Advantages And Disadvantages Of Continuous Enteral Infusion
The main advantage of continuous duodenal infusion is that it provides continuous delivery of levodopa so that plasma concentrations of the drug can be kept near constant thus reducing motor complications. Levodopa is an acidic drug and needs to be given in a large volume of fluid; thus, dermal administration is not practical . The beneficial effects of continuous levodopa infusion on motor fluctuations and dyskinesias arise because it bypasses erratic gastric emptying in Parkinsons patients which in turn increases the available dopa in the nervous system. Titration of levodopa dosage is easy with this method. Another advantage is that other Parkinsons medications such as oral levodopa and dopamine agonists can be eliminated when this method is used.
Duodenal dopa administration has several disadvantages. First, a surgical procedure or percutaneous endoscopic gastrostomy is required for the placement of a small tube to the duodenum. Second, the accompanying pump may be cumbersome for some patients. Secondary effects may also occur which include sporadic blockage of tubes, displacement of the inner tube, leakage at the tube connection, and local infections. Finally, high cost may be a limiting factor.
Randomized Controlled Trials Of Levodopa Enteral Infusion
Experimental Models Of Parkinsonism In Laboratory Animals
Cbd Vs Other Movement Disorders
A study mentioned that basal ganglia dysfunction is responsible for causing movement disorders, like tremors and chorea .
The British Journal of Pharmacology released a study that supported cannabinoids affinity in activating receptors in the basal ganglia .
The authors added that the activation might have therapeutic potential in treating Huntingtons disease and Parkinsons disease symptoms.
A 2018 study released in Neurochem evaluated how CBD and other cannabinoids might have neuroprotective effects in an HD cell culture model .
In the study, CBD, tetrahydrocannabinol , and cannabinol showed 51-84% protection against Huntington-induced cell death.
Moreover, a review from Neurology mentioned that CBD might have reduced chorea among patients with HD. A dose of 300mg/d CBD was administered to patients orally for three weeks.;
Mild improvements in choreic movements were reported in the first week. In the second week, further improvements were reported .;
Chorea, like tremors, is a movement disorder. However, a tremor is classified for its rhythmicity and predictability, while chorea has more random and untimely movements .
Meanwhile, a contrasting study was released by Pharmaceuticals, where a controlled clinical trial showed no significant improvements among 15 patients with HD.;
In the study, patients were treated with 700mg/d for six weeks. The study did acknowledge that high doses of oral CBD might hold a therapeutic effect on social anxiety, insomnia, and epilepsy .
Clinical Motor Cardinal Signs
A-/hypo-/bradykinesia: These terms are defined, collectively, as slowed voluntary movement. Separately, akinesia indicates the absence of voluntary movement, while hypokinesia means smaller movements, and bradykinesia refers to slowness of movement. They usually determine any impairment in fine motor movements, facial expression , monotonic and hypophonic speech with a reduction of speed, and general motion amplitude. This can have an important impact in functional skills like arm swinging when walking, raising from a chair, handwriting, and general gesturing .
This cardinal sign is one of the best that emerges from its origin of dysfunction, which is cited in this chapter . It has been determined especially by a characteristic involving the movement programming of the cerebral cortex, in particular the supplementary motor area .
2. Rest tremor : this sign is usually asymmetric, consisting of alternate contractions of agonist and antagonist muscles, including flexors, extensors, pronators, and supinators of the wrists and arms, resulting in the pill rolling movement of the hand. It has a medium frequency and tends to disappear with action. The legs, lower jaw, or head may also be involved, resulting in an adduction-abduction movement of the lower limbs and yes-yes or no-no motion in the head .
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Improving Physical Capacity: Resistance Training
Due to both central and peripheral causes, PD patients suffer muscle weakness . Weakness in the lower limbs particularly affects basic daily tasks such as standing up from a chair and walking. Moreover, sarcopenia is considered a secondary cause of bradykinesia. Muscle weakness is also strongly related to impaired balance, since it reduces the ability to respond to postural and balance modifications. When considering this observation, its association with the risk of falls is straightforward. Moreover, the consequences of balance loss may adversely contribute to the maintenance of bone mass density in the hip, increasing the risk of hip fracture.
In PD, the nigral dopaminergic deficit results in an increase in tonic inhibition of the thalamus and reduction in the excitatory drive to the motor cortex leading to disruption of cortical activation of the muscle. Conceivably, this disorder may result in impaired motor unit recruitment and could contribute both to bradykinesia and muscle weakness.
When considering these impairments, resistance training has been proposed as an efficient intervention aimed at reducing muscle weakness, bradykinesia, balance problems, as well as improving bone parameters, physical functioning, ADLs and the quality of life.
How Is Parkinson’s Disease Diagnosed
A person doesn’t need to have all the signs and symptoms of Parkinson’s disease to be diagnosed with it.
“In general, people have a combination of the motor symptoms and the non-motor symptoms,” says Dr. Nwabuobi. “Some people have more non-motor symptoms than motor and vice versa, but in order to have a diagnosis of Parkinson’s, you definitely need the motor symptoms. We’re looking for specific things , including a rest tremor, bradykinesia, rigidity, and poor balance.”
According to the Parkinson’s Foundation, a person needs to have two of the four main motor symptoms of Parkinson’s over a period of time to be diagnosed with the disease.
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Staying Safe At Home With Parkinsons
Simple changes around the home can make it easier for you to function well while dealing with Parkinson’s symptoms. Pituch notes that healthcare providers can help you come up with a detailed plan for living safely and independently at home.
Discuss specific strategies with your Parkinson’s medical team;to design a safer living space. Occupational therapists can suggest ways to create an environment that’s friendly to those with Parkinson’s; this type of therapist looks at things like furniture placement, handrails, extensions on toilets, and floor coverings to determine where possible hazards lie.
Difference Between Spasticity And Rigidity
Spasticity generally occurs only during muscle stretch and is usually accompanied by increased tendon reflexes and a Babinskis response. There is usually a difference between resistance in one direction of movement as compared to the opposite direction and some patients may represent with Clasp-Knife phenomenon
In rigidity, muscle tone is increased even at rest and is usually presents during passive range of motion in all directions across individual joints. The plantar reflex and tendon reflexes are usually normal. There is absence of synergy.
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What Are The Causes
The cause of Parkinson’s is largely unknown. Scientists are currently investigating the role that genetics, environmental factors, and the natural process of aging have on cell death and PD.
There are also secondary forms of PD that are caused by medications such as haloperidol , reserpine , and metoclopramide .
Turning Over And Getting Out Of Bed
Another frequent problem reported by people with PD is difficulty in turning over and getting out of bed. There are, in my view, 2 main reasons why this task is difficult to perform. First, it is a complex sequential motor skill that has many subcomponents, which include:
throwing back the bed covers,
shifting the pelvis toward the center of the bed so that, when the turn is completed, the body is not too close to the edge,
turning the head,
Speech And Occupational Therapy
Parkinsons disease can lead to slurred speech and difficulty swallowing. A speech and language therapist can provide muscle training techniques that may help overcome some of these problems.
An occupational therapist can help identify everyday tasks that can be challenging and work with the person to find practical solutions.
This may include new strategies for dressing, preparing meals, performing household chores, and shopping. Adaptations to the home environment can also make daily living easier.
For people with Parkinsons disease, deep brain stimulation may help manage:
- an electrode inside the part of the brain that controls movement
- a pacemaker-like device, or neurostimulator, under the skin in the upper chest
- a wire under the skin connecting the neurostimulator to the electrode
The neurostimulator sends electrical impulses along the wire and into the brain via the electrode. These impulses can prevent symptoms by interfering with the electrical signals that cause them.
There is a small risk of brain hemorrhage, infection, and headaches. Some people may see no improvement, or their symptoms may worsen. There may also be discomfort during stimulation.
Nevertheless, the AAN considers this treatment safe and effective for specific people and say any adverse effects are usually mild and reversible. Anyone considering this treatment should discuss the pros and cons with a healthcare professional.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms; others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Parkinsons Clinical Signs Diagnosis And Rating Scales
The three clinical motor cardinal signs of PD, a-/hypo-/bradykinesia, rest tremor, and rigidity, are directly related to the degeneration of dopaminergic neurons. However, other motor symptoms and signs, secondary to degeneration of nondopaminergic pathways, can be described such as loss of postural control, postural stability/balance, and gait disturbance. In addition, the most well-known nonmotor characteristic motor symptoms have also been described. There can be additional psychiatric and autonomic features found, as well as cognitive impairment, sleep disorders, olfactory dysfunction, and pain.
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Passive Manipulation Of Limbs
To test for the presence of rigidity, we need to passively manipulate the limbs of the patient. However, If the disease is in its early stage or the symptoms are well controlled with medications, we may not be able to see rigidity. We will need to use some activation maneuvers, that basically consist in performing repetitive movements with the limb contralateral to the one that is being tested.
Also, there are two types of rigidity:
-;;;;;; Lead-pipe rigidity: where the tone is uniformly and smoothly increased throughout the entire range of movement
-;;;;;; Cogwheel rigidity: where a tremor is superimposed on the hypertonia, making the movement irregular due to intermittent increase and reduction of tone
Upper Extremity Testing
For the upper extremity the most sensitive joint where to check for rigidity is the wrist. To uncover rigidity, passively rotate the wrist and feel for a resistance to the movement. It is very important that the arm of the patient is fully relaxed when rotating the wrist. To do this, place your proximal hand under the patients forearm, while your distal hand grabs and rotates the wrist of the patient. When rigidity is present, the range of motion will be preserved but you will feel a resistance in performing the movement.
Wrist rotation with activation maneuver.
It is also possible to test for rigidity in the elbow by passively flexing and extending the forearm.
Elbow flexion-extension with activation maneuver.
Lower Extremity Testing
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
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Does Cbd Help With Tremors
Researchers have yet to find out how CBD affects tremors. CBD is widely studied for its ability to reduce the symptoms of movement disorders. So far, we know that CBD can reduce muscle spasms, convulsions, and tremors associated with conditions like epilepsy, Parkinsons Disease , and Multiple Sclerosis;. One study actually found that CBD reduced the intensity of tremors in patients with PD during their REM sleep stage.
The mechanism behind the potential positive effect of CBD on tremors isnt well-known yet. However, scientists speculate that the ECS is the major therapeutic target in this relationship.
Lets elaborate on that mechanism using the examples of different types of tremors.
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Keith and Regu, Had Developed Up To 21 Additional Symptom Triggers. While placing my main assessment focus on the amount of medulla swelling Keith and Regu had, and, If I could link their kidney, low back and hip problems to the spinal faults I saw in their X-rays, as Initial;Symptom Causal Triggers, I also found another 18 secondary causal-triggers for Keith, and an additional 21 secondary triggers for Regu, which I had to deal with, in order to help them reach remission. Providing they continued living by the follow-up advice I gave them to help themholdtheir remission, they would have an excellent chance of holding their;remission long-term.
AFTER 30 YEARS DIAGNOSED, & 15 YEARS IMMOBILISED, WHILE SUFFERING HORRIBLE KIDNEY PAIN & FINALLY FINDING THE ANSWERS;IN ONLY 5 DAYS,;ON THE B.A.10 PROGRAM, BARRY BLACK , IS ONE PARKINSON PATIENT WHO WILL AGREE WITH THIS STATEMENT BELOW: ;
IN THE AREA OF SPECIALISED RIGIDITY DISEASE TREATMENT, IT IS MY OPINION THE HEALTHCARE SYSTEM NEEDS A HUGE KICK UP THE REAR END, IN LIGHT OF THE MANY BEFOREANDAFTER VIDEOS I OFFER AS PROOF THAT A CUREDOESEXIST.
UNLESS WE HELP THESE PATIENTS, AND GET THEM BACK IN THE WORKFORCE PAYING TAXES, GOVERNMENTS WILL FALL FROM THE SUBSEQUENT FINANCIAL BURDEN OF;HAVING TO SUPPORT SO MANY DEBILITATED PEOPLE.
Barry Black’s Solution Was Multi-Directional
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What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
Cardiovascular Training For Parkinsons Patients
While there is a limited amount of randomized controlled studies confirming the long term benefits of cardiovascular training in PD patients, there is a growing body of data suggesting that this is the case. Patients with mild to moderate PD progression who underwent high intensity treadmill training showed changes in brain plasticity, namely a lengthening of the cortical silent period , a measure of corticomotor excitability typically shortened in Parkinsons patients . Patients that perform cardiovascular exercise also have an increased longevity in mortality studies , further implicating the existence of long term benefits.
Less conventional therapies, such as body weight-supported treadmill training, have also been attempted in patients with mild to moderate PD , and have led to a greater improvement in ambulation speed, number of steps, and short-step gait compared to conventional physical therapy , with the benefits lasting for about four months . However, the precise differences between treadmill trainings have been difficult to fully assess, as a study attempting to identify the differences between assisted weight bearing, additional weight bearing, and conventional treadmill training in patients found improvements to balance, UPDRS, and gait regardless of the specific type of treadmill training utilized .
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