Gait & Balance Abnormalities
Parkinsons Disease Exam
Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.
Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.
We have three tests for this part of the PD exam:
1);;;; Standing up from a chair
2);;;; Free walking
3);;;; Provoked pull test maneuver for balance
Botulinum Toxin In The Management Of Blepharospasm: Current Evidence And Recent
Blepharospasm is a focal dystonia of the orbicularis oculi muscles, producing excessive eye closure. This produces significant disability through functional blindness. Botulinum neurotoxins have become the…
Botulinum toxin in the management of blepharospasm: current evidence and recent developments Amy Hellman and Diego Torres-RussottoTher Adv Neurol Disord. 2015 Mar; 8: 8291.
Blepharospasm is a focal dystonia characterized by involuntary closure of the eyelids
Blepharospasm often begins as excessive blinking, usually accompanied by feelings of dryness or irritation of the eyes
It is often exacerbated by bright lights, reading, and watching television. Like other dystonias, blepharospasm may be alleviated by sensory tricks including touching the eyes , the upper face, speaking, or even singing .
Find a comprehensive guide to possible side effects including common and rare side effects when taking Sinemet for healthcare professionals and consumers.
Sinemet Side Effects:
Tell your doctor if you experience unlikely but serious side effects including:
greatly increased eye blinking/twitching
uncontrolled muscle movements in your face ;
extrapyramidal disorder -blepharospasm
Levodopa-induced Dyskinesia: Clinical Features, Pathophysiology, and Medical ManagementSanjay Pandey and Prachaya SrivanitchapoomAnn Indian Acad Neurol. 2017 Jul-Sep; 20: 190198.
Luquin et al . reported dyskinesia in 168 of 220 PD patients receiving levodopa treatment
Parkinson’s Disease Can Affect The Eyes And Here’s What We Know So Far
by Salil Patel, Chrystalina Antoniades, Pearse Keane, Siegfried Wagner, The Conversation
Parkinson’s disease is the second most common neurodegenerative disease, affecting over 10 million people worldwide. It’s characterized by changes in movement, including tremors, and slower and more rigid movements. But researchers are also beginning to investigate other symptoms of Parkinson’s diseaseincluding those involving the eye.
Parkinson’s results from the degeneration of dopamine neurons in the brain’s basal gangliaan area involved in voluntary movement. Though no cure exists for Parkinson’s, symptoms can be managed with drugs that replace dopamine.
No single diagnostic test exists for Parkinson’s as the blood-brain barrier and skull make it hard to assess the brain. As a result subjective assessments of symptoms are used to diagnose patients.
Given Parkinson’s is known to affect the body’s motor system, it’s perhaps not surprising it has been shown to disrupt eye movements. Promisingly, Parkinson’s may be diagnosed using technologies that already exist by showing subtle changes in eye movements and the thinning of specific layers in the retina. This may help measure the effectiveness of treatments and determine the progression of the disease.
Changes in movement
Though evidence from the small number of stimulation studies conflict, they highlight how Parkinson’s disease could influence eyes movements.
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Hand And Finger Stimulation Exercises
I have done a lot of hand/finger stimulation and experimented to optimize such exercises, in the spirit of Curiosity and Play.;I’ve personally found significant benefit in pursuing this line of research. Indeed, I have managed to recover a lot of my independence and quality of life through hand and finger therapy, and I know just how much of a major part it has played in my own progressive symptom reduction.
I therefore encourage everyone with PD to do as much hand and finger stimulation as possible, through games and play and self-discovery. By doing nothing, the only thing that will happen is that out situation will rapidly become worse, because we will lose the use of our hands quicker and consign ourselves to increased suffering. By applying neuroplasticity techniques , we can delay the worse ravishes of the disease or even, like in my own case, continuously push the symptoms back and recover some independence. I feel this is an important message for those newly diagnosed, in particular.
Here are some suggestions of the type of stimulatory exercises and games which can help, more ideas which I have personally found beneficial will be provided in forthcoming articles.
Parkinsons Disease And Progressive Supranuclear Palsy
Patient Leaflets Team
- Reference Number: HEY1159/2020
- Departments: Ophthalmology Department, Orthoptic
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Is It Normal For A Person Living With Dementia To Close Her Eyes All Day
Home>Community Voices>Your Questions Answered>Is it normal for a person living with dementia to close her eyes all day?
Is it normal for a person with dementia to close her eyes the whole day while being fed, exercised and laid down to bed? At other times, the person with dementia is wide awake while being fed, walking, listening to stories of the paid caregiver. Is this a cycle with people who have dementia?-Jerry
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The study enrolled 20 patients who had been newly diagnosed with Parkinsons disease, and 20 age-matched healthy subjects, to assess changes in the visual system associated with the disease. The participants underwent magnetic resonance imaging scans, which researchers used to look at changes in the white and gray matters, as well as ophthalmologic examinations.
They found that patients presented significant changes in the brain structures associated with the visual system, such as changes in the optic radiations, decreased white matter volume and reduced volume of the optic chiasm .
As a consequence, patients experienced visual alterations, such as an inability to perceive colors, decreased visual acuity, and a reduction in blinking, which often led to dry eyes.
According to Arrigo, these changes may appear more than a decade before the motor symptoms associated with Parkinsons disease, which makes them potential biomarkers to diagnose and follow this disease.
The study in depth of visual symptoms may provide sensitive markers of Parkinsons disease, Arrigo said. Visual processing metrics may prove helpful in differentiating Parkinsonism disorders, following disease progression, and monitoring patient response to drug treatment.
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How Is Daytime Sleepiness Treated
Consider making certain lifestyle modifications, such as:
- Establish good sleep hygiene, including a set bedtime and wake-up time.
- Get exposure to adequate light during the day and darkness at night.
- Remember indoor lighting may not be sufficient to promote a normal circadian rhythm.
- Avoid sedentary activities during the day.
- Participate in activities outside the home. They may help provide stimulation to prevent daytime dozing.
- Get physical exercise appropriate to your level of functioning, which may also promote daytime wakefulness. Strenuous exercise, however, should be avoided six hours before sleep.
- Do NOT drive while sleepy if you experience excessive daytime sleepiness. Motor vehicle accidents increase during periods of drowsiness and may be associated with sudden onset of sleep .
- Talk to your doctor about possibly decreasing the dosage of dopamine agonists if you experience daytime sleepiness or sleep attacks.
- Talk to your doctor about decreasing stimulants like caffeine, modafinil and methylphenidate .
How Parkinsons Affects Your Eyes
Eye Movement Problems
There are three fundamental types of eye movements.
- Pursuit eye movementsallow the eyes to travel together to follow a moving target in the horizontal or vertical direction.
- Saccadic eye movements are the rapid eye movements that allow the eyes to quickly jump to a new target. They are important when reading as the eyes need to jump from the end of one line and to the beginning of the next.
- Vergence eye movements are used when the target is coming towards or away from a person. When the target comes towards a person for example, the eyes have to move slightly together, or converge, to keep vision of the target clear.
In PD, the saccades tend to be slow, which means reading can be difficult if the eyes are unable to find the correct place on the next line. If a person has Levodopa-induced dyskinesias, the saccades can become fast and erratic which can also be problematic.
Another common eye movement issue for people with PD is difficulty with vergence eye movements. In PD, the eyes are often not able to come together sufficiently as a target draws near. This is called convergence insufficiency, which can cause double vision, especially when focusing on near tasks. This problem can also affect a persons ability to read.
Eye movement solutions
In terms of complementary and alternative therapies, art therapy has been seen to alleviate some of the vision effects associated with Parkinsons disease.
Abnormalities of blinking
External eye disease
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Recently Fred Has Found His Eyes Are Closed Involuntarily Most Of The Time Though If He Makes An
You dont think, Oh, it would be nice to have my eyes closed now?
The mask that is the expressionless face, typical of many people with Parkinsons, probably distresses the people who have to live with it more than it embarrasses the person who has it. It tends to be the position the face falls into when not actively doing something else. Lack of facial expression can be hard for the family.
Memory Or Thinking Problems
Having issues with thinking and processing things could mean your disease is progressing. Parkinsons is more than a movement disorder. The disease has a cognitive part as well, which means it can cause changes in the way your brain works.
During the final stage of the disease, some people may develop dementia or have hallucinations. However, hallucinations can also be a side effect of certain medications.
If you or your loved ones notice that youre getting unusually forgetful or easily confused, it might be a sign of advanced-stage Parkinsons.
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What Is A Parkinsons Tremor
Other health issues can also cause tremors, like multiple sclerosis or essential tremor. But Parkinsonâs tremors are different because theyâre usually:
- Resting. Parkinsonâs tremors happen when your muscles are still. They go away when you move. They also lessen while you sleep. For example, if youâre sitting in a chair with your arm relaxed, you may notice that your fingers twitch. But if youâre using your hand, like when you shake someone elseâs hand, the tremor eases or stops.
- Rhythmic. Parkinsonâs tremors are slow and continuous. They arenât random tics, jerks, or spasms.
- Asymmetric. They tend to start on one side of your body. But they can spread to both sides of the body.
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.
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Foods That Are Hard To Chew
Many people with Parkinsons have difficulty with chewing and swallowing foods. A person needs medical help if this is the case. A speech and language therapist may be able to help a person overcome this issue.
However, if a person is finding certain foods hard to chew and swallow, they may wish to avoid these foods.
Such foods include:
- dry, crumbly foods
- tough or chewy meats
If a person does wish to eat chewy meats, they could try using gravy or sauce to soften them and make eating easier.
They could also try chopping meat into smaller pieces or incorporating meat into casseroles, which can make it more tender.
Having a drink with a meal can also make chewing and swallowing easier.
How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
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When To Seek Hospice Care
When you or your loved one have a life expectancy of six months or less, you become eligible for hospice care a type of comfort care provided at the end of life for someone living with end-stage Parkinsons disease. Hospice provides extra support so your loved one can live as comfortably as possible.
If you have experienced a significant decline in your ability to move, speak, or participate in activities of daily living without caregiver assistance, its time to speak with a hospice professional.
Read more: What is hospice care?
Some of the things that determine whether your loved one with end-stage Parkinsons is eligible for hospice include: difficulty breathing, bed bound, unintelligible speech, inability to eat or drink sufficiently, and/or complications including pneumonia or sepsis.
If you live in South Jersey, our nurse care coordinator can answer your questions and decide if your loved one is ready for hospice care. Call us 24/7 at 229-8183.
Foods Containing Nutrients That People May Be Deficient In
Some research suggests that people with Parkinsons often have certain nutrient deficiencies, including deficiencies in iron, vitamin B1, vitamin C, zinc, and vitamin D.
The above study points out that some of these deficiencies may be associated with neuroinflammation and neurodegeneration, which are key factors in Parkinsons.
Therefore, people with Parkinsons may wish to consume more of the following foods.
Foods containing iron
The following foods are good sources of iron:
- certain fortified foods
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Hospice Eligibility For Parkinsons Disease
Due to the progressive nature of Parkinsons disease, it can be challenging for families to know when their loved one is eligible for the support of hospice care. If a loved one has been diagnosed with six months or less to live or if they have experienced a decline in their ability to move, speak, or participate in the activities of daily living without caregiver assistance, it is time to speak with a hospice professional about next steps.;
What Are The Symptoms Of End
Stage four for Parkinsons disease is often called advanced Parkinsons disease because people in this stage experience severe and incapacitating symptoms. This is when medication doesnt help as much and serious disabilities set in.
Theres an increased severity in:
- How you speak a softer voice that trails off.
- Falling and trouble with balance and coordination.
- Freezing a sudden, but temporary inability to move, when you start to walk or change direction.
- Moving without assistance or a wheelchair.
- Other symptoms such as constipation, depression, loss of smell, low blood pressure when going to stand up, pain, and sleep issues.
Many times someone with advanced PD cant live on their own and needs help with daily tasks.
Stage five is the final stage of Parkinsons, and assistance will be needed in all areas of daily life as motor skills are seriously impaired. You may:
- Experience stiffness in your legs. It may make it impossible to walk or stand without help.
- Need a wheelchair at all times or are bedridden.
- Need round-the-clock nursing care for all activities.
- Experience hallucinations and delusions.
As Parkinsons disease progresses into these advanced stages, its symptoms can often become increasingly difficult to manage. Whether you or your loved one with end-stage Parkinsons lives at home, in an assisted living facility or a nursing home, hospice services can optimize your quality of life and that of your family members as well.
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What Typically Causes Closed Eye Hallucinations
Closed-eye hallucinations are related to a scientific process called phosphenes. These occur as a result of the constant activity between neurons in the brain and your vision.
Even when your eyes are closed, you can experience phosphenes. At rest, your retina still continues to produce these electrical charges.
If you close your eyes in a lit-up room or outside in the sunlight, chances are that small amounts of light could create a visual effect. There may also be an increased likelihood of seeing more colors when light pressure, such as a blindfold or sleep mask, is placed against your closed eyelids.
Other causes of closed-eye hallucinations may be related to medical conditions, including the following: