Parkinson’s Disease And Walking

Symptoms Of Parkinsons Disease

Parkinsons has four main symptoms:

• Tremor in hands, arms, legs, jaw, or head
• Muscle stiffness, where muscle remains contracted for a long time
• Slowness of movement
• Impaired balance and coordination, sometimes leading to falls

Other symptoms may include:

The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.

People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.

Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.

Study: Parkinsons Disease And Walking

The study from the University of Iowa and the Veterans Affairs Medical Center of Iowa City found that for Parkinsons patients who were still mobile, walking three times a week showed a marked improvement in symptoms, with less depression and fatigue. Best of all, this is an affordable treatment.

Parkinsons causes a loss of brain cells that produce the neurotransmitter that is important for movement. Symptoms are usually barely perceptible at first, like a minor tremor in the limbs, but this will progress to difficulty walking and talking over time. This loss of mobility often leads to depression in many patients. Sadly, there is no cure for Parkinsons disease.

But as this study shows, we can slow its progression.

Let me explain this study in a little more detail.

To begin, researchers at the University of Iowa recruited a group of 60 Parkinsons patients with mild to moderate symptoms and ran a variety of tests to ensure that they were walking at a moderate paceenough to raise their heart rates, but not by too much. The participants walked for 25 minutes at an average speed of 2.9 miles an hour. This pace raised their heart rates to an average of 47% of its maximum capacity. They repeated this exercise regularly over the course of six monthsbut there were some minor differences that took place during this time.

The study was divided into two stages.

The researchers hope that there will be a third stage to the study since the results were encouraging.

Ten Tips To Put The Freeze On Freezing

While these methods can be helpful to get out of a freeze that is already underway, physical therapy techniques that incorporate these types of cueing strategies are utilized to reduce freezing of gait overall. Rhythmic auditory cueing is one such technique which utilizes rhythm and music to improve gait in PD and other neurologic diseases.

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Effects Of Aerobic Exercise On Gait In People With Pd

Six studies,,,,, provided data for stride/step length and gait velocity, and five studies,,,, provided data for step cadence. It was found that compared with the control group, aerobic exercise had a significant effect on improving gait in people with PD. Specifically, aerobic exercise significantly increased the stride/step length and the gait velocity in people with PD. However, aerobic exercise had no significant associations with the step cadence in people with PD .

Fig. 6: Meta-analysis results of the effect of aerobic exercise on gait in people with PD.

The pooled estimates were obtained from fixed effects analysis. Diamonds indicated the size of the effect of each study summarized as SMD. The size of the shaded square was proportional to the percentage weight of each study. Horizontal line represented the 95% CI and the vertical dashed line represented the overall effect.

Why Does Pd Cause Gait Problems

It is not clear why some people with PD have a problem walking and others do not. Research suggests that there is a link between gait and difficulties with learning, attention, and memory.4

The brain circuitry that controls walking is quite complex, with many connections between various areas of the brain, including:4

• The motor cortex, which is responsible for planning and initiating movement
• The basal ganglia, where brain cells that help regulate movement are located
• The cerebellum, which helps coordinate movements

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Why Does Freezing Of Gait Occur

It is not completely clear why some people with PD experience freezing of gait and others do not. Research suggests that there is a relationship between freezing of gait and cognitive difficulties. The brain circuitry that controls gait is extremely complex and involves multiple connections between various parts of the brain, including:

• areas in the front of the brain that plan and initiate movement
• areas of the basal ganglia where the dopaminergic neurons that refine and control movement are found
• areas in the brainstem which modulate movement and wakefulness

Freezing of gait seems to be caused by short-lasting episodes of inhibition of these brain circuits that coordinate gait. The specific abnormalities that cause the problem may differ from person to person.

B: Pick Your Own Music

Now that youve seen the full effects of walking to a beat, take your pick of music.

Below I have laid out a list of songs you can try out that have a range of tempos. There is a slow, medium, and fast playlist. Start walking to a slower song . As you get comfortable, you can increase the tempo.

The end goal is to walk to a beat that is slightly faster than your stride. Not only will this push you to transcend your normal Parkinsonian gait, it will also give you a longer lasting therapeutic effect after you stop listening.

Here are the playlists:

You can, of course, choose your own songs. In fact, once you practice a few times with these songs, I encourage you to start using your own selections .

Either way, I want you to look forward to turning on your iPod or Android, and that means having songs that make you want to dance, to move, to run. If you dont know the tempo of a song you like, you can measure the beats per minute at songbpm.com.If you want to change the tempo of a song that is too fast or too slow, I like to use the app TempoSlowmo. You can download it for free in the Apple App Store for your iPod or on Google for your Android.

Good luck. If you have any questions or comments about the post, Id love to see them! Write them in the comment section below and Ill respond as soon as I see it!

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How To Improve Walking For The Parkinsons Patient

One of the typical problems for the patient with Parkinsons disease is with walking. The disease damages the part of the brain called the basal ganglia.

This part of the brain is what produces dopamine. As the disease advance and the dopamine levels start to wane, disturbances in movement become common. The patient will start to walk with short, quick scuffling steps. He also will have trouble stopping and starting to move, and may have poor balance and tremors. All of these symptoms make it more likely that he will suffer a fall. So, there are some important tips as the caregiver that you should remember to help him to walk and to prevent falls:

#1 Use Auditory Cues

You may want to try to use helpful phrases with your loved one, such as take long steps, or step up. These gentle reminders can help him to alter his walking pattern. Your patient also may get stuck sometimes, and have trouble with initiating movement. These type of short, firm commands could help him to start moving again. We also have found that the use of a metronome that matches the walking speed of the patient can really help.

#2 Use Visual Cues

#3 Modify the Environment

To cut down on scuffles, try to have a very smooth floor for the patient to walk on. Tile or linoleum work well. Try to avoid carpets if possible, especially ones with a higher nap.

Get rid of throw rugs and any other obstacles, including coffee tables, footstools and magazine racks.

#4 Increase His Mobility

What Causes Walking Problems

The pattern of how you walk is called your gait. Many different diseases and conditions can affect your gait and lead to problems with walking. They include:

• Abnormal development of the muscles or bones of your legs or feet
• Arthritis of the hips, knees, ankles, or feet
• Cerebellar disorders, which are disorders of the area of the brain that controls coordination and balance

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Discriminant Analyses Of Freezers And Non

For model 1 , group membership was predicted using only the 10-m walking test at comfortable walking speed , the sole predictor variable contributing significantly to the model. Five of ten freezers and 13 of 14 non-freezers were correctly classified. The accuracy of model 1 and its cross validation were both 75.0%. For model 2 , none of the predictor variables contributed significantly to the model. For model 3 , group membership was predicted using stepping accuracy on symmetric stepping stones of the goal-directed stepping task and turning time of full turns such that 7 of 10 freezers and 12 of 14 non-freezers were correctly classified, with an accuracy of 79.2%. The accuracy of the cross-validated model was 70.8%. For model 4 , none of the predictor variables contributed significantly to the model. The results of an exact McNemar’s test demonstrated that there was no statistical significant difference in the proportion of freezers and non-freezers identified with models 1 and 3 .

What Causes Parkinsons Disease

Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

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How Are Speech Problems Treated

There are many options to help improve your speech. A speech-language pathologist can help you pick the right approaches for you. Speech-language pathologists are trained health care professionals who specialize in evaluating and treating people with speech, swallowing, voice, and language problems.

Ask your doctor for a referral to a speech-language pathologist. It is also important to contact your health insurance company to find out what therapy and procedures are eligible for reimbursement and to find a list of SLPs covered by your plan. Finally, visit a SLP who has experience treating people with PD.

Future Of Freezing Of Gait Treatments

Various research approaches may transform how freezing of gait is treated in the future. Cognitive training strategies are being studied to determine if they improve freezing of gait. Another approach is the development of wearable technology systems that can detect an imminent freeze and then automatically deploy a sensory cue. Novel deep brain stimulation targets are also being developed as a method of controlling freezing of gait.

APDA invests in research that may lead to new treatments for the gait disorders of PD. Here are some examples:

Christopher Bishop, PhD, at Binghamton University in Binghamton, NY, is studying an area of the brainstem known as the pedunculopontine nucleus, which plays a key role in movement and wakefulness. It has been an experimental DBS target for relief of freezing of gait and PD-related gait disorders with mixed results. Dr. Bishop is probing the specific functions of this key brain area to determine how they impact PD symptoms.

Aasef Shaikh, MD, PhD, at Cleveland VA Medical Center, University Hospitals Cleveland, and Case Western Reserve University in Cleveland, OH, is studying the complex interactions of various neurologic systems, their effects on gait and balance in PD, and how they can be modified by DBS. The systems that Dr. Shaikh studies include vision, eye movements, the inner ear/vestibular system, and proprioception.

Tips and takeaways

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Vagus Nerve Stimulation For Parkinsons Disease

Vagus Nerve Stimulation has been shown to improve walking in patients with Parkinsons Disease.

What is Parkinsons Disease?

Parkinsons disease is a progressive, neurodegenerative disorder with no known cure. The majority of medical treatment is aimed at relieving the individual of symptoms rather than attempting to cure the disease. Many are often limited by debilitating symptoms that significantly reduce quality of life. Parkinsons symptoms include the following:

• Slowness and incoordination of movement
• Posture, balance and walking difficulties
• Poor executive function and memory loss
• Changes in writing and speech

The Beginning of Parkinsons

Parkinsons disease actually begins outside of the brain, and travels through nerves, such as the vagus nerve, to enter the brain. Classically, Parkinsons is associated with the loss of the neurotransmitter dopamine due to the degeneration of an area of the brain called the substantia nigra . However, there is actually a decrease in norepinephrine before dopamine becomes depleted. There is degeneration in an area of the brain called the locus coeruleus before there is a problem with the substantia nigra.

Existing treatment strategies for Parkinsons disease are purely to relieve symptoms. However, the treatment is often accompanied by terrible side effects. New treatments are vital to developing more effective ways of treating Parkinsons.

Vagus Nerve Stimulation

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Improving Flexibility And Range Of Motion

Improving your flexibility can help you improve your balance and gait, as well as reduce rigidity. Try these exercises:

• Sit in a chair and bend your upper body at the waist to your right and left.
• Get on all fours and turn your upper body to the right and left. Lift your arm on the side youre turning to as you turn.

Also work on lower-body strength training. Strength training can help you improve your balance, walk further distances, and potentially increase your walking speed. Some exercises to try include:

• Leg presses. While sitting down, push a weight away from your body using your legs.
• Squats. Start in an upright position with your legs slightly wider than hip distance. Bend your knees while pushing your glute muscles back, so that your knees dont come over your toes. You can hold onto something if necessary. You dont have to go down more than a few inches.
• Exercise bike. If you have access to a recumbent exercise bike , using the bike can help strengthen your legs.
• Repeatedly sit in and rise out of a chair. Repeating the motions of sitting down and rising helps strengthen your leg and core muscles. It also helps you practice a functional activity.

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Effects Of Aerobic Exercise On Bbs In People With Pd

Nine studies,,,,,,,, provided data for BBS. It was found that compared with the control group, aerobic exercise had a significant effect on improving BBS in people with PD .

Fig. 5: Meta-analysis results of the effect of aerobic exercise on BBS in people with PD.

The pooled estimates were obtained from fixed effects analysis. Diamonds indicated the size of the effect of each study summarized as SMD. The size of the shaded square was proportional to the percentage weight of each study. Horizontal lines represented the 95% CI and the vertical dashed line represented the overall effect.

To Prevent Falls Exercise

Exercise is the only intervention that significantly reduces a persons risk of falling, among older people without PD as well as people with Parkinsons. Research is beginning to show how exercise changes the brain for the better and can help people with PD gain back some of their automatic balance reflex.

In a study, Dr. Horak and her team asked participants with PD to stand on a quickly moving treadmill, until they began walking. Participants initially took too-small steps, but with one hour of practicing, they improved, taking bigger steps to stay balanced while walking.

Many kinds of exercise can improve a persons balance. Consider trying:

• Tai Chi: a moving meditation where movements involve shifting the bodys center of mass back and forth over the feet. Studies found fewer falls among people with PD who practiced Tai Chi three times a week.
• Dance: to dance tango, a person has to walk backward and sideways, take big steps and both follow and lead good ways for people with PD to practice balance control.
• Boxing: the rapid arm movements provide good balance training.
• Agility boot camp: completing different tasks in a series of stations can improve balance.

Tip: People with PD may have other medical issues that affect their ability to exercise, such as arthritis or neuropathy. Work with a physical therapist to find an exercise that suits your needs.

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