Parkinson’s disease patients turn to dance

Phyllis Valentine never trained as a dancer, but she fondly remembers whirling around the room doing the polka with her father as a young girl.

She also remembers watching her father’s steady deterioration after he was found to have Parkinson’s disease, a debilitating neuromuscular condition that eventually robs patients of the ability to perform even the most basic movements without great difficulty. So when, at the age of 75, Valentine received a similar diagnosis, she figured any dancing was solidly in her past.

“The doctor told me I was in the early stages,” says the former New Yorker, a petite woman with an irreverent sense of humor who lacks the tremor that is the most recognizable sign of a Parkinson’s patient. “But I was scared to death.”

Parkinson’s, which results from the dying of brain cells that produce dopamine, a chemical messenger critical to movement, can result in tremors, stiffness, difficulty with speech and general movement impairment.

About 1 million American have the disease and approximately 60,000 new cases are diagnosed annually.

Paradoxical as it may seem to pair movement-restricted patients with artists who make a living from their flexible and athletic bodies, David Levanthal — the MMDG dancer who has become the unofficial authority on Dance for PD — says both bring “a superconsciousness to movement.” The physical and mental discipline a dancer requires to execute challenging steps travel along the same brain pathways that a Parkinson’s patient must exercise to retain even the most pedestrian movement

 For more information visit us at www. parkinsonresearchfoundation.org.

By CARRIE SEIDMAN
Source:http://health.heraldtribune.com/2012/06/05/parkinsons-disease-patients-turn-to-dance/

Comparing exercise in Parkinson’s disease-The Berlin BIG Study.

Ebersbach G, Ebersbach A, Edler D, Kaufhold O, Kusch M, Kupsch A, Wissel J

Physiotherapy widely used Parkinson’s disease (PD), bυt tr r few controlled studies comparing active interventions. Recently, a technique named “Training BIG” b introduced. Training BIG derived frοm t Lee Silverman Voice Treatment focuses ο intensive exercising οf high-amplitude movements. I t present comparative study, 60 patients wt mild tο moderate PD wr randomly assigned tο receive tr one-tο-one training οf BIG, group training οf Nordic Walking (WALK), οr domestic nonsupervised exercises (HOME). Patients BIG WALK received 16 hours οf supervised training within 4 (BIG) οr 8 (WALK) weeks. T primary efficacy measure w ffr change Unified Parkinson’s Disease Rating Scale (UPDRS) motor score frοm baseline tο follow-up t 16 weeks between groups. UPDRS scores wr obtained b blinded video rating. ANCOVA οw significant group differences fοr UPDRS-motor score t final assessment (P < 0.001). Mean improvement οf UPDRS BIG w -5.05 (SD 3.91) whereas tr w a mild deterioration οf 0.58 (SD 3.17) WALK οf 1.68 (SD 5.95) HOME. BIG w ο superior tο WALK HOME timed-up--ο timed 10 m walking. Tr wr ο significant group differences fοr quality οf life (PDQ39). T results provide evidence tt BIG effective technique tο improve motor performance patients wt PD. (c) 2010 Movement Disorder Society.

Exercise and Parkinson's Disease

Reviewed by Jon Glass, MD

Because Parkinson's disease affects your ability to move, exercise helps to keep muscles strong and improve flexibility and mobility. Exercise will not stop Parkinson's disease from progressing;but, it will improve your balance and it can prevent joint stiffening.

You should check with your doctor before beginning any exercise program. Your doctor may make recommendations about:

* The types of exercise best suited to you and those which you should avoid
* The intensity of the workout (how hard you should be working)
* The duration of your workout and any physical limitations
* Referrals to other professionals, such as a physical therapist who can help you create your own personal exercise program

The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Generally, exercises that stretch the limbs through thefull range of motion are encouraged.

Here are some tips to keep in mind when exercising.

* Always warm-up before beginning your exercise routine and cool down at the end.
* If you plan to workout for 30 minutes, start with 10-minute sessions and work your way up.
* Exercise your facial muscles, jaw, and voice when possible: Sing or read aloud, exaggerating your lip movements. Make faces in the mirror. Chew food vigorously.
* Try water exercise, such as water aerobics or swimming laps. These are often easier on the joints and require less balance.
* Work out in a safe environment; avoid slippery floors, poor lighting, throw rugs, and other potential dangers.
* If you have difficulty balancing, exercise within reach of a grab bar or rail. If you have trouble standing or getting up, try exercising in bed rather than on the floor or an exercise mat.
* If at any time you feel sick or you begin to hurt, stop.
* Select a hobby or activity you enjoy and stick with it. Some suggestions include: gardening; walking; swimming; water aerobics; yoga; tai chi.

Why Exercise is So Important

Daily exercise therapy is one of the best things that you can do for yourself to counteract the negative effects of PD & other neurological & muscular disorders. A lack of physical activity reduces the amount of oxygen to the brain, contributes to further cell damage, loss of cognitive skills and muscle control.

Exercise brings additional oxygen & glucose to the brain, both of which are crucial to brain function. The body responds by forming new capillaries to bring the additional blood to nerve cells and by boosting brain chemicals that protect neurons and strengthen new neuronal connections. We have learned from stroke victims that the human brain has the ability to create new connections and bypass damaged areas to regain lost motor skills & muscle control. Remarkable results have been achieved, over time, with daily mental & physical exercise therapy. Mental concentration on repetitive physical movements can provide benefits to our muscles as well as our mental ability to control them.

When nerve cells are deprived of stimuli they atrophy, suggesting that stimulation of the central nervous system by physical activity may retard the loss of nerve cells in the brain and elsewhere. Exercise has been shown to enhance blood flow to various parts of the brain as well as to increase the speed with which nerve messages travel through the brain.

In addition to the effects of Parkinsons, most people diagnosed with this disease are over the age of 50 and therefore are also experiencing the normal effects of aging.

According to the American Academy of Orthopaedic Surgeons:

* As muscles age, they begin to shrink and take longer to respond
* Tendons become stiffer & less able to tolerate stress
* Handgrip strength decreases, making routine tasks more difficult
* The heart muscle becomes less capable, making us tire more quickly
* Joint motion becomes more restricted & flexibility decreases
* Joints become inflamed and arthritic as the cushioning cartilage begins to breakdown

However the good news is, that we now know that most of the changes in our musculoskeletal system that were attributed to normal aging are in fact the result of inactivity and or insufficient physical exercise. The less physical activity and exercise we do the less capable we become.
According to the Mayo Clinic, "Exercise has important benefits for everyone regardless of age or physical condition... When your condition threatens to immobilize you, Exercise keeps you moving... to retain your mobility & function, use it or lose it".

Gameworld: Motion games broaden uses beyond exercise

By John Gaudiosi
RALEIGH, North Carolina (Reuters Life!) – Ever since Nintendo launched the Wii, gamers have been interacting with characters and working out with virtual trainers in titles like Electronic Arts’ “EA Sports Active” or Ubisoft’s “Your Shape.”
Nintendo is even encouraging families to exercise together with “Wii Games: Summer 2010,” a national tour that kicks off in Jersey City, New Jersey on July 16 with Olympic gymnast Shawn Johnson serving as an ambassador for the competition.

Now researchers, scientists and game developers are using Nintendo’s console for many other health-oriented applications, and in some cases are getting millions of dollars in grants to dream up new technologies.

A recent gathering of over 400 top minds at the sixth annual Games for Health Conference in Boston found innovative new ways that video games with motion-sensor controllers are being used to help doctors and patients.

Through a grant from the National Institute of Health, Red Hill Games and the School of Nursing at the University of California San Francisco are using Wii technology to create games that help people with Parkinson’s disease improve their balance. One called “Rail Runner” requires patients to stand up and sit down to operate an old-fashioned railroad hand cart.

“Most of these patients are in their 70s and 80s, and they really love these games,” said Bob Hone, creative director at Red Hill Studios. “They really want something that’s going to address their disease, and what’s different is these games are designed specifically for them.”

Red Hill is incorporating similar Wii technology into games to help improve gait and balance in kids with Cerebral Palsy.

“These kids sometimes have physical challenges, so we’ve taken that into account to make games where they feel like they’re walking and they get to the finish line successfully,” said Hone.

GROWING BUSINESS
This fall, Sony Computer Entertainment America will launch PlayStation Move for PlayStation 3 and Microsoft will introduce Kinect for Xbox 360. These new devices are expected to not only open up gaming to a new mainstream audience, but also offer pioneers in the burgeoning Games for Health arena the ability to dream up new technology.

“The impact of these new technologies is going to be as seismic as Nintendo was when it originally came out with the Wii and the Wii balance board, because it’s going to extend across more platforms,” said Stephen Yang, a researcher and assistant professor at New York’s College of Courtland.

“There are a lot of great game designers out there who will be able to tap into these new physical interactions with games and bring new experiences that will be both fun and beneficial for patients,” Yang said.

John Lumpkin, MD, senior vice president of the Robert Wood Johnson Foundation, has seen first-hand the advances that motion-sensor controllers and physical games have had on both his patients and his own children.

“These games promote motion, which increases the heart rate and burns more calories,” said Lumpkin. “Even a game with the simplest motion like playing drums on ‘Rock Band’ can have a gamer burning twice as many calories per hour as he or she would just sitting around, while a more vigorous game like ‘Dance Dance Revolution’ can burn as many as six times the amount of calories,” said Lumpkin.
Lumpkin said what really excites him, and many in his field, is that fact that today researchers are using a Wii balance board game to help stroke victims regain their balance just as effectively as an $18,000 piece of equipment.

That’s one reason why the Games for Health sector has been growing exponentially over the past six years with no slowdown in sight.

“When you look at the economic activity associated with Health Care in the U.S. it’s approximately 16 percent of gross domestic product, even in countries that spend less on health care, it’s still double-digit GDPs,” said Ben Sawyer, co-founder, Games for Health.

“Small games for health developers are receiving grants in the tens of millions to the low hundreds of millions” of dollars, said Sawyer. “When you combine those numbers with game sales of titles like Konami’s ‘Dance Dance Revolution,’ Ubisoft’s ‘Your Shape,’ Nintendo’s ‘Wii Fit’ and Electronic Arts’ ‘EA Sports Active,’ the Games for Health sector is well over $1 billion annually.”

The Benefits of Exercise for People Who Suffer From Parkinson’s Disease

by Jeremy Parker

Many sufferers of Parkinson’s disease quickly find that various aspects of their life are no longer controllable in the way that they used to be however by exercising regularly Parkinson sufferers can continue to control their gross movements i.e. walking, holding objects etc. for longer which adds a mental and emotional boost to their wellbeing. Research has shown that exercise may also improve the synthesis of dopamine in the brain and increase the levels of neurotrophic factors which are beneficial compounds.

Exercise for people diagnosed with Parkinson’s disease incorporates muscle strengthening, flexibility and toning activities so that muscles and joints stay flexible and strong. It is normal for a physiotherapist to implement an exercise schedule for the patient that includes a range of activities to work all muscles of the body over a two or three day period. So for example, day one of the cycle may include walking and strengthening exercises for the arms and hands whereas day two might be a yoga class where flexibility of the joints is the main focus.

It is essential to monitor the patient’s progress, not only so that any improvements and decreases in function are recorded but also as a stimulus for the patient; when people see improvement and can visualise the effort that they put in they are much more positive about continuing the regime.

In general exercise should test the entire body and not just the limbs so that posture and movement is maintained for as long as possible. Good posture is essential in the later stages of Parkinson’s disease because stooping can hamper breathing and swallowing. Exercises for posture include callisthenics, yoga, Pilates, tai chi, and swimming however not every sufferer will enjoy these types of activities. Simply sitting upright while reading a book or watching TV and walking with a straight back will also help though, thus walking the dog or playing with the children or grandchildren are great ways to work the body muscles and to enjoy daily exercising.

Regular exercise for the Parkinson’s sufferer will reduce the incidence of muscle cramps, rigidity of the joints and the aches and pains associated with staying still for long periods of time. Also, because exercise helps the sufferer to maintain control over many of their gross movements (although maybe not the tremors) it gives them a heightened sense of achievement and so stress and anxiety levels remain low. Keeping a positive mental attitude is incredibly important in conditions like Parkinson’s disease where sufferer can very easily become frustrated and discouraged with their predicament.

As with all exercise routines, the patient should start with a good warm up followed by the exercise activity of their choice or which has been scheduled for that day, and then they should finish with a positive cool down so that the chances of developing muscle cramps and injuries are greatly reduced. An exercise session should ideally last around 15-20 minutes and should not by any means exhaust the patient. Overexertion can be equally as damaging to a Parkinson’s sufferer as no exercise at all.

In order to make daily exercise more appealing and less of a chore it may be worth trying to find a friend or relative that is willing to exercise with the patient. Also, a bit of variety in the type of exercise will not only mean that the exercise stays interesting but it will also ensure that all muscles and joints of the body are used to a satisfactory level.

Effect of exercise on reactivity and motor behaviour in patients with Parkinson’s disease.

J Neurol Neurosurg Psychiatry.

Authors: Müller T, Muhlack S

Background Following cued levodopa (LD) intake, endurance exercise showed a beneficial effect on scored motor performance in patients with Parkinson’s disease (PD) in comparison with rest. This may result from an exercise induced increase in endogenous dopamine synthesis. As a result, beneficial effects on movement and reactivity may occur. Objectives To measure reactivity and motor performance in a repeated fashion with instrumental tasks after cued administration of soluble 200 mg of LD/50 mg of benserazide. Design PD patients consecutively performed paradigms, which assess reactivity and movement performance, after a standardised period of rest or of age-related, heart rate adapted endurance exercise on two consecutive days in a random order. Results Reactivity and execution of simple and complex motion series were significantly better following exercise than after rest. Discussion Endurance exercise has a beneficial effect on reactivity and movement behaviour in PD patients following cued application of LD probably due to an augmented synthesis and release of dopamine and other catecholamines and release in the prefrontal cortex, the nucleus accumbens and the basal ganglia. Small changes in catecholamine modulation of prefrontal cortex cells can have profound effects on the ability of the prefrontal cortex to guide behaviour. Previous exercise may also improve pedunculopontine nucleus function, which is involved in motor-related attention processes.

Computer use and physical exercise may reduce risk of memory loss

Crack open a book and hop on a stationary bike to ward off memory loss.

The combination of moderate physical exercise and computer use may help reduce the risk of mild cognitive impairment later in life, Mayo Clinic researchers found.

Individually, the effects of moderate exercise and computer use prove to significantly reduce the risk of mild cognitive impairment, according to the study.

But Yonas Geda, a neuropsychiatrist at the Mayo Clinic, said, “The combined effects are better than the arithmetic sum of the individual effects.”

Mild cognitive impairment is the intermediate stage between normal cognitive aging and dementia, he said. He gave the example of people losing their keys on occasion, which would be considered a normal occurrence. Forgetting about a flight or another important event, however, may be signs of mild cognitive impairment and early stages of Alzheimer’s disease, he said.

Normal cognitive aging involves the brain function to remain intact, while a decrease in processing speed in the brain occurs, said Dr. Diana Kerwin in the Division of Geriatrics at Northwestern University. In the absence of cognitive diseases, it is expected that people take longer to do their taxes or balance their checkbooks, she said.

People in the study who engaged in any amount of moderate exercise were 36 percent less likely to have mild cognitive impairment than people who did not exercise.

Those who participated in any amount of computer use were 44 percent less likely to have mild cognitive impairment than people who did not use the computer.

The joint effect of moderate exercise and computer use causes “synergistic interaction,” explains Geda, which is greater than if each exercise were performed independently.

“Exercise can help delay or prevent the onset of cognitive decline,” said Kerwin, who also is affiliated with the Cognitive Neurology and Alzheimer’s Disorder Center in the Neurobehavioral Clinic at Northwestern University. Exercise can also maintain healthy blood vessels and glucose levels and lower blood pressure, she said.

The 926 participants, ages 70 to 90, were evaluated in a case-control study, which meant a cause-and-effect relationship could not be drawn from the data, Geda said.

Since there is not a cause-and-effect relationship, there is a possibility that people who engage in physical and mental exercise are less likely to show memory loss or that a person with memory loss is less likely to perform mental and physical activities.

“We know as far as successful aging, one of the best activities is to remain engaged,” Kerwin said, whether it be social, cognitive, physical exercise, or a combination.

Geda recommended craft activities, such as knitting and quilting, social activities and any other moderate physical exercise to reduce the risk of mild cognitive impairment.

Kerwin suggested that people participate in activities that are cognitively challenging, but also activities that they are interested in. “If people enjoy the activity, it increases the likelihood that they’ll do it,” she said.

Barbara Wijnicki, a 73-year-old Chicago resident, keeps active by taking yoga and dance classes, walking regularly and reading books.

“I always have a book to read and I think it may be helping me with my mental capactity,” she said. “I believe that just being active and being with other people is good for the brain and the mental part.”

Exercises For The Parkinson Patient

Just as running water does not freeze, so moving muscles do not freeze.
Know the facts. The maintenance of normal muscle tone and function is an important aspect of the treatment of parkinsonism. In part, medication administered for your illness achieves this goal. However, to realize the full benefit of the medication daily exercise and activity are essential. This booklet outlines some of the exercises capable of maintaining muscle power and tone and preventing deformities of the limbs and spine. Their daily performance has proved most beneficial to patients with this illness.

TEN BASIC EXERCISES FOR THE PARKINSON PATIENT
1. Bring the toes up with every step you take. In Parkinson's disease, "you never make a move", without lifting the toes.

2. Spread the legs (10 inches) when walking or turning, to provide a wide base, a better stance, and to prevent falling. It may not look "beautiful," but neither does falling.

3. For greater safety in turning, use small steps, with feet widely separated. Never cross one leg over the other when turning. Practice walking a few yards and turn. Walk in the opposite direction and turn. Do so fifteen minutes a day.

4. Practice walking into tight corners of a room, to overcome fear of close places.

5. To insure good body balance, practice rapid excursions of the body. Backward, forward and to the right and left, five minutes, several times a day. Don't look for a wall when you think you are falling. It may not be there. Your body will always be there to protect you, if you will practice balance daily.

6. When the legs feel frozen or "glued" to the floor, a lift of the toes eliminates muscle spasm and the fear of falling. You are free to walk again.

7. Swing the arms freely when walking. It helps to take body weight off the legs, lessens fatigue, and loosens the arms and shoulders.

8. If getting out of a chair is difficult, rise with "lightning speed," to overcome the "pull of gravity." Sitting down should be done slow, with body bent sharply forward, until one touches the seat. Practice this at least a dozen times a day.

9. If the body lists to one side, carry a shopping bag loaded with books or other weights in the opposite hand to decrease the bend.

10. Any task that is difficult, such as buttoning a shirt. or getting out of bed, if practiced 20 times it day, becomes easier the 21st time.

FOR TIGHT MUSCLES AND POOR POSTURE
STANDING
1. Stand ln front of a wall, facing it about 8" away. Raise arms and reach as high as possible toward the top of the wall. Lean toward the wall and stretch.

2. With your back to the wall, alternate raising legs as high as possible by bending the knee as if marching in place.

3. Holding on to something secure, squat down as far as possible, bending knees; then come up.

SITTING
1. Sitting in straight-back chair, place your arms behind the chair and bring your shoulders back as far as possible; raise your head up and look at the ceiling.

2. Sitting In the same chair, grip the ends of a broom or mop stick with both hands, try to raise it over your head until you get it behind your head. Keep head and shoulders as erect as possible.

3. Sitting in same chair, place one leg at a time on another chair and press the knee straight. Keep it there 15 minutes. Try both legs together.

4. Sitting in a chair, raise legs up from the knee alternately, as if stamping your feet.

LYING ON A FIRM BED OR FLOOR
1. Lie on the floor or bed, flat on your back; try to press your body to the floor as flat as possible. Move your head from right to left as far as possible. Make sure your head, shoulders, back, and knees touch the surface.

2. Lie on the floor or bed on your abdomen. Do the following one by one:

1. Put your hands behind back and look up to ceiling, trying to raise your chest off the floor.
2. Kick your legs alternately, as if swimming.
3. Turn your head from right to left.

FOR BETTER BALANCE
1. Stand with hands on hips, feet spread apart:

1. Practice marching in place
2. Practice raising leg straight out to the rear.
3. Practice raising leg out to the side.
4. Practice drawing a circle with the leg.

2. Standing with hands at side, feet spread apart:

1. Lean forward and back
2. Lean to both sides
3. Lean in a circular motion and reverse the motion

FOR WALKING
1. When walking, REMEMBER:

1. Take as large a step as possible
2. Raise your toes as you step forward, hitting ground with your heels
3. Keep legs apart and posture straight
4. Swing arms and look straight ahead - your feet know where the floor is located.

2. Collect a dozen magazines; lay them out in a straight line. Space them so that you can take as long a step as possible. Practice walking over these magazines without stepping on them.

3. For a better swing to arms, walk holding a rolled magazine in each hand; keep elbows straight.

4. Practice walking sideways, backwards, and take big steps.

FOR TURNING
1. When practicing turning:

1. Keep feet spread-apart and head high
2. Use small steps; rock front side to side
3. Raise legs from the knees

2. If you feel glued to the floor:

1. Raise your head, relax back on your heels and raise your toes
2. Rock from side to side, bend knees slightly and straighten up and lift your toes
3. It sometimes helps if the arms are raised in a sudden short motion

FOR GETTING IN AND OUT OF A CHAIR
1. If you become glued a few steps before you reach the chair, try this: Don't aim for the chair but some object past it. Pass the chair as closely as possible and as you go by it sit down.

2. To sit down, bend forward as far as possible and sit down slowly. Get close to the chair. Do not fall into the chair.

3. To get up, move to the edge of the chair, bend forward and push up vigorously using your arms; try to count 1 2 3 GO! If you have a favorite armchair, raise the back legs with 4" blocks. This will help you to get up easily. Don't let people drag you up by your arms, but help you by pulling you under your arms, or with a slight push on your back.

FOR GETTING OUT OF BED
1. Place blocks under the legs of the head of the bed. This will elevate the head of the bed, & make it easier for you to sit up and swing the legs off the bed.

2. A knotted rope tied to the foot of the bed can help you to pull yourself up.

3. To get to a sitting position, shift the body down and rock yourself by vigorously, throwing your arms and legs toward the side of the bed.

FOR USING YOUR ARMS AND HANDS
1. Practice buttoning and unbuttoning your clothes; practice cutting food and writing. Squeeze a ball or work with "Silly Putty." Keep your fingers busy many times a day. Tear paper; take coins out of the pocket; play the piano.

2. Always try to dress yourself completely. Use shoehorns, elastic laces, or extra-long shoelaces to get a better grip. Dress in the most relaxed and comfortable position, sitting or standing, but make sure you are in a safe position.

3. To keep elbows straight and shoulders loose, install a pulley in doorway, place a chair under it or slightly in front. Stretch your arms and shoulders in all directions. By working the pulley when seated, you can get a more vigorous pull.

FOR GREATER SAFETY IN BATHTUB AND TOILET
If it is difficult to sit down in a bathtub, try the following:

1. Place a bench, stool or chair inside the tub; have the legs sawed off to tub height. Sit on the chair and soap yourself. Use shower to rinse, or rubber shower extension.

2. Bathtub grab bars are available. Purchase only those that attach securely.

3. Raised toilet seats are commercially available.

4. Toilet armrest for getting on and off the toilet are available.

FOR SPEECH, FACE AND CHEWING DIFFICULTIES
1. Practice singing and reading aloud with forceful lip movements. Talk into a tape recorder, if one is available.

2. Practice making faces in front of a mirror. Recite the alphabet and count numbers with exaggerated facial motions. Massage your face with vigor when washing and bathing.

3. When chewing food, chew hard and move the food around; avoid swallowing large lumps.

The previously outlined general exercises and suggestions are designed to help you. They are ancillary to medical treatment which should be carried out in consultation with your physician. In special instances where other diseases are associated with parkinsonism, your physician may wish to limit the intensity of your physical activity. Conversely, more intensive physical therapy may be indicated and in some instances should be done under the direction of a physical therapist.

All activities possible should be engaged in: work, walking, shopping, house chores, gardening, visiting, senior clubs, church organizations, travel, theater, swimming, sports, gymnasium, health clubs, "Y" activities, etc.


For more information and resources about Parkinson's disease you can check out www.parkinsonresearchfoundation.org It's one of the most comprehensive websites on the internet for Parkinson's disease information.