quality of life.
Can you describe how physical therapy can benefit people with Parkinson’s disease?
Exercise and physical therapy are considered to be neuroprotective and can slow down the progression of Parkinson’s disease. It is considered standard practice to refer individuals to physical therapy, along with occupational therapy and speech therapy, upon diagnosis of Parkinson’s disease. Physical therapy can help people with Parkinson’s disease learn lifelong exercise habits to improve and maintain their mobility. Per the Parkinson’s Foundation and the American College of Sports Medicine, a well-rounded exercise program includes the following: aerobic training, strength training, balance and agility training, along with multitasking and stretching. Individuals with Parkinson’s disease typically demonstrate bradykinesia (slow movements), hypokinesia (small movements), rigidity, tremor, and postural instability (imbalance). The LSVT BIG program focuses on improving amplitude of movement and intensity of movement to address the bradykinesia and hypokinesia. LSVT BIG is an intensive, whole-body exercise program which includes functional mobility and daily activity training, conditioning, gait training, coordination, strengthening, and balance activities.
Is there something you would like people to know about Parkinson’s research or care during Parkinson’s Awareness Month?
I met an individual with Parkinson’s disease who described Parkinson’s disease as a “snowflake “ disease because each individual with Parkinson’s disease can present differently. In addition to the four primary motor symptoms of Parkinson’s disease (bradykinesia, rigidity, tremor, and postural instability), there are many other nonmotor symptoms that people with Parkinson’s disease experience; e.g., sleep disorders, fatigue, and anxiety and depression, to name a few. A Multidisciplinary approach to treatment is recommended and may include physical therapy, occupational therapy, speech therapy, social work, a Movement Disorder Specialist (neurologist with specialized training in movement disorders like Parkinson’s disease), psychologist/psychiatrist, and a registered dietician. An integrated clinical team can provide comprehensive care to address the wide array of symptoms people with Parkinson’s disease experience to enhance their quality of life.