Parkinson’s disease is a neurodegenerative disorder that predominately affects the dopamine-producing neurons in a specific area of the brain called the substantia nigra. If you can think of your brain like a post office – messages coming and going all day long, being passed from one area to the next until they finally reach their destination. Dopamine producing neurons are like the post office workers, enabling the smooth delivery of messages between one area of the post office to the next. Without the workers – messages get lost, delayed or disrupted. By the time a person with Parkinsons presents with physical symptoms, they will have lost up to 70% of these dopamine producing neurons.
Parkinson symptoms are laden with distorted messages between the brain and the body. Symptom experience is specific to each individual and can be split into movement and non-movement categories. Typical movement symptoms include tremor in arm or leg usually on one side to begin, muscle stiffness, slowness of movement and impaired balance or coordination, sometimes leading to falls. Anyone diagnosed with Parkinson’s is all too familiar with being asked to put their finger to their nose! Non-movement symptoms, which are likely less well known, include sleep disorders, anxiety, hallucinations, impaired sense of smell or taste, difficulty eating or speaking, constipation and urinary issues. Non-movement related symptoms may have even occurred prior to the movement symptoms and are just as important in terms of management.
Management Toolbox and the Multidisciplinary Team
Unfortunately, there is currently no silver bullet cure for Parkinson’s and the rate at which one’s Parkinson’s progresses varies from person to person. In better news, there are treatments with years of research behind them that have been designed to curb the rate at which symptoms progress. Management of Parkinsons is like a large box of tools, each tool used to combat symptoms unique to each person.
The first step to living well with Parkinson’s is to become super informed about the disease itself. Having knowledge about the disease and how it progresses supports one to be their own best advocate. Parkinsons Association Ireland, who have a local Cork branch, have a myriad of videos, articles and podcasts all available through their website. An educated patient should never be underestimated!
Most people diagnosed with Parkinson’s will require input from varying healthcare professionals throughout the course of their condition. Given the dearth of neurorehabilitation networks available to people living with neurological conditions in Ireland, one may be tasked to co-ordinate a team of their own.
Patients will often be diagnosed by a consultant neurologist or geriatrician. Their role will be to prescribe Parkinson’s specific medication and to support you to make clinically important decisions regarding disease management. Initially patients may not require much medical intervention. However, available medications aim to slow the breakdown of dopamine such as MAOb inhibitors, some help to settle tremors like anticholinergics and others act to replace dopamine that has been lost but do not have long lasting effects.
Other medical team members include but are not limited to; Parkinsons disease nurse specialist, Psychologists, dieticians, and physiotherapists. All of whom can offer different expertise to support symptom management.
Physiotherapists, Exercise, and the PD Rebels
Many individuals with Parkinson’s find creative ways to adapt to challenges posed by the condition. Engaging in sport, art, music, writing, or other forms of self-expression can be therapeutic and empowering, enabling individuals to focus on their abilities rather than limitations.
Exercise is widely accepted as an effective management tool for Parkinsons disease. Physiotherapists with experience in this area should be able to build an exercise programme that aims to curtail movement challenges associated with the disease. Those with Parkinsons should engage in exercise that drives what is called ‘neuroplasticity’ – the brains natural way of re-wiring movement pathways. To promote neuroplasticity, exercise prescription needs to include activities of hight intensity, high-effort and include movements that challenge one’s balance and co-ordination. A vast body of research has gone into exercise and Parkinsons disease with various modalities having positive outcomes. These include but are not limited to, moving to music, treadmill training, tai chi, PD warriors and boxercise. Other activities that can be beneficial include mindfulness, yoga, painting, golfing and socialising. The Parkinsons association of Ireland offer a range of these activities both online and by their local branches.
The PD rebels is an exercise group set up over 4 years ago by physiotherapists in the Mardyke Arena UCC in conjunction with the Parkinsons Association of Ireland. The class runs weekly for approximately 45 minutes and can be attended either in person or online. People are assessed by a physiotherapist in the clinic and then referred to the class depending on their suitability. The programme aims to hit those intensities that promote neuroplasticity as well as acting as a social outlet for the attendees. The class is based off the ‘PD warriors’ challenge that is backed by years of research and well renowned across the world. If you would like to know more about the PD rebels, you can call the clinic on 021 490 4760 or email firstname.lastname@example.org.