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) 923-4700
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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 4
The Motor Symptoms of Parkinson s Disease 5
The Motor Symptoms of Parkinson s Disease The classic triad : Tremor Bradykinesia (slow, small movements) Rigidity (muscle stiffness) 6
The Motor Symptoms of Parkinson s Disease Four cardinal manifestations : Tremor Bradykinesia (slow, small movements) Rigidity (muscle stiffness) Loss of balance 7
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
How are movements produced in the brain? 9
How are movements produced in the brain? FRONTAL LOBES (CEO) 10
How are movements produced in the brain? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE 11
How are movements produced in the brain? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) MUSCLE 12
How are movements produced in the brain? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) MUSCLE 13
How are movements affected in PD? FRONTAL LOBES (CEO) BASAL GANGLIA (LOGISTICS) DOPAMINE SPINAL CORD (RELAY STATION) MUSCLE 14
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
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
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
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
But all this may not be enough! 19
But all this may not be enough! So people with Parkinson s ask: What can I do? 20
Managing the motor symptoms: Some general principles 21
Managing the motor symptoms: Some general principles Once you have Parkinson s your muscles are no longer on automatic transmission 22
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
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
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
Managing the motor symptoms: Getting there 26
Managing the motor symptoms: Getting there Thinking every time you move can be taxing 27
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
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
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
What kind of exercise? How much? 31
What kind of exercise? How much? Any exercise is better than no exercise 32
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
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
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
But I am very physically active; do I still need to exercise? 36
But I am very physically active; do I still need to exercise? YES! 37
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
How do I stick to my exercise program? 39
How do I stick to my exercise program? Make it a habit 40
How do I stick to my exercise program? Make it a habit Put it on your schedule 41
How do I stick to my exercise program? Make it a habit Put it on your schedule Pick something you will enjoy doing 42
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
Who can help me when my doctor says my treatment is optimized but I still have motor symptoms? 44
Who can help me when my doctor says my treatment is optimized but I still have motor symptoms? Physical therapist Strength, weakness, balance 45
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
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
Putting it all together: Addressing specific symptoms Activities of daily living Freezing Falling Speech and voice 48
Activities of Daily Living 49
Activities of Daily Living Time your activities to coincide with: Best effect of your medications When you are least tired 50
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
Freezing 53
Freezing Remove clutter from your living space 54
Freezing Remove clutter from your living space Striped patterns on the floor Stripes across thresholds 55
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
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
Falling 58
Falling Understand the circumstances of your falls 59
Falling Understand the circumstances of your falls Change the way you do things Remember manual transmission? Think before you act 60
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
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
Speech and Voice 63
Speech and Voice You have to reset your voice level: think loud 64
Speech and Voice You have to reset your voice level: think loud Slow down and separate the words 65
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
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
Thank You! 68
Questions and Discussion 69
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
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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