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

BASIC EXERCISES FOR PARKINSON'S - MY TOP 10

NAVIGATING SAFELY THROUGH THE DAY

While these may not look like the exercises that you expected, they are the basics for people with Parkinson's and other neuro-motor diseases. We cover walking, turning, balancing, sitting, rising, arm swinging, daily tasks and yawning.

1. Toes up. No, I'm not asking you to be a leprechaun but just to remember that when you are taking a walking step: the motion is heel to toe. You rock forward. Your foot does the heel-toe roll.

Try it slowly with the weight shift to the off leg, putting your heel on the floor and then rocking forward to your toe, weight shift and ready to repeat with the other foot.
As you do take that heel and toe roll, you will feel your calf and ankle muscles stretch. That stretch will get you out of trouble when your calves cramp as they do in PD. Just heel and toe to work it out. This will also work for the "freeze" if you just put your heel down and your toe up. You will be able to work it through because you have practiced, practiced, practiced.
When you hear that foot drag, you are probably walking toe to heel... to trip.

The problem with wearing high heels is that your legs and feet are always in that toe-heel position and you can feel the pain in your calf muscles. As a general rule high heels and PD don't mix.

2. Broader wheel base to prevent tipover If you hear your pant legs brushing together with evey step you take, your legs are too close together. The optimal distance for your legs to be apart is about 10 inches. This will aid your balance and prevent falling.

3. Long Strides for walking - Short steps for turning. Practice by walking several strides and then turning and walking back. Repeat. A few times a day for a total of at least 15 minutes. You will notice that the shorter steps - with feet still spread apart - will get you through the turn without the danger of tripping over a leg crossed in front. Those short turning steps will help you balance.
You are not a morotcycle, don't lean into the turn. Don't lead with your shoulders. Balance will come from good counterbalance.

4. Many PD patients are leery of tight spaces because of balance issues. Try walking into, through and out of those tight corners of a room. You are teaching yourself to overcome the fear - not to panic.

6. Get out into and of that chair. Easier said than done. So do it as rapidly as possible. Quit fighting with gravity. Sit Down slowly. Your body will be bent forward and your butt will touch the seat. Knowing where the seat is can be aided by "feeling" it with the back of your knee. (A stage sit)  5. Back to balance. You will be in public situations where there will be no wall or hand rail to support or catch you if you fall. You need to practice walking rapidly, stepping heel first with toe up, legs spread apart. Turn left, turn right, turn around. Don't hug the wall. Do the expectant father pace several times a day. Each time you stride try to lift you leg higher as if marching. That stretching is important with a disease that tightens your muscles.

Reach for the chair

8. Listing to one side. Since it is often difficult to find the vertical with your eyes and ears, let your body find it with the following exercise. While you are doing your striding and turning exercises carry a tote bag with books on the opposite side of the list. The additional weight should help to compensate for the lean. Let your body feel the straightness you achieve so that you can walk that way without a heavy weight.

7. Swing your arms Yes, both of them. Lots of good reasons. Practice by sitting in an armless chair and just swing. Now get out of that chair and stride across the room while you swing both arms. It will loosen the muscles, aid your balance, generally make you feel better by lessening fatigue. If you are already having difficulty moving one arm, get your arms moving before you begin to walk. It may sound odd but when you first try to walk and swing your arms, you will find it is easier if your arms are already in motion.

Reach higher

Warm up: Stretch your arms as high as you can before you begin the weight carry. Feel the stretch in your arms, neck, chin, shoulders, spine, stomach, small of your back and gluteal muscles. The better the stretch, the more you will feel it throughout your body. Don't overstretch, this is a warm up.

For finer finger tasks

9. Daily tasks are becoming difficult. If you are having problems buttoning your shirts you can buy an entirely new wardrobe and go western with snaps or you can retrain your fingers to button the shirts in your closet. Put on a shirt and button and unbutton 5 times the first day, 10 times the next, 15 times for the next session and finally 20 times. You will find that it becomes easier with repetition. You will have to bring this exercise back into your regimen many times as your PD progresses. My wife made me do this 20 times the first day but I think that easing into it would be better.

Perhaps it is buckling your seat belt. Practice 10 to 20 times every time you are in the vehicle. You have to consciously relearn that which may be hidden in your brain.

10. Yawn. Oh good grief! Just keep yawning that big, rude fake yawn until your body picks it up naturally yawns. But why yawn? One theory is to induce more oxygen into the body and to expel carbon dioxide. Paratroopers often yawn before jumping and Olympic athletes are known to yawn before competition.

Yawning opens the shoulders, that is it relieves some muscle tension by the very act of yawning. It may stretch the lung tissues and increase the heart rate. It also frees the diaphragm. And here is where it is really important, it is a step towards clearer speech. By opening the throat it helps you avoid choking by eliminating swallowing problems.  And don't just yawn, pandiculate. Get your arms and shoulders involved in the stretching that comes with a real yawn. You see it on TV. Arms out at the shoulders, hand to the mouth.  Throw out your chest and stretch back from the shoulder blades. Feel your throat opening.

Don't yawn alone. If possible get someone to yawn along with you. It is contagious so beginning with a fake yawn will usually result in real and productive yawns.

For a simple hand stretching exercise, try the tennis ball between the fingers. 
Thumb and indexfinger
Roll to index and middle fingers
Then roll to middle and ring finger
The ring and pinkie are the hardest
Although you feel as if you should be squeezing the ball, stretching is better for PD

Swim Therapy for Parkinson's Symptom Relief

8:00am is kind of early for me now since my Home Depot days of the 2:30am alarm clock. Nevertheless I was awake and walking through a light rain in the parking lot of the Peter B. Lewis Aquatic & Therapy Center headed for the front door. It was my first appointment there.

Inside the building the front desk personnel looked at my insurance cards, gave me a long medical questionnaire to fill out, a HIPPA briefing and an arm full of handouts. My therapist, Ron came out. He introduced himself and we walked back to an exam room where we reviewed my medical history.

I was impressed by Ron's knowledge of Parkinson's and his thorough reading of my medical record. He was really concerned that I wasn't using a chair when I take a shower. He told me that a lot of people only find out they have a balance problem when they fall in the tub and break an arm or fracture their skulls. He reminded me that falls are the number two cause of death of Parkinson's patients.

Next, I stripped to my briefs and Ron checked my strength and range of motion at a number of joints of my body. He recorded all this information in a laptop. Then he gave me a neurological exam that was as good as any neurologist has given me.

Finally he watched me walk and made some suggestions about how I could learn to take longer strides to eliminate the shuffle I have been developing. He pointed out that I was taking two striding steps but dragging my left foot on the third step. He said I would have to be aware of that drag which indicated the shortening of the stride so that I could step away from that drag to a normal pace.

Back at the desk Ron told me that he would design an exercise program for me. It would reduce my symptoms and allow me to do more physically. He gave me a twice weekly schedule for the next four weeks, told me to get some aquatic shoes, bring my swim suit and next week he'd start teaching me the exercises.

I'll keep you posted.