Central Nervous System Medications that can Impact Physical Therapy Sessions

Question

Answer

Any medicine that impacts that central nervous system will have an impact on the patient’s physical therapy and on their physical actions. A very important piece, and especially pertinent to you as physical therapist, not only is it the use of the medication itself, but the dose and the changing of dosing that can have a big impact.  For example, let’s say the patient has been diagnosed with diabetic neuropathy and gabapentin or neurontin has been added to their regimen.  That first dose will cause changes in the communication of these neurotransmitters.  The patient will feel may feel a little disoriented, not thinking as quickly, and reflexes can be slowed.  The messaging and the signaling within the body has slowed and changed because of the addition of that medicine.  Maybe they are started on 300 mg once a day and they come to physical therapy.  You notice by the second or third day that they seem fine; completely normal.  Then they come back and they are not responding as quickly again.  There has probably been a dose increase.  With these medications, often the patient is started at a low dose and then carefully titrated to a higher dose over time.  That should be true of every medicine on the following list. 

Seizures :

·       Carbamazepine

·       Phenytoin

·       Phenobarbitol

·       Levetiracetam

·       Valproic acid

Neuropathic pain:

·       Gabapentin

·       Pregabalin

Depression:

·       Fluoxetine

·       Citalopram

·       Duloxetine

·       Trazadone

·       Venlafaxine

Anxiety:

·       Alprazolam

·       Lorazepam

·       Buspirone

·       Diazepam

·       Quetiapine

Each time that dose goes up, you will likely find that your patient responds a little differently.  The patient may have side effects of being a little groggy, a little confused, and/or experiencing slowed reaction times.  If your patient is newly started on one of these medicines and you find that you cannot get them to meet your goals because of some of these side effects, perhaps they have been started on a dose that is too high.  It can often take two or three days for a patient to equilibrate and get used to a dose change.