Parkinson s Disease Foundation. PD ExpertBriefing: Managing the Motor Symptoms in PD

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1 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. If you have any questions, please contact: Valerie Holt at vholt@pdf.org or call (212)

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4 Managing Motor Symptoms of Parkinson s Disease Sotirios A. Parashos, M.D., Ph.D. Minneapolis Clinic of Neurology Struthers Parkinson s Center 4

5 The Motor Symptoms of Parkinson s Disease 5

6 The Motor Symptoms of Parkinson s Disease The classic triad : Tremor Bradykinesia (slow, small movements) Rigidity (muscle stiffness) 6

7 The Motor Symptoms of Parkinson s Disease Four cardinal manifestations : Tremor Bradykinesia (slow, small movements) Rigidity (muscle stiffness) Loss of balance 7

8 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 Tripping and falling speech (dysarthria) Freezing of gait Communication difficulties Cramped handwriting Loss of finger dexterity Double and blurred vision Swallowing trouble Weakness Trouble getting up/sitting down 8

9 How are movements produced in the brain? 9

10 How are movements produced in the brain? FRONTAL LOBES (CEO) 10

11 How are movements produced in the brain? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE 11

12 How are movements produced in the brain? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) MUSCLE 12

13 How are movements produced in the brain? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) MUSCLE 13

14 How are movements affected in PD? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) MUSCLE 14

15 How do we treat the motor symptoms in PD? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) DRUGS L-Dopa Dopamine Agonists (like pramipexole, ropinirol, and rotigotine) MAO inhibitors (like selegiline and rasagiline) Anticholinergics (like trihexyphenidyl and benztropine) MUSCLE 15

16 How do we treat the motor symptoms in PD? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) DRUGS L-Dopa Dopamine Agonists (like pramipexole, ropinirol, and rotigotine) MAO inhibitors (like selegiline and rasagiline) Anticholinergics (like trihexyphenidyl and benztropine) MUSCLE 16

17 How do we treat the motor symptoms in PD? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) DRUGS L-Dopa Dopamine Agonists (like pramipexole, ropinirol, and rotigotine) MAO inhibitors (like selegiline and rasagiline) Anticholinergics (like trihexyphenidyl and benztropine) MUSCLE DEEP BRAIN STIMULATION 17

18 How do we treat the motor symptoms in PD? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) DRUGS L-Dopa Dopamine Agonists (like pramipexole, ropinirol, and rotigotine) MAO inhibitors (like selegiline and rasagiline) Anticholinergics (like trihexyphenidyl and benztropine) CELL TRANSPLANTS MUSCLE DEEP BRAIN STIMULATION 18

19 But all this may not be enough! 19

20 But all this may not be enough! So people with Parkinson s ask: What can I do? 20

21 Managing the motor symptoms: Some general principles 21

22 Managing the motor symptoms: Some general principles Once you have Parkinson s your muscles are no longer on automatic transmission 22

23 Managing the motor symptoms: Some general principles Once you have Parkinson s your muscles are no longer on automatic transmission You have now a manual transmission body 23

24 Managing the motor symptoms: Some general principles Once you have Parkinson s your muscles are no longer on automatic transmission You have now a manual transmission body 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 24

25 Managing the motor symptoms: Some general principles Once you have Parkinson s your muscles are no longer on automatic transmission You have now a manual transmission body 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

26 Managing the motor symptoms: Getting there 26

27 Managing the motor symptoms: Getting there Thinking every time you move can be taxing 27

28 Managing the motor symptoms: Getting there Thinking every time you move can be taxing This new way of moving has to become a habit 28

29 Managing the motor symptoms: Getting there Thinking every time you move can be taxing This new way of moving has to become a habit You will get better with practice 29

30 Managing the motor symptoms: Getting there Thinking every time you move can be taxing This new way of moving has to become a habit You will get better with practice We call this practice Exercise! 30

31 What kind of exercise? How much? 31

32 What kind of exercise? How much? Any exercise is better than no exercise 32

33 What kind of exercise? How much? Any exercise is better than no exercise Walking, biking, treadmill and Nordic walking, ballroom dancing, yoga, tai chi, progressive strengthening and stretching are all excellent forms of exercise 33

34 What kind of exercise? How much? Any exercise is better than no exercise Walking, biking, treadmill and Nordic walking, ballroom dancing, yoga, tai chi, progressive strengthening and stretching are all excellent forms of exercise Good advice: check with your doctor first; a physical therapist may be a great help 34

35 What kind of exercise? How much? Any exercise is better than no exercise Walking, biking, treadmill and Nordic walking, ballroom dancing, yoga, tai chi, progressive strengthening and stretching are all excellent forms of exercise Good advice: check with your doctor first; a physical therapist may be a great help Start with 30 minutes three times a week 35

36 But I am very physically active; do I still need to exercise? 36

37 But I am very physically active; do I still need to exercise? YES! 37

38 But I am very physically active; do I still need to exercise? YES! Remember, you have to practice new ways of doing things, so you develop new habits! 38

39 How do I stick to my exercise program? 39

40 How do I stick to my exercise program? Make it a habit 40

41 How do I stick to my exercise program? Make it a habit Put it on your schedule 41

42 How do I stick to my exercise program? Make it a habit Put it on your schedule Pick something you will enjoy doing 42

43 How do I stick to my exercise program? Make it a habit Put it on your schedule Pick something you will enjoy doing Have a partner 43

44 Who can help me when my doctor says my treatment is optimized but I still have motor symptoms? 44

45 Who can help me when my doctor says my treatment is optimized but I still have motor symptoms? Physical therapist Strength, weakness, balance 45

46 Who can help me when my doctor says my treatment is optimized but I still have motor symptoms? Physical therapist Strength, weakness, balance Occupational therapist Daily activities, dexterity, assistive equipment 46

47 Who can help me when my doctor says my treatment is optimized but I still have motor symptoms? Physical therapist Strength, weakness, balance Occupational therapist Daily activities, dexterity, assistive equipment Speech therapist Articulation, voice, swallowing 47

48 Putting it all together: Addressing specific symptoms Activities of daily living Freezing Falling Speech and voice 48

49 Activities of Daily Living 49

50 Activities of Daily Living Time your activities to coincide with: Best effect of your medications When you are least tired 50

51 Activities of Daily Living 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 51

52 52

53 Freezing 53

54 Freezing Remove clutter from your living space 54

55 Freezing Remove clutter from your living space Striped patterns on the floor Stripes across thresholds 55

56 Freezing Remove clutter from your living space Striped patterns on the floor Stripes across thresholds Stepping, or side-to-side rocking in place Humming, counting Metronome Laser light 56

57 Freezing Remove clutter from your living space Striped patterns on the floor Stripes across thresholds Stepping, or side-to-side rocking in place Humming, counting Metronome Laser light Gait assistive device (walker) 57

58 Falling 58

59 Falling Understand the circumstances of your falls 59

60 Falling Understand the circumstances of your falls Change the way you do things Remember manual transmission? Think before you act 60

61 Falling Understand the circumstances of your falls Change the way you do things Remember manual transmission? Think before you act Avoid multitasking that requires balancing Do a lot of activities in a sitting position 61

62 Falling Understand the circumstances of your falls Change the way you do things Remember manual transmission? Think before you act Avoid multitasking that requires balancing Do a lot of activities in a sitting position Fall-proof your living space Consider a gait assistive device 62

63 Speech and Voice 63

64 Speech and Voice You have to reset your voice level: think loud 64

65 Speech and Voice You have to reset your voice level: think loud Slow down and separate the words 65

66 Speech and Voice You have to reset your voice level: think loud Slow down and separate the words See a speech therapist: you will be given homework 66

67 Speech and Voice You have to reset your voice level: think loud Slow down and separate the words See a speech therapist: you will be given homework DO THE EXERCISES Remember this has to become a new habit 67

68 Thank You! 68

69 Questions and Discussion 69

70 Upcoming PD ExpertBriefings PD Medications: Managing Side Effects Tuesday, April 8, 2014, 1:00 PM - 2:00 PM ET Hubert H. Fernandez, M.D. Cleveland Clinic Lerner College of Medicine When Parkinson's Interferes with Gastrointestinal Function Tuesday, June 24, 2014, 1:00 PM - 2:00 PM ET Peter A. LeWitt, M.D., Professor of Neurology Wayne State University School of Medicine and Director, Parkinson s Disease and Movement Disorder Program, Henry Ford Hospital 70

71 Resources from PDF Fact Sheets Falls Prevention Speech Therapy PD Resource List 750 Resources Online Seminars Gait, Balance and Falls in Parkinson's Disease Understanding the Progression of Parkinson s

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