Heads Up - I Have Parkinson's Disease

What Can Be Done to Correct PD Postural Instability and balance

For the past year and a half, I've been getting a Swedish massage at least 3 times a month because it reduces the arthritic pain in my knees. This is pain that keeps me from being able to walk very far - like out to the car in the parking lot, or exercise as much and as hard as I want. The massage therapist has spent hours on the stiffness and muscle knots in my shoulders. The massage allows me to avoid taking pain killers, prescription or over the counter.

Massage provides many benefits. For this person with Parkinson's disease, it reduces the rigidly and stiffness of the PD affected muscles in my left side neck and shoulder, arm and hand. When it's been a couple of weeks between massages, I have more difficulty getting in and out of the car and the shower. After the massage it is easier for me to get my legs between the rollers in the leg extension and leg curl machines at the therapy center.

The massage therapist can feel stiffness in my body that I haven't felt yet or have forgotten about. This week she was concerned about my posture, the fact that I walk or sit with my head down. Not good.

My wife has been after me about it as well. She's been making me march up and down the hall with my head up - looking down the hall at her hand held at face level. "Never mind the cats," she says, "they'll get out of the way. Just look up and ahead." My massage therapist even suggested that I could look up at the ceiling. Wow! That calls for a lot of trust in my balance.

So I took off my prism reading glasses, put on the every-place-else trifocals, set down my cane and marched up and down the hall with my head held higher. And what do you know, my wife said my stride was longer and my gait twice as fast!

This reminder isn't new to me. Back in the day when our son played hockey, at the coaches request I made a plywood barricade to hang on front of the goal cage for shooting practice. The barricade had openings at the four corners for the entry of the successful puck. I painted it black and in large white letters we printed LOOK UP as a reminder for the shooter to keep his eyes not on the puck but on the goal.

And of course the same was  true in horseback riding. Looking down sent the horse a message through my spine and seat that he was to shorten his stride. Look up, look ahead for forward impulsion.

Abraham N Lieberman, MD, at the Mohamed Ali Center in Phoenix, AZ, judges morbidity by a patient's posture. Those with their heads down in their 70s will not be alive in their 90s. So I'm trying to concentrate on that. I keep having mental images of the bad posture of PWPs I have met at the physical therapy center and at the support group, several bent close to 90 degrees. I really don't want to end up like that but I don't know if I have the resolve to keep my head up enough to avoid it, even though postural instability is a quality of life or death matter for me.

I know that the concern isn't just about the appearance I present - looking more like an old man rather than the middle age man I might be - this isn't just about walking faster. Because I know that bad PD posture means I am shutting off my airways, compressing my organs, contributing to those nasty internal problems. This is about survival. I am going to not only tolerate those shouts to look up when she isn't even looking, I'm going to try to keep my head up because I want to look ahead.

Addendum: We recently read an 2007 article entitled Impaired vertical postural control and proprioceptive integration deficits in Parkinson's disease and feel that there is more to think about on the issue of balance and PD and the specialized requirements of a PwP.  We'll be posting that article on or before 2/25/2010

WATER THERAPY SESSIONS FOR PARKINSON'S

Aqua Therapy exercises for maintaining PD balance

I've gone to my first and second aqua therapy sessions.

I try to get there 20 minutes before the scheduled time of my session because I never know how long it will take me to get dressed. In the men's locker room I remove my shoes and socks, unbutton and take off my shirt, slacks and underwear and then put on my swim suit. Sometimes it can take 5 minutes apiece to remove my shirt and pants; I'm still not used to that frustration but it is part of PD.

I meet up with Barb my therapist in the hall to the pool. I walk down a flight of stairs with handrails on either side and step into the pool. I always have trouble with that first step but Barb is watching out for me. If I were in a wheel chair I could use the lift to be lowered into the pool.

The first exercise is walking to the other end of the 60 foot pool and back, then walking it backwards and sideways. This is warm up. Other walking exercises follow. These are designed to improve my gait and include swinging both of my arms. It is a special lesson for my left arm.

During my first session, while walking the pool I met a group of Russian Americans. I was alarmed at first because I could not understand what was being said - now what sense am I losing? - but then I recognized one word "horses" and realized their therapist was instructing them in Russian.

Next exercise is marching from one end to another with knees stepping high like a Rockette . Good stretching. Next as I hold onto the side of the pool, I do leg lifts, right leg, left leg in all directions.

Then Barb has me step away from the side and exercise my arms against the resistance of the water. I can feel that exercise testing my balance. In another exercise I have to perform a bicycle motion with my legs as I hold onto the edge of the pool. It is the most complicated exercise. I could feel that in my shoulders which was unexpected.

There were also a couple of exercises which I've forgotten already. But they did not forget me because by the next day I could feel some aching of muscles which I had not been using.

After I had completed my exercises Barb told me I could stay in the water and walk around to continue cooling down, which I did, walking in circles in the same way that I used to cool down horses after riding.

I have Kaiser Medicare Plus, the co-pay is $10.00. I go back next week for the next two sessions.

Since the last session I found that I can wear shoes around the house. I hadn't been happy wearing even the most comfortable shoes in the last month; despite the cold, I had been barefoot, but no longer.