Parkinson’s Disease

Written By: Jennifer Hinkel, DPT, Director of Rehabilitation Services

April is Parkinson’s Awareness Month, and this year Western Wisconsin Health would like to increase awareness about the ailment and its symptoms. Parkinson’s is a neurological disease that affects communication between the brain and muscles. Many associate Parkinson’s Disease with the famous actor Michael J. Fox. Other well-known diseases that fall into this category are muscular sclerosis, ALS (amyotrophic lateral sclerosis) and muscular dystrophy. These conditions are similar in that the brain is no longer getting effective messages to the muscles because nerve pathways are deteriorating. The speed with which the deterioration occurs varies greatly between individuals in addition to the differences between the variety of conditions.

Parkinson’s originates in a part of the brain (the basal ganglia) that impacts how signals are sent to other parts of the brain(1). The affected part of the brain will then not be able to send signals appropriately, which is when physical symptoms are seen. As damage increases in the brain, symptoms will become more severe. There are two types; postural instability gait disorder and tremor dominant, with less dementia occurring with the tremor dominant type(1). Secondary Parkinsonism is when Parkinson like symptoms are present, but with different root causes.

Common symptoms of Parkinson’s and their impact on quality of life:

• Festinating gait – difficulty initiating walking, causing the upper body to get ahead of the feet. Even if the feet catch up to the upper body, the shuffling feet often continue.

o  This is often where falls occur, making people more fearful of walking.

o  In this situation, assistive devices can be more of a hazard than solution.

• Freezing – the brain is sending signals to move, but the body is not receiving them.

o  This can be both a physical and safety concern but is also a source of embarrassment for those who have Parkinson’s.

• Tremors – most often seen in the forearm/hand

o  Tasks such as driving, eating, and writing that we all take for granted become frustrating and embarrassing situations.

• Flat affect – lack of facial expression that comes on as muscular control decreases
• Loss of balance

o  Fear of falling is unfortunately not unique as a symptom, and it is very common for people to choose not to be active due to their fear of falling and injuring themselves.

• Decreased volume/poor perception of volume when speaking

o  Social interactions become more difficult, potentially triggering feelings of isolation.

• Monotone voice – inflections and emotions typically heard in speech patterns are no longer present

o  The impact of non-verbal’s are well known and to not have that aspect of communication can be very frustrating.

• Difficulty swallowing/managing secretions

o  This can be embarrassing to the point of avoiding social situations.

Understanding the impact of Parkinson’s disease on the body is very important when trying to grasp the impact on quality of life for both the person diagnosed and their support system. Physical, occupational and speech therapists play an integral role in helping patients improve their ability to function in their daily life. Because progressive disorders like Parkinson’s do not have a cure, they require different strategies for treatment. Rather than fixing a problem, the goal is to maintain function. Treatment plans for Parkinson’s patients center around exercises to offset the symptoms and resulting challenges to improve quality of life as well as the long-term goal of slowing the progression of the disease. 

One program in particular, LSVT Big & Loud, which is a program Western Wisconsin Health currently offers, was developed based on research that assessed the impact of rehab on symptoms and quality of life (2). This is an intensive, 4-week program that focuses on functional goals of the patient and has both PT/OT (physical therapy/occupational therapy) and speech therapy components. It is recommended that both speech (Loud) and PT/OT (Big) components are done together for maximum benefits, but some patients choose to do one at a time or one component only. It is important to understand that not every person can tolerate this level of activity. Patients will often work with therapy 1-2 days a week to build enough strength and endurance to be able to tolerate the intensive nature of Big & Loud.

Big & Loud has been shown to have carryover effects up to two years after the program has been completed (2). To achieve long lasting results a repetitive, progressive format is used to retrain the brain’s perception of movement patterns and volume when speaking in addition to building strength and endurance (including muscles used for swallowing). This format improves long term carryover of improvement and is effective for patients whose symptoms include dementia. Patient participation is key, with homework being assigned to apply principles learned during sessions to their daily activities.   

When should a person diagnosed with Parkinson’s disease begin working with rehab? In general, it is much easier to maintain than get back what has declined, a principle that is critical to understand with progressive neurological disorders. Unfortunately, it is not always possible to regain function that been lost. Obviously attending rehab when symptoms begin to worsen is important, but we also recommend patients attend the Big & Loud program early in the disease process. Getting your body and mind in good shape before symptoms start impacting daily life will slow progression. This also gives patients and their caregivers a good understanding of how to stay proactive mentally and physically as well as gaining a better understanding of how their lives will change as the disease progresses.

Until there is a cure for Parkinson’s, our goal for patients is to help them achieve independence for as long as possible as well as maximizing the quality of life for our patients. We understand how challenging this condition can be for both patients and caregivers and always strive to not only achieve our patient’s goals but also work with caregivers to keep them healthy as they care for their loved ones.

For more information about the LSVT Big & Loud program or to schedule a consultation at Western Wisconsin Health please call 715-684-1111. Western Wisconsin Health-Building a healthier tomorrow, together.

Sources:

1. F.A. Davis PT Collection; Physical Rehabilitation, seventh edition
2. lsvtglobal.com