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  /  Neurological disorder   /  Progressive Supranuclear Palsy (PSP)

Progressive Supranuclear Palsy (PSP)

Progressive Supranuclear Palsy (PSP) is a rare, degenerative neurological disorder that affects movement, balance, speech, and vision. Often mistaken for Parkinson’s disease, PSP progresses more rapidly and lacks an effective cure, making management of symptoms critical. Among various treatment modalities, physical therapy (PT) plays a crucial role in enhancing the quality of life for individuals with PSP.

Understanding PSP

  • Symptoms:

PSP is characterized by a range of symptoms, including:

    • Balance and gait issues: Frequent falls, especially backward.
    • Eye movement abnormalities: Difficulty moving the eyes up and down.
    • Stiffness and rigidity: Muscular stiffness and awkward movements.
    • Speech and swallowing difficulties: Slurred speech and dysphagia.
    • Cognitive impairment: Memory problems, slowed thinking, and mood changes.
  • Epidemiology:

PSP is relatively rare, affecting approximately 3 to 6 people per 100,000 globally. It typically presents in individuals around the age of 60, with a slight predominance in men. The progression of the disease varies, but life expectancy after diagnosis is usually about 5 to 7 years.

  • Causes:

The exact cause of PSP is unknown, but it is associated with the accumulation of abnormal tau protein in the brain. This accumulation leads to the degeneration of brain cells, particularly in areas controlling movement, coordination, and cognitive functions. Genetic factors and environmental triggers are also being studied as potential contributors.

Medical Intervention

Medical management of PSP focuses on alleviating symptoms, as there is no cure for the disease. Key interventions include:

  • Medications: Dopaminergic medications, such as those used in Parkinson’s disease, may provide limited benefit. Antidepressants and medications to manage other symptoms like muscle stiffness and sleep disturbances are also prescribed.
  • Speech Therapy: To address speech and swallowing difficulties.
  • Occupational Therapy: To assist with activities of daily living and recommend adaptive devices.
  • Surgery: Rarely considered, but deep brain stimulation (DBS) has been explored in some cases with limited success.

Physical Therapy in PSP

Physical therapy is vital in managing PSP due to its multifaceted benefits in addressing the motor and functional impairments caused by the disease. Here’s how PT contributes to the treatment of PSP:

  1. Improving Balance and Preventing Falls
    • Balance training is crucial as PSP patients are prone to frequent falls due to postural instability. Therapists employ exercises that enhance the patient’s proprioception and balance, helping to reduce the risk of falls.

    Step-by-Step Exercise:

    • Tandem Stance: Stand with one foot directly in front of the other, heel to toe. Hold onto a stable surface if needed. Try to maintain balance for 30 seconds.
    • Single-Leg Stance: Stand on one leg, using a chair or wall for support. Hold for 10-15 seconds and repeat with the other leg.
  2. Enhancing Mobility and Gait
    • Gait training and strength exercises can help improve the walking ability of PSP patients. Techniques such as treadmill training and the use of assistive devices can significantly aid in maintaining mobility.

    Step-by-Step Exercise:

    • Heel-to-Toe Walk: Walk in a straight line, placing the heel of one foot directly in front of the toes of the other foot. Practice this for 10-20 steps.
    • Marching in Place: Lift one knee at a time, aiming to get your thigh parallel to the ground. Perform this for 1-2 minutes.
  3. Maintaining Range of Motion
    • Regular stretching and flexibility exercises help prevent joint stiffness and maintain the range of motion, which is often compromised in PSP.

    Step-by-Step Exercise:

    • Seated Hamstring Stretch: Sit on the edge of a chair, extend one leg straight, and reach towards your toes. Hold for 20-30 seconds and switch legs.
    • Upper Body Stretch: Interlace your fingers and stretch your arms overhead, reaching as high as possible. Hold for 20-30 seconds.
  4. Strengthening Muscles
    • Muscle weakness is a common issue in PSP. Physical therapists design strength training programs tailored to the patient’s abilities, focusing on both upper and lower body strength to support daily activities.

    Step-by-Step Exercise:

    • Sit-to-Stand: Sit on a chair with your feet flat on the ground. Stand up slowly, then sit back down. Repeat 10-15 times.
    • Wall Push-Ups: Stand facing a wall, place your hands on the wall at shoulder height, and perform push-ups. Do this 10-15 times.
  5. Improving Posture
    • Postural exercises aim to correct the characteristic forward-leaning posture seen in PSP patients. This involves training the core muscles and teaching proper alignment techniques.

    Step-by-Step Exercise:

    • Chest Stretch: Stand with your arms at shoulder height and pull them back to open your chest. Hold for 20-30 seconds.
    • Core Activation: While seated, engage your abdominal muscles by pulling your belly button towards your spine. Hold for 10-15 seconds and repeat.
  6. Assisting with Functional Activities
    • Physical therapists also work on improving the patient’s ability to perform daily tasks independently. This includes practicing transfers, such as moving from sitting to standing, and other activities of daily living (ADLs).

    Step-by-Step Exercise:

    • Transfer Practice: Practice moving from sitting to standing and vice versa using different surfaces like chairs, beds, and toilets. This helps improve confidence and safety in daily movements.
  7. Utilizing Assistive Devices
    • PTs assess and recommend appropriate assistive devices like walkers, canes, or wheelchairs, ensuring they are used correctly to maximize safety and independence.

Can PSP Be Prevented?

Currently, there is no known way to prevent PSP, as the exact causes remain unclear. However, early diagnosis and intervention can help manage symptoms more effectively and improve the quality of life for those affected.

Degrees of PSP

PSP does not have formally recognized stages or degrees like some other diseases. However, its progression can be categorized informally into early, middle, and late stages based on symptom severity and functional impairment. Early intervention with therapies, including physical therapy, is crucial to managing the disease effectively at all stages.


Physical therapy is a cornerstone of symptomatic treatment in Progressive Supranuclear Palsy. By focusing on improving balance, mobility, strength, and functional independence, physical therapists help patients maintain a higher quality of life despite the progressive nature of the disease. Early intervention and consistent therapy are key to managing PSP effectively, highlighting the importance of a proactive and tailored approach in physical therapy


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