there are different ways to pay attention to your feet so that you can walk with bigger steps. If you have problems with freezing, small steps can be ‘food’ for freezing. Paying attention to your feet is one of many methods to take bigger steps. This video shows how to pay attention to your feet for better walking.
Attention strategies for walking Read More »
Having difficulty with turning while you walk? Read More »
Parkinsonism is an umbrella term used for individuals who present with some of the symptoms of Parkinson’s with the main feature being slowness of movement. Idiopathic Parkinson’s disease is the most common form of Parkinsonism and the most treatable. It is typically referred to as: Parkinson’s disease or Parkinson’s or PD. The ‘Atypical Parkinson’s’ (also known as Parkinson’s Plus Syndromes) houses 4 diagnostic categories. Each category has it’s own distinguishing features. Secondary Parkinsonism is caused by something other than a lack of dopamine but can effect the dopamine system. An example of a secondary Parkinsonism is the result of medications which block the action of dopamine. This type of secondary Parkinsonism can be reversible by removing the medication causing the symptoms.
When someone is diagnosed with Parkinsonism there is often uncertainty what that means. ‘Does that mean I have Parkinson’s disease?’ You may, or you may have something else that currently looks like Parkinson’s but over time your symptoms will become more clear. Also, your response to Parkinson’s medications will offer more information to help with a more definitive diagnosis. This process can take some time to unfold depending on how pronounced the individual symptoms present themselves and if medications offer substantial relief or not. Click on the chart to see a larger version.
As you look at the chart, the terms falling and dementia can be disconcerting. When looking at information which condenses an entire diagnoses in a few words, you should view it with caution since the degree which an individual can experience symptoms is largely variable and not everyone experiences all symptoms. The autonomic symptoms experienced by the ‘Atypical Parkinson’s’ category may also effect people with PD but to a lesser degree and only contributes to the sometimes daunting task of establishing a definitive diagnosis. A Movement Disorder neurologist is the most knowledgeable in sorting out Parkinsonisms.
What is Parkinsonism? Read More »
Get Started With a Walking Program – Your Health Depends On It Read More »
People with PD who have orthostatic hypotension are not always diagnosed which can limit there abilities if left untreated. Here is an individual with PD who is coming to physical therapy for the 1st time to address her PD and is scheduled to undergo DBS(deep brain stimulation) surgery in the near future. It was the patient who requested physical therapy. She was feeling down because over the course of a year she was trying to increase her walking endurance however because of extreme fatigue and legs feeling like they were going to buckle, her walking endurance worsened. She was unable to stand for more than a minute before needing to sit. When asked if she had blood pressure problems, she denied any problems. When asked if she ever had her blood pressure taken while standing or after standing for a few minutes the answer was no. She reportedly drinks a lot – about a gallon of water a day. Her sitting blood pressure was 98/54 Heart rate 60. Initial standing 78/52 heart rate 64. After 3 minutes her blood pressure did rebound somewhat but the systolic was still below the initial sitting blood pressure. She was advised to see a nutritionist since I thought her fluid intake seemed excessive and could potentially act as a diuretic – but wasn’t sure. She contacted her neurologist and communicated the blood pressure readings. She took her blood pressure at home everytime she was symptomatic with systolic readings typically in the 70’s. The neurologist started her on florinef. The nutritionist calculated her recommended fluid intake which was less than the gallon she had been drinking. With these adjustments she is now walking on average 8,000 steps a day. her systolic is in the 120’s
orthostatic hypotension – Parkinson’s Read More »
Recently I met a women with Young Onset PD (YOPD). We were sitting next to each other in a class. She introduced herself and casually mentioned she has PD. She mentioned it so casually that I thought I misunderstood her because she didn’t exhibit any symptoms. Later she informed me that she had symptoms since 2003 (7 years ago). Was treated for a “frozen shoulder” initially. Five years later was diagnosed with YOPD and clinically presented with right sided bradykinesia, rigidity and tremor at that time. She started to exercise very regularly and is asymptomatic! She admits to getting stiff after sitting for more than 45 minutes and therefore attempts to limit her sitting within this time interval. With more research demonstrating how higher intensity exercise can reduce bradykinesia and rigidity, I asked what she did for her exercise regimen. I was amazed at how much work she put into her exercise program and wondered how many people could maintain this level of motivation. I was equally impressed by the variety of activities she incorporated which most likely helped keep her motivated. Here is the exercise regimen she outlined:
For many of you this schedule may seem or would be overwhelming. Simply having the time for this routine is a separate problem. For this individual it is doable. Looking at her program critically may help others make choices to improve their activity. I think a key component for these activities is that she has chosen ways to exercise which are fun for her. She has a back up system in place that if she doesn’t want to go out of her home to exercise – she has a room dedicated to exercise. The mirrors in her room are a great idea since people with PD may think they are moving well but when they actually see themselves move they are often surprised how underscaled their movements are. The mirrors offer additional feedback to optimize amplitude of movement and form. The Wii games are great because you can compete against yourself and monitor your progress for added incentive. Dancing challanges balance and strength and is typically an aerobic activity. Any activity performed with music improves drive and motivation to keep going when otherwise you may have stopped much sooner. So adding music to any kind of exercise may help keep you going as long as it doesn’t distract or interfere with the activity. Enrolling in an exercise research study is another great idea not only to exercise but meet different people and learn other things to do to help yourself after the study has finished. Yoga stretching typically stretches more than one area at a time AND can help strengthen your muscles by attempting to hold the position (bonus).
Reversing PD symptoms with exercise-what can we learn? Read More »
Current research is indicating that exercise may be neuroprotective. Exercise offers hope to control the progression of PD. The opposite also seems to hold true. Being sedentary may actually accelerate the progression of PD. Research is indicating that higher intensity exercise is needed to improve or reverse symptoms of PD.
Effects of inactivity versus exercise on neuroplasticity in Parkinson’s Read More »
Last week I was seeing a person with PD with a camptocormic posture (this is a more extreme forward bent posture) who was experiencing back fatigue and pain when walking with a cane. (I’ll call him ‘Sam’) This back problem limited Sam’s ability to walk. The cane offered some support and more relief than not using any assistive device. In therapy ambulation was limited to 100 feet when using the cane. I had informed him that a walker could offer greater back support and allow him to walk more. Sam wasn’t very receptive to this suggestion and shunned the use of a walker but was willing to try it out in therapy. When walking with the walker Sam was able to walk 900′ without a rest, his back pain was under good control and he was able to walk at a more natural walking speed. He was a bit winded because he hadn’t walked such a distance or speed for some time. He admitted he could walk better with the walker but was still reluctant to rely on such a device. I asked Sam what he didn’t like about the walker. He said it made him feel more disabled. Sam and I discussed the meaning of being disabled and explained to him that he was actually more disabled walking with a cane and in the long run using a cane would actually be detrimental. The walker in Sam’s case will offer back protection, improve his walking abilities and ultimately be a healthier choice.
Using a walker is not disabling Read More »
Recently I received emails asking for balance exercises. This seems like a simple question but the answer is not always straight forward. Exercises which would enhance the balance of a person with young onset PD will look quite different from exercises to enhance the balance of an elderly person with PD who also has arthritis. Generally speaking the muscles in our legs are the main guide wires for balance. Fortunately there are many avenues to strengthen these guide wires. Performing exercises in a standing position offers the greatest return on your investment. These types of exercises or activities would be: Tai Chi, Dance (becoming more popular and definitely more fun), Rock Steady boxing, Delay the Disease program, playing Wii games/balance activities, LSVT BIG or Parkinson’s wellness recovery program or simply performing conditioning exercises. Yoga, another form of strengthening which isn’t necessarily performed in the standing position, offers both strength and flexibility benefits. The level of difficulty can be adjusted with all of these activities. Balance exercises should be performed in a safe environment so that proper support is available to prevent a fall and at an intensity to achieve strength gains.
Balancing Balance Exercises Read More »
