PD ExpertBriefing Managing the Motor Symptoms in PD Led By

Parkinson’s Disease Foundation

PD ExpertBriefing:Managing the Motor Symptoms in PD

Led By: Sotirios A. Parashos, M.D. Minneapolis Clinic of Neurology and

Struthers Parkinson's Center

This session was held on:Tuesday, March 11 , 2014 at 1:00 PM ET.

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Managing Motor Symptoms of Parkinson’s Disease

Sotirios A. Parashos, M.D., Ph.D.

Minneapolis Clinic of Neurology

Struthers Parkinson’s Center

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The Motor Symptoms of Parkinson’s Disease

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• The “classic triad”:

– Tremor

– Bradykinesia (slow, “small” movements)

– Rigidity (muscle stiffness)

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• Four “cardinal manifestations”:

– Tremor

– Bradykinesia (slow, “small” movements)

– Rigidity (muscle stiffness)

– Loss of balance

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The Cardinal Manifestations produce many seemingly unrelated symptoms

• Slow stiff walking

• Loss of arm swing

• Loss of facial expression -“mask” face

• Drooling

• Soft voice (dysphonia)

• Slurred, monotonous speech (dysarthria)

• Communication difficulties

• “Cramped” handwriting

• Loss of finger dexterity

• Double and blurred vision

• Swallowing trouble

• Weakness

• Trouble getting up/sitting down

• Tripping and falling

• Freezing of gait

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How are movements produced in the brain?

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FRONTAL LOBES (CEO)

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FRONTAL LOBES (CEO)

BASAL GANGLIA(LOGISTICS)DOPAMINE

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FRONTAL LOBES (CEO)


SPINAL CORD (RELAY STATION)

MUSCLE

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FRONTAL LOBES (CEO)



MUSCLE

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How are movements affected in PD?

FRONTAL LOBES (CEO)

BASAL GANGLIA(LOGISTICS)

DOPAMINE


MUSCLE

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How do we treat the motor symptoms in PD?

FRONTAL LOBES (CEO)


DOPAMINE


MUSCLE

DRUGSL-DopaDopamine Agonists

(like pramipexole, ropinirol, and

rotigotine)MAO inhibitors

(like selegiline and rasagiline)

Anticholinergics(like trihexyphenidyl

and benztropine)

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FRONTAL LOBES (CEO)


DOPAMINE


MUSCLE






and benztropine)

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FRONTAL LOBES (CEO)


DOPAMINE


MUSCLE






and benztropine)

DEEP BRAIN STIMULATION

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FRONTAL LOBES (CEO)


DOPAMINE


MUSCLE






and benztropine)

DEEP BRAIN STIMULATION

CELL TRANSPLANTS

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But all this may not be enough!

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But all this may not be enough!

So people with Parkinson’s ask:

What can I do?

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Managing the motor symptoms:Some general principles

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• Once you have Parkinson’s your muscles are no longer on “automatic transmission”

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• You have now a “manual” transmission body

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• Just like with learning how to drive stick shift, you have to “think” when you move; the CEO (frontal lobes) has to do more work

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• Just like with learning how to drive stick shift, you have to “think” when you move; the CEO (frontal lobes) has to do more work

• You have to “think”

big and loud!25

Managing the motor symptoms: Getting there

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• Thinking every time you move can be taxing

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• This new way of moving has to become a habit

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• You will get better with practice

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• You will get better with practice

• We call this practice

Exercise!

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What kind of exercise? How much?

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• Any exercise is better than no exercise

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• Walking, biking, treadmill and Nordic walking, ballroom dancing, yoga, tai chi, progressive strengthening and stretching are all excellent forms of exercise

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• Good advice: check with your doctor first; a physical therapist may be a great help

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• Good advice: check with your doctor first; a physical therapist may be a great help

• Start with 30 minutes three times a week

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But I am very physically active; do I still need to exercise?

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YES!

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YES!• Remember, you have to practice new ways of

doing things, so you develop new habits!

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How do I stick to my exercise program?

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• Make it a habit

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• Make it a habit

• Put it on your schedule

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• Make it a habit


• Pick something you will enjoy doing

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• Make it a habit


• Pick something you will enjoy doing

• Have a partner

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Who can help me when my doctor says my treatment is “optimized” but I still

have motor symptoms?

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• Physical therapist

– Strength, weakness, balance

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• Occupational therapist

– Daily activities, dexterity, assistive equipment

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• Occupational therapist

– Daily activities, dexterity, assistive equipment

• Speech therapist

– Articulation, voice, swallowing

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Putting it all together: Addressing specific symptoms

• Activities of daily living

• Freezing

• Falling

• Speech and voice

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Activities of Daily Living

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• Time your activities to coincide with:

– Best effect of your medications

– When you are least tired

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• Time your activities to coincide with:

– Best effect of your medications

– When you are least tired

• Find the equipment that will help you:

– Writing implements

– Dressing devices

– Eating utensils

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Freezing

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Freezing• Remove “clutter” from your living space

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• Striped patterns on the floor

• Stripes across thresholds

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• Stepping, or side-to-side rocking in place

• Humming, counting

• Metronome

• Laser light

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• Stepping, or side-to-side rocking in place

• Humming, counting

• Metronome

• Laser light

• Gait assistive device (walker)

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Falling

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Falling• Understand the circumstances of your falls

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• Change the way you do things

• Remember “manual transmission”?

• Think before you act

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• Avoid multitasking that requires balancing

• Do a lot of activities in a sitting position

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• Avoid multitasking that requires balancing

• Do a lot of activities in a sitting position

• “Fall-proof” your living space

• Consider a gait assistive device

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Speech and Voice

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Speech and Voice

• You have to “reset” your voice level: think “loud”

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Speech and Voice


• Slow down and separate the words

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Speech and Voice



• See a speech therapist: you will be given homework

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Speech and Voice



• See a speech therapist: you will be given homework

• DO THE EXERCISES• Remember this has to become a new habit

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Thank You!

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Questions and Discussion

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Resources from PDF

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PD ExpertBriefing Managing the Motor Symptoms in PD Led By