By Dr. Carin Shuler PT, DPT, MS, CHC
Are you concerned about Parkinson’s Disease because of tremors that you or a loved one has noticed occurring recently? Or have one of you had a fall due to slowing or freezing up of movement, postural instability and declining balance? Or maybe voice changes and swallowing problems have become noticeable. These are happening for a reason! It’s like when your car’s check engine light comes on! These are warning lights or symptoms. And yes, these can all be symptoms of Parkinson’s disease (PD). Have you or a loved one received a diagnosis of Parkinson’s disease?
You may be familiar with Parkinson’s Disease. Most people are at least aware of some of the symptoms of PD such as a tremor. Perhaps you learned of PD from news about famous people such as Muhammed Ali, Neil Diamond, Billy Graham or Michael J. Fox having PD. No matter how you came to know of PD, this can be devastating and scary news when you first hear this condition affects you or a loved one! You may be understandably frightened and uncertain what the next steps are for treatment. You may not understand the brain damage that occurs in PD. You may be anxious about how to maintain independence in all areas of yours or a loved one’s life. It can be daunting without expert help. Read on to learn more about PD and about how a multidisciplinary team of experts can help you!
The Check Engine Light Is On!
Symptoms of Parkinson’s Disease
Symptoms of Parkinson’s Disease are many and varied. Symptoms are what the person knows is affecting their daily life. Symptoms are not the reason or cause of the problems. Just like with your car with the check engine light on, the longer you try to drive with that light flashing, the more potential for damage exists. Getting in for an early or immediate “diagnostic check” just like you would do for your car’s engine is important! It will help you to get the correct diagnosis for the reasons behind your symptoms.
With Parkinson’s Disease, your brain is like your car’s engine. The symptoms are depending on the areas of the car’s engine or the areas of the brain affected. It also depends what stage of Parkinson’s Disease a person is in. Is it early, middle or late stage damage; again just like your car’s engine. If you caught it early and didn’t drive much while the check engine light was on, the damage would be less and the car could be fixed more readily. With an early stage of PD diagnosed, the treatments can begin early and the benefits can be greater.
There are both movement-related (motor) and non-movement related (non-motor) symptoms. The motor symptoms are characterized by a slow decline in speed of movement, walking, balance, flexibility of the joints, smoothness of movement, and overall coordination of both gross motor (large movements) and fine motor (small movements) function. The slowness of movement (called hypokinesia or bradykinesia) can result in rigid movements or a freezing of movements. Muscle tone can also become rigid.
The difficulty in walking or getting in and out of such things as a bed, chair, bathtub or car that the slowness of movement causes can put the patient at risk for falls. Falls can be serious. Falls can cause injuries or even death. Doctors of Physical Therapy are especially trained to help with motor symptoms, fall prevention and large movements like walking. Rigid movements and movements with a shaking tremor can also result in problems with reaching, grasping, dressing, cooking, eating, bathing, and writing and in the use of technology, like cell phones. With these symptoms, Occupational Therapists are able to help with such activities of daily living (called ADLs). They can also help with independent activities of daily living (IADLs) like shopping and other community based needs. Physical Therapy and Occupational Therapy can help a great deal in most symptoms causing impaired function. They are often the first therapies to be recommended for someone with PD.
These symptoms can involve not only the arms and legs, but also the face, jaw and mouth; the trunk and spine as well as the muscles that help swallowing and that produce the voice. The latter can affect the volume of the person’s voice (called hypophonia). Occupational Therapy and Speech Therapy are extremely important for people with these types of symptoms. With swallowing training, they can help to keep the person from choking on foods and to help the family in preparing the correct types of foods. Volume of the voice is also helped by both therapies and is so important for people to be able to understand the person when speaking. This could be critical if they were calling for help!
Although PD is known as a movement disorder, it has become increasingly recognized that either PD itself and/or the side effects of the anti-parkinson’s drugs are associated with several of the serious non-motor problems. These may include cognitive impairment, such as a decline in executive function with increasing incompetence and dementia; mental health/psychiatric conditions such as depression, anxiety, apathy, personality changes and impulse control disorders. Sleep disturbances/fatigue, autonomic nervous system and sensory disturbances such as visual problems and pain also often occur.
However, it is also known that the motor impairments caused by PD like the slowness of movement can also be mistaken for non-motor symptoms such as cognitive decline, apathy, and incompetence. It is important for everyone to be aware of this so as to not assume a slowness of movement or response is indeed, a cognitive issue. Any suspicion of cognitive decline should be assessed first by a professional such as an Occupational or a Speech Therapist.
Medications are the main medical treatment for PD at this time. The side effects of these medications can also produce involuntary motions. These motions are the involuntary writhing movements that are observed in people taking these medications. Considering all of these symptoms, it is important to have Physical, Occupational and Speech Therapy for optimal function, safety, independence and slowing the progression of the disease.
A Team Approach
In addition to the medications prescribed by physicians to treat PD and the consideration for deep brain stimulation as treatment, a professional, multidisciplinary team of therapies is necessary in rehabilitation and management of PD. This team is important from the time of the initial diagnosis on. Maintaining physical activity and ADLs) is very important and as such, these therapies include Physical, Occupational and Speech Therapy. Special equipment may be needed in the home and these professionals can also assess any such equipment needs. Examples may be canes, walkers, bath transfer benches or shower chairs, grab bars, specialized eating utensils and the like.
Also, a Medical Social Worker can evaluate further any mental health and cognitive issues that may require additional counseling and support. This includes support for the family members too who are caregivers. This may include financial and community-based resources for the patient and family.
Lifestyle management and specific nutritional counseling is also an important aspect of the treatment for PD. Therefore certified Health Coaches, Nutritionists or Registered Dieticians may also be part of the multidisciplinary team. There is no cure for PD but regular exercise and eating a healthy diet with foods with antioxidants is important in preventing and managing PD. Imagine damage in our bodies and brains are like “rust”. Antioxidants help to fight the “rust” in our bodies and brain. They are molecules that help to protect cells from “bad stuff” like air pollution, cigarette smoke and pesticides. Antioxidants are found in a variety of foods; fruits, vegetables, nuts and even dark chocolate. They are also found in some beverages like red wine, coffee and tea. There are also important considerations when diet and nutrition can help with specific symptoms, like ongoing (chronic) constipation or in tolerating medications better. There is also ongoing research on gluten free and keto diets in preventing and/or managing PD, Watch for a follow up blog from Rehab House Call on nutrition and lifestyle management to possibly help prevent and slow Parkinson’s Disease!
As you can see, a team approach is important in helping people with Parkinson’s Disease! Seek out these experts to help! Read on to understand how these experts use the concept of brain change in treating PD!
If you or a loved one have any of these symptoms or have been diagnosed with PD, give the experts at Rehab House Call a call at 951-344-6141 or CLICK HERE NOW for a FREE CONSULT! We are happy to help! The earlier therapy starts, the better! AND Rehab House Call experts are MOBILE and can come to you! This is an added bonus during the COVID 19 pandemic!
The Concept of Brain Change
The concept of brain change or flexibility in learning after damage (or neuroplasticity) is at the forefront of our science for treatment interventions for Parkinson’s Disease. Neuroplasticity is the notion that our brains are able to change; are able to be flexible (plastic) and/or create new pathways to help areas that are damaged or impaired. Brain repair and brain change is what we as therapists aim for. If we as therapists can stimulate the nervous system to make these changes, we can slow the progressive decline of PD.
As such, specific therapeutic movement programs for PD are becoming well known. Two that are most common are called LSVT “BIG” & “LOUD” and “PWR!4Life” . LSVT LOUD training stands for Lee Silverman Voice Treatment. This therapy is to amplify the voice. Many Speech Therapists have this training. In LSVT BIG, PT’s and OT’s work with patients with PD to increase the amplitude (size) or range of their movements. By teaching exaggerated movement patterns, therapists can retrain the brain’s pathways and muscles.
PWR!4Life is known as Parkinsons Wellness Recovery and more information of this program can be found here: Parkinson Wellness Recovery | PWR! – Implementing research-based Parkinson specific exercise programs. PWR!Moves GET BETTER and STAY BETTER with Exercise. (pwr4life.org).
Per their website:
“ PWR!4Life™ is not a static or singular approach. It is a comprehensive neuroplasticity-principled program that integrates the latest research on Parkinson disease and Rehabilitation, Exercise, and Wellness. Therefore, it is always being updated. This type of research-based integrated exercise and wellness programming is necessary to counteract the inactivity, motor deterioration, and symptoms of PD. PWR!4Life is a PROACTIVE program that allows you to optimize your brain change (neuroplasticity), brain repair, and increase your desire to participate in everyday LIFE. Therefore, it should start at diagnosis and continue “4 Life”! With early intervention and ongoing programming, you can GET BETTER and STAY BETTER. But better yet, your efforts may trigger positive brain changes (neuroplasticity) that are disease modifying and thereby, contribute to slowing the disease progression”
Rehab House Call therapists and certified health coaches are specially trained and certified to treat patients with PD. We subscribe to the concepts of neuroplasticity, evidenced-based practice and integrating wellness into treatment. Give us a call for a FREE CONSULT to discuss PWR!4Life or LSVT BIG and LOUD more.
References
https://www.nature.com/subjects/parkinsons-disease
Physical Therapy and Parkinson's | Parkinson's Foundation
Physical Therapy for Parkinson’s Disease | Johns Hopkins Medicine
What is LSVT BIG (lsvtglobal.com)
Pwr4life.org
Hampton, B. A, Tunney, N., & Dubal, D. (2019). Impact of LSVT BIG on functional outcomes in a patient with Parkinson’s disease: A case study. GeriNotes, 26(1), 20-23
Health Benefits of Antioxidants | Dr. Sears Wellness Institute
Parkinson's Disease Archives from Dr. David Perlmutter (drperlmutter.com)
Wheat: The UNhealthy Whole Grain | Dr. William Davis (wheatbellyblog.com)
PLEASE CALL REHAB HOUSE CALL AT 951-344-6141 OR CLICK HERE NOW FOR A FREE CONSULT IF YOU OR A LOVED ONE HAS SYMPTOMS OF PD!
