Progressive supranuclear palsy (PSP)
Background + Physiology
PSP is a rare neurodegenerative condition that is classed as a Parkinsonism condition. That means some of its clinic features resemble Parkinson’s but it is not Parkinson’s. In Parkinson’s part of the brain called the basal ganglia is affected which impairs dopamine production. PSP is different and follows a different process. We have a naturally occurring protein in our brain called Tau which helps with the function of nerve cells. For some reason and it is not understood why, in people with PSP they aren’t able to clear excess Tau. In healthy individuals there is a fair equilibrium that we produce tau as fast as we get rid of it but in people with PSP it starts to accumulate in brain tissue which can become toxic. There are thought to be 6-10 people out of every 100,000 living with the condition at any one time.
Clinical signs
- Postural instability, tend to be frequent fallers, particularly falling backwards.
- Marked cognitive impairment with emotional lability
Altered mobility, often with a wide base, slow and stiff. - Increased stiffness, particularly in the trunk
One of the key signs is an inability to fully look down and up. - Some slurred speech and swallowing issues are common.
Goals of physiotherapy:
- Education on falls prevention
Ensure they have a safe transfer method and issued mobility aid if appropriate. - Mobility training, particularly working on larger, deliberate steps and providing cueing strategies if required.
- Environmental modification to reduce falls risk.
- To maintain independence and optimise quality of life for as long as possible.
My perspective
PSP is a difficult condition to treat! The cognitive impairments that come along with PSP can make it challenging for patients to remember teachings, particularly if they live alone, so providing visual reminders is useful where possible. As a physio, you are not treating them hoping for improvement. You are providing techniques to keep them mobile and safe for as long as possible. The condition progresses fairly quickly and you should keep this in mind to always have a plan for what to try next when they deteriorate, which unfortunately they will. Keeping the sessions quite function based, working on things like walking, balance and weight shifting works quite well.