According to the The National Parkinson Foundation, an estimated one million people in the United States, and four to six million worldwide, have parkinson's disease. It affects more people than multiple sclerosis, amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease), muscular dystrophy, and myasthenia gravis combined.
In this segment, Emily Devine, DPT, joins the show to discuss management of Parkinson's Disease, Parkinson Wellness Recovery & LSVT-BIG Certifications for Parkinson's Disease.
Selected Podcast
Exercise and Management of Parkinson’s Disease
Featured Speaker:
Emily Devine, DPT
Emily Devine, DPT, is a physical therapist at Stoughton Hospital. Transcription:
Exercise and Management of Parkinson’s Disease
Melanie Cole (Host): According to the National Parkinson’s Foundation, an estimated one million people in the United States and four to six million people worldwide have Parkinson’s disease. It affects more people than multiple sclerosis, ALS, muscular dystrophy and myasthenia gravis combined. My guest today is Dr. Emily Devine. She is a physical therapist at Stoughton Hospital. Welcome to the show Dr. Devine. So, what is Parkinson’s disease? People hear this term, it can be quite scary to hear this kind of diagnosis. What exactly is it?
Dr. Emily Devine, DPT (Guest): Yeah, so by definition, Parkinson’s is a neurodegenerative disorder that affects our dopamine system and it is mainly the thing that drives our movement, dopamine. So, when Parkinson’s disease is addressing that and kind of kills off those neurons, our movement doesn’t become as smooth or normal as it was prior.
Melanie: So what are some symptoms and really who is at risk? Is there a genetic component to Parkinson’s?
Dr. Devine: Yeah, well there is genetic component, a predisposition to Parkinson’s disease. If you have a family history of it, you are about two times more likely to possibly have it. But it generally is more idiopathic in nature, so it just kind of unsure and nonspecific symptoms kind of just comes on. Generally, people, I guess overall, the epidemiology of Parkinson’s again is about 1% of the population over 60, 4% of the population over 80. It is more common in men than women. And like you said, over a million people in North America, 6+ million in the world have this disease and it is going to probably double by 2040.
Melanie: So, is there something people would notice that would send them to see a neurologist or you know, even to their primary care provider, something, you know people shake, people have these kinds of things and they all right away that is what they go to in their mind. But what are some of the symptoms that would say you know, get in to see somebody?
Dr. Devine: Yeah, that’s a really good question. And whoever you talk to you know what led them to the doctor is somewhat always different. Often with Parkinson’s, the first time somebody goes to the doctor is when they have some sort of postural instability or a fall. And often by the time they get to the doctor, because of that reason, the Parkinson’s is somewhat progressed. Some things though that people or loved ones may notice is that sometimes the arm starts to swing a little bit less on one side more than the other. They develop more of a forward posture, more of a shuffling gait, tremors which you are referring to can happen with Parkinson’s but only about 70% of cases have that. So, that is not like always a true tell thing, but oftentimes, it is more the arm swing or just a little bit of a difference in how they are moving or even more of a flat affect of their face.
Melanie: Is it tough to diagnose?
Dr. Devine: It is, it is. There are definitely some things that the physician, your medical physician will go through when they do see you in the office. Oftentimes, the big thing is that the person does have what is called bradykinesia which is just slowness of movement. That is probably one of the bigger symptoms I suppose of Parkinson’s disease and then they have to have at least one of the following either rigidity, that resting tremor you mentioned, and then again, the instability of their posture.
Melanie: So, when we speak about management for Parkinson’s disease, Dr. Devine, really it seems like it’s a management of the symptoms because there is no real cure, yet is there?
Dr. Devine: That’s true. Management is I guess always a challenge with any disease. A lot of times, from a physician aspect, they may get you started on medications which have been somewhat of a gold standard carbidopa, levodopa is often used. That might be familiar to your listeners. But what they have found more recently is exercise actually has been managing symptoms very, very well. In fact, for people that exercise, or Parkinson’s people that exercise more than two and a half hours per week, they tend to have a lower degree of mobility impairment. They have lower care giver burden and then just lower impairment in their everyday activities so we encourage people that get a diagnosis of Parkinson’s disease to start exercising now because that’s where they are going to see a slower decline in their quality of life. And physical therapy can definitely get you started on that. There is a lot of different things we want you to focus on with regards to strengthening and posture and movement. One particular is called LSVT Big which stands for Lee Silverman Voice Treatment and Big is kind of the second part of this treatment that started initially with speech therapy and that treatment is done by a physical therapist for four times per week for four weeks and the goal there is really to improve movement perception and to almost kind of recalibrate their movement.
Melanie: So, okay, well we hear about the exercises and you say you know it is great to do them with a physical therapist. So, what are some of these types of exercises and you mentioned this Big program and the LSVT, what does that involve for the Parkinson’s patient and their family. Are we talking about aerobic training and flexibility, you mentioned balance and posture? How do all these things tie together?
Dr. Devine: Yeah and you kind of said it right there, they do all tie together so within those hour sessions, you really do touch on all aspects of that. Generally, with LSVT Big it is prescription based so it includes daily exercises that are you are taught and eventually are doing independently and then it really works on more specific movements and tasks and functional tasks. Now, a patient or a person that has Parkinson’s can also just exercise regularly. We want patients to work at a high level like it is kind of the hardest you could ever work with your exercise program. You want to work at about a seven or eight to get the most benefits from it and they could do strengthening you know just like we would do at the gym, just maybe more bias it towards posture muscles, your core, stretching your ankles and your hamstrings and things like that.
Melanie: Are there studies Dr. Devine, that show whether or not things like isometric training can help with those tremors and that sort of thing or is it pretty much standard weight training, you are lifting weights, you are doing your flexibility. Are there some kind of unusual therapies you might try?
Dr. Devine: There is not necessarily an exercise that I’m aware of any way, that will necessarily decrease your tremor. There are treatments out there that have been shown to help somewhat with tremors and that is called deep brain stimulation. That is obviously outside of the scope of physical therapy and it is brain surgery, but it has been shown to help quite a great deal with tremors or people that have more a tremor dominant Parkinson’s and so we can always help kind of get folks in the right direction if we find that may be beneficial for them to consult with a physician about.
Melanie: And as they are working with a physical therapist as these evolving exercises that become more encompassing movements to address these motor patterns, sequencing and the changes that they are going through?
Dr. Devine: Yeah, so, initially, when you are starting to learn some of these movements, you will learn them, you know just kind of the basics and then from there, those exercises that you have learned, you kind of take them into more task oriented or functional areas so for example, you may work initially just on turning. You know turning around, which is a challenge sometimes for people with Parkinson’s, in a big open space. Well sometimes with Parkinson’s when you are in a smaller space, it makes it even more difficult and so you learn how to do these big turns in these big open spaces and then you progressively challenge that a little bit more, maybe working into a smaller space, a more crowded environment, multitasking, adding different cognitive challenges to it and really trying to develop those new movement patterns.
Melanie: So, tell us about the Optimism Walk coming up that Stoughton Hospital is involved in.
Dr. Devine: Sure. Yeah, the Optimism Walk is put on by the American Parkinson’s Disease Association here in Wisconsin. It takes place on August 27th at 11 A.M. It is in Madison at Warner Park which is on the north side. It is a free walk, so you can just register and come and they are encouraging people to try to raise donations for the walk and it is about a mile around beautiful Warner Park and it is just a nice fun family friendly event to get people out, get some awareness out and help raise some money for Parkinson’s Disease in the community.
Melanie: So, awareness is an interesting topic in itself for Parkinson’s. What else do you want the listeners to know about Parkinson’s awareness and what they should do or think about if they have a loved one that has been diagnosed?
Dr. Devine: That’s a really good question. I think the biggest thing that I think our loved ones need to know is that they need to help motivate and encourage movement through for the person that has Parkinson’s. Trying to encourage them to get involved in exercise, even better, maybe even a group exercise program which we do have here through Stoughton Hospital as well. Those kinds of activities can get their loved one more involved and kind of get more engaged and it really does help. You know those exercise group classes also serve almost as a support group, which we also have those as well, so just trying to encourage involvement in whatever they may find in their community that they could participate in is probably one of the bigger things that they could do.
Melanie: And your best advice, about exercise and Parkinson’s and what you really want people to know about the benefits of keeping active and managing those symptoms.
Dr. Devine: Yeah, my best advice is start now. So, when it comes to exercise and Parkinson’s as you know and we have learned today, Parkinson’s is a progressive disease, so the sooner the better. There is no real waiting to get going on exercising and trying to get yourself motivated to get started. The research is out there. The proof is in the pudding, so to speak, so if you can get out and get either involved with physical therapy or a local exercise class, do it, because it will make some differences in your daily movements and you will notice it and your families will notice it as well.
Melanie: Thank you so much Dr. Devine for being with us today. You are listening to Stoughton Hospital Health Talk and for more information you can go to stoughtonhospital.com. That’s Stoughton hospital.com. This is Melanie Cole. Thanks so much for listening.
Exercise and Management of Parkinson’s Disease
Melanie Cole (Host): According to the National Parkinson’s Foundation, an estimated one million people in the United States and four to six million people worldwide have Parkinson’s disease. It affects more people than multiple sclerosis, ALS, muscular dystrophy and myasthenia gravis combined. My guest today is Dr. Emily Devine. She is a physical therapist at Stoughton Hospital. Welcome to the show Dr. Devine. So, what is Parkinson’s disease? People hear this term, it can be quite scary to hear this kind of diagnosis. What exactly is it?
Dr. Emily Devine, DPT (Guest): Yeah, so by definition, Parkinson’s is a neurodegenerative disorder that affects our dopamine system and it is mainly the thing that drives our movement, dopamine. So, when Parkinson’s disease is addressing that and kind of kills off those neurons, our movement doesn’t become as smooth or normal as it was prior.
Melanie: So what are some symptoms and really who is at risk? Is there a genetic component to Parkinson’s?
Dr. Devine: Yeah, well there is genetic component, a predisposition to Parkinson’s disease. If you have a family history of it, you are about two times more likely to possibly have it. But it generally is more idiopathic in nature, so it just kind of unsure and nonspecific symptoms kind of just comes on. Generally, people, I guess overall, the epidemiology of Parkinson’s again is about 1% of the population over 60, 4% of the population over 80. It is more common in men than women. And like you said, over a million people in North America, 6+ million in the world have this disease and it is going to probably double by 2040.
Melanie: So, is there something people would notice that would send them to see a neurologist or you know, even to their primary care provider, something, you know people shake, people have these kinds of things and they all right away that is what they go to in their mind. But what are some of the symptoms that would say you know, get in to see somebody?
Dr. Devine: Yeah, that’s a really good question. And whoever you talk to you know what led them to the doctor is somewhat always different. Often with Parkinson’s, the first time somebody goes to the doctor is when they have some sort of postural instability or a fall. And often by the time they get to the doctor, because of that reason, the Parkinson’s is somewhat progressed. Some things though that people or loved ones may notice is that sometimes the arm starts to swing a little bit less on one side more than the other. They develop more of a forward posture, more of a shuffling gait, tremors which you are referring to can happen with Parkinson’s but only about 70% of cases have that. So, that is not like always a true tell thing, but oftentimes, it is more the arm swing or just a little bit of a difference in how they are moving or even more of a flat affect of their face.
Melanie: Is it tough to diagnose?
Dr. Devine: It is, it is. There are definitely some things that the physician, your medical physician will go through when they do see you in the office. Oftentimes, the big thing is that the person does have what is called bradykinesia which is just slowness of movement. That is probably one of the bigger symptoms I suppose of Parkinson’s disease and then they have to have at least one of the following either rigidity, that resting tremor you mentioned, and then again, the instability of their posture.
Melanie: So, when we speak about management for Parkinson’s disease, Dr. Devine, really it seems like it’s a management of the symptoms because there is no real cure, yet is there?
Dr. Devine: That’s true. Management is I guess always a challenge with any disease. A lot of times, from a physician aspect, they may get you started on medications which have been somewhat of a gold standard carbidopa, levodopa is often used. That might be familiar to your listeners. But what they have found more recently is exercise actually has been managing symptoms very, very well. In fact, for people that exercise, or Parkinson’s people that exercise more than two and a half hours per week, they tend to have a lower degree of mobility impairment. They have lower care giver burden and then just lower impairment in their everyday activities so we encourage people that get a diagnosis of Parkinson’s disease to start exercising now because that’s where they are going to see a slower decline in their quality of life. And physical therapy can definitely get you started on that. There is a lot of different things we want you to focus on with regards to strengthening and posture and movement. One particular is called LSVT Big which stands for Lee Silverman Voice Treatment and Big is kind of the second part of this treatment that started initially with speech therapy and that treatment is done by a physical therapist for four times per week for four weeks and the goal there is really to improve movement perception and to almost kind of recalibrate their movement.
Melanie: So, okay, well we hear about the exercises and you say you know it is great to do them with a physical therapist. So, what are some of these types of exercises and you mentioned this Big program and the LSVT, what does that involve for the Parkinson’s patient and their family. Are we talking about aerobic training and flexibility, you mentioned balance and posture? How do all these things tie together?
Dr. Devine: Yeah and you kind of said it right there, they do all tie together so within those hour sessions, you really do touch on all aspects of that. Generally, with LSVT Big it is prescription based so it includes daily exercises that are you are taught and eventually are doing independently and then it really works on more specific movements and tasks and functional tasks. Now, a patient or a person that has Parkinson’s can also just exercise regularly. We want patients to work at a high level like it is kind of the hardest you could ever work with your exercise program. You want to work at about a seven or eight to get the most benefits from it and they could do strengthening you know just like we would do at the gym, just maybe more bias it towards posture muscles, your core, stretching your ankles and your hamstrings and things like that.
Melanie: Are there studies Dr. Devine, that show whether or not things like isometric training can help with those tremors and that sort of thing or is it pretty much standard weight training, you are lifting weights, you are doing your flexibility. Are there some kind of unusual therapies you might try?
Dr. Devine: There is not necessarily an exercise that I’m aware of any way, that will necessarily decrease your tremor. There are treatments out there that have been shown to help somewhat with tremors and that is called deep brain stimulation. That is obviously outside of the scope of physical therapy and it is brain surgery, but it has been shown to help quite a great deal with tremors or people that have more a tremor dominant Parkinson’s and so we can always help kind of get folks in the right direction if we find that may be beneficial for them to consult with a physician about.
Melanie: And as they are working with a physical therapist as these evolving exercises that become more encompassing movements to address these motor patterns, sequencing and the changes that they are going through?
Dr. Devine: Yeah, so, initially, when you are starting to learn some of these movements, you will learn them, you know just kind of the basics and then from there, those exercises that you have learned, you kind of take them into more task oriented or functional areas so for example, you may work initially just on turning. You know turning around, which is a challenge sometimes for people with Parkinson’s, in a big open space. Well sometimes with Parkinson’s when you are in a smaller space, it makes it even more difficult and so you learn how to do these big turns in these big open spaces and then you progressively challenge that a little bit more, maybe working into a smaller space, a more crowded environment, multitasking, adding different cognitive challenges to it and really trying to develop those new movement patterns.
Melanie: So, tell us about the Optimism Walk coming up that Stoughton Hospital is involved in.
Dr. Devine: Sure. Yeah, the Optimism Walk is put on by the American Parkinson’s Disease Association here in Wisconsin. It takes place on August 27th at 11 A.M. It is in Madison at Warner Park which is on the north side. It is a free walk, so you can just register and come and they are encouraging people to try to raise donations for the walk and it is about a mile around beautiful Warner Park and it is just a nice fun family friendly event to get people out, get some awareness out and help raise some money for Parkinson’s Disease in the community.
Melanie: So, awareness is an interesting topic in itself for Parkinson’s. What else do you want the listeners to know about Parkinson’s awareness and what they should do or think about if they have a loved one that has been diagnosed?
Dr. Devine: That’s a really good question. I think the biggest thing that I think our loved ones need to know is that they need to help motivate and encourage movement through for the person that has Parkinson’s. Trying to encourage them to get involved in exercise, even better, maybe even a group exercise program which we do have here through Stoughton Hospital as well. Those kinds of activities can get their loved one more involved and kind of get more engaged and it really does help. You know those exercise group classes also serve almost as a support group, which we also have those as well, so just trying to encourage involvement in whatever they may find in their community that they could participate in is probably one of the bigger things that they could do.
Melanie: And your best advice, about exercise and Parkinson’s and what you really want people to know about the benefits of keeping active and managing those symptoms.
Dr. Devine: Yeah, my best advice is start now. So, when it comes to exercise and Parkinson’s as you know and we have learned today, Parkinson’s is a progressive disease, so the sooner the better. There is no real waiting to get going on exercising and trying to get yourself motivated to get started. The research is out there. The proof is in the pudding, so to speak, so if you can get out and get either involved with physical therapy or a local exercise class, do it, because it will make some differences in your daily movements and you will notice it and your families will notice it as well.
Melanie: Thank you so much Dr. Devine for being with us today. You are listening to Stoughton Hospital Health Talk and for more information you can go to stoughtonhospital.com. That’s Stoughton hospital.com. This is Melanie Cole. Thanks so much for listening.