Are musculoskeletal problems in Parkinson’s disease neglected

Parkinson’s disease – PD patients do not receive adequate treatment for musculoskeletal problems. This was the conclusion reached by Kim YE et al. from the Department of Neurology and Movement Disorder Center, Parkinson Study Group, Seoul National University Hospital, Seoul, Republic of Korea.

The researches found the prevalence of musculoskeletal problems was significantly higher in the Parkinson disease (PD) group compared to controls. However these musculoskeletal problems in the PD group tended to receive less treatment than that of the control group despite PD patients having a higher prevalence than in the controls.

White Matter Changes Correlate with Cognitive Functioning in Parkinsons Disease

Diffusion tensor imaging (DTI) can be used to see cortical white-matter integrity in Parkinson’s disease (PD).

Writing in Frontiers in Neurology, 05/02/2013 Theilmann RJ et al from Neurology Service VA San Diego Healthcare System and the Department of Neuroscience, University of California San Diego, USA  show that abnormal tissue diffusivity may be sensitive to cognitive changes and cognitive decline in PD. These changes may be of prognostic use in the future.   Motor symptom severity did not correlate to abnormal tissue diffusivity.

FMRI and insights into degeneration of dopaminergic neurons in the substantia nigra in Parkinson’s disease

Parkinson’s disease PD results in motor, cognitive, sensory and affective deficits that lead to movement impairment. The mechanism is a degeneration of dopaminergic neurons in the substantia nigra. Dr. van der Vegt JP et al Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Denmark present in Brain, 04/04/2013 present evidence that suggests that these deficits are not due to the contaminating effect of dopaminergic treatment. The team do this by testing drug-naive patients with Parkinson’s disease who underwent whole-brain functional magnetic resonance imaging. They show that the core regions of the meso–cortico–limbic dopaminergic system, including the ventral tegmental area, ventral striatum, and medial orbitofrontal cortex, are already significantly compromised in the early stages of Parkinson’s disease PD.

 

Hip fracture in Parkinson’s disease (PD)

Published in Movement Disorders, 02/26/2013 Dr. Walker compares the incidence and outcomes of Parkinson’s disease (PD) who suffer hip fracture compared to non PD patients in North East England. The team from the Department of Medicine, North Tyneside General Hospital, United Kingdom saw that PD patients had poorer mobility before hip fracture, had less mobility post surgery and took longer to be discharged into community physical rehabilitation. The team concludes that occupational and physiotherapists managing people with PD who sustain a hip fracture should be aware of potential complications of the condition to improve physical rehabilitation outcomes.

Neurostimulation as a treatment for motor dysfunction in Parkinson’s disease

Published in the New England Journal of medicine- Dr. Deuschl  - Department of Neurology, University Hospital Schleswig–Holstein, Campus Kiel discuss neurostimulation as an established treatment for advanced Parkinson’s disease. The group also show how neurostimulation for Parkinson’s Disease patients with Early Motor Complications also results in an improvement of functional ability.

The group looked at quality of life at 2 years post treatment using the Parkinson’s Disease Questionnaire (PDQ-39) as well as the secondary outcomes of Parkinsonian motor disability, activities of daily living, levodopa-induced motor complications, and time with good mobility and no dyskinesia.

Nonmotor symptoms and Parkinsons disease

Writing in neurology Jan 2013, Dr. Khoo et al study the frequency of non motor symptoms in early PD.  Dr. Khoo team consisted of scientists and physical and occupational therapists from Newcastle University, Newcastle upon Tyne; Imperial College, MRC Clinical Sciences Centre, London; and Cambridge Centre for Brain Repair (Cambridge University, Cambridge, UK.

Because Nonmotor symptoms (NMS) are common in patients with established Parkinson disease (PD) the team determined the frequency of NMS in newly diagnosed PD patients. The most common NMS symptoms were excessive saliva, forgetfulness, urinary urgency, hyposmia, and constipation and even in the early stages of PD, NMS is detrimental to patients’ functional status and quality of life and sense of well being.

 

Assistive technology imjproves walking in neurological disease and injury

Assistive technology assists walking

Writing in the January edition of disability Rehabilitation Dr. Wittwer and his group from Trobe University, Melbourne, Australia; Department of Physiotherapy look at clinical trials that assess assistive rehabilitation technologies that synchronise over-ground walking to rhythmic auditory cues. The objective is to improve temporal and spatial gait measures in adults with neurological clinical conditions and improve walking. The group found that this technology will result in a short-term improvement in gait in patient groups including stroke, Huntington’s disease, spinal cord injury, traumatic brain injury, dementia, multiple sclerosis and parkinson’s disease.

 

Brain Stimulation Helps Parkinson’s Patients

There are several medications available to Parkinson’s patients to relieve their symptoms but when they aren’t effective a procedure called deep brain stimulation (DBS) is sometimes used. DBS consists of surgically implanting electrodes in deep brain structures that help control movement, and then delivering stimulation through the electrodes with a device very much like a pacemaker. One common target is the subthalamic nucleus (STN). The problem has been that although DBS can relieve movement problems it may incur problems in the patient’s cognition. Doctor’s do not fully understand the reasons for that.

A theory is being investigated by Dr. Joel Perlmutter, a professor of neurology and radiology at Washington University in St. Louis, Mo. to try to improve DBS and reduce its side effects. He has been targeting the stimulation to one particular site in the brain and avoiding another nearby site. Funding for the research is being provided from the National Institute of Neurological Disorders and Stroke through a recent congressional act called ARRA.

Studies show that stimulating the dorsal part (top) of the STN  can lead to desirable activity in the brain’s motor pathways, while stimulating the ventral part (bottom) can lead to negative activity in other brain pathways that are involved in cognition.

Dr. Perlmutter, together with his team, will examine Parkinson’s patients who have received DBS to the STN, and to try to pinpoint the location of the electrodes – which can possibly change after surgery. Their purpose is to  analyze how electrode location affects the  motor symptoms, cognitive function and cortical activity. In order to  locate the electrodes, the team instituted a method that involves reconstructing 2-D brain scans into 3-D maps, and then using landmarks in and around the STN for orientation.

From this research there should be a better understanding of how DBS works and improvements made in  treating Parkinson’s. This will include a better design and targeting of the electrodes. Besides that, the research is expected to yield insights into the function of the STN and how it is involved in other neurological disorders.

When Parkinson’s disease causes movement disorders physical therapy solutions become vital. The HANDTUTOR has been in the forefront of Parkinson’s patient exercise therapy for some time now. The HANDTUTOR consists of a safe comfortable glove with position and speed sensors that precisely record finger and wrist motion. Rehabilitation games allow the patient to exercise Range of Motion, speed and accuracy of movement opposition and pinch movement practice. The HANDTUTOR facilitates evaluation and treatment of isolated and combined finger/s and wrist joint.

Together with its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) the HANDTUTOR is currently in use in leading U.S. and European hospitals and rehabilitation clinics. They are fully certified by the FDA and CE and are available for use in the patient’s home through telerehabilitation.

See WWW.MEDITOUCH.CO.IL for further information.

Five Ways to Relieve Arthritis Pain

Arthritis has no known cure–just relief from pain. It’s called– exercise. Below are 5 exercises that are designed to bring joint relief, relieve stress and assist in weight loss. They can be fun too.

Doctors say that physical activity  is the best medicine  there is for arthritis pain relief, .

Patience White, M.D., chief public health officer of the Arthritis Foundation and professor of medicine and pediatrics at the George Washington University School of Medicine states that exercise can decrease pain, especially for people with osteoarthritis which is the most common type of arthritis.

 In the Cochrane Database of Systematic Reviews it was reported that exercise, such as walking, was  as effective  as drugs like Aleve or Advil in reducing knee pain.

By working out regularly it  may prevent sore joints and stop arthritis from getting worse.

Kevin Fontaine, Ph.D., assistant professor of medicine at the Center for Mind-Body Research at Johns Hopkins University School of Medicine in Baltimore states that  physically active people  have a higher quality of life and are less likely to become disabled or have days with lots of pain.

 Workouts also keep off the pounds. Obesity can increase the risk of arthritis and/or make its symptoms worse.

 Just 20 minutes three times a week or two 10 minute intervals is enough to make a difference according to Arthritis Today, the journal of the Atlanta-based Arthritis Foundation.

There are also new medications that can help relieve arthritis pain and swelling allowing patients to work out according to  Halsted Holman, M.D., professor emeritus of medicine and former director of the Stanford Multi-Purpose Arthritis Center at Stanford University’s School of Medicine.

Generally it is necessary to begin exercising only with a physician’s agreement.

A workout should be a challenging experience, but not painful enough to cause injury, Dr. Holman says.

 If you have sore joints or muscle pain that continues for even two hours after exercising or if the pain is worse the next day then the exercises were overdone. In that case the workout should be shortened or done more gently.

Here are 5 arthritis exercises that are sure to ease  arthritis symptoms:

1. Walking

 Walking is known to strengthen muscles, which in turn helps shift pressure away from the joints, and reduces pain.

 It also brings nourishing oxygen to the  joints by compressing and releasing cartilage in the knees.

 The Arthritis Foundation recommends walking 10 minutes at least 3-5 days a week to start.

As you progress, take longer walks and include short bursts of speed getting to a moderate pace until you are able to walk 3-4 miles an hour.

 People with serious hip or knee problems should first check with their doctor before beginning a walking program.

2. Water Exercise

How it helps: The University of Washington Department of Orthopedics and Sports Medicine recommends warm water – between 83˚ F and 90˚ F – to help relax  muscles and decrease pain.

Swimming and aerobics exercises in water are good for stiff, sore joints.

Water also supports the body as one moves. This reduces stress on the knees, hips  and spine, and offers resistance without any weights.

Water exercises are  ideal for people who need to relieve severe arthritis pain in knees and hips.

Arthritis Today quotes “Water provides 12 times the resistance of air, so one is  really strengthening and building muscle”.

When immersed in the water don’t pedal faster than 50-60 revolutions a minute. Add resistance  after a warm up period of  five minutes and don’t add more pedaling than you can handle.

3. Indoor Cycling

Matthew Goodemote, head physical therapist at Community Physical Therapy & Wellness in Gloversville, N.Y.  says that indoor cycling is one of the best ways to get a cardiovascular workout without stressing weight-bearing joints.

 Since there’s no need to lean the bike to turn a stationary bike is  a good option for people with balance issues – a common problem among some arthritis patients.

 When starting this arthritis exercise be sure that the seat height is at a position which allows the knee to be completely straight  when the pedal is at the lowest point, according to the University of Washington Department of Orthopedics and Sports Medicine.

One should not pedal faster than 50-60 revolutions per minute. A warm up period of five minutes should be allowed at first. Then patients should start 5 minute sessions 3 times a day. Then increase gradually to 7 and up to 20 minutes a day providing there is no pain.

 People with very painful knees should avoid indoor cycling, because it can aggravate the condition.

4. Yoga

 Steffany Haaz, MFA, a certified movement analyst, registered yoga teacher and research coordinator at Johns Hopkins Arthritis Center says that beginner yoga classes that have simple, gentle movements gradually build balance, strength  and flexibility  which are elements that can be  beneficial for people with arthritis.

Yoga  reduces inflammation, increases energy and, in general, allows for a more positive mental outlook, according to Psychosomatic Medicine, an Ohio State University study published in their journal.

To start, take a class at a  gym,  community center or yoga studio. You can find a certified teacher through the Yoga Alliance, the accrediting body for yoga instructors worldwide. It is important to tell the instructor before class about your  arthritis  so that they can  modify poses to accommodate your limited mobility.

For those that prefer doing Yoga at home,  there is a company called Gaiam that produces yoga videos and recently collaborated with the Mayo Clinic to produce a DVD entitled  “The Arthritis Wellness Solution” . It contains tips from specialists and a segment showing specific yoga for arthritis sufferers  and includes meditation exercises which are designed to enhance circulation and  relieve tension which helps relieve arthritis pain.

 Yoga should never hurt. If it does that means it’s overdone.

Straps, blankets and chairs can be used  to accommodate people with  limited range of motion, strength or balance.

5. Tai Chi

This traditional style of Chinese martial arts  goes back centuries and features slow, rhythmic movements to induce mental relaxation and enhance balance, flexibility and strength.

Tai chi is very valuable to arthritis patients because its movements are very slow and controlled. They put little force on the joints.

Some studies have shown that Tai Chi can improve life satisfaction, mental well-being  and perceptions of health, which oppose negative effects of  pain associated with arthritis.

The November 2009 issue of Arthritis Care & Research, a journal of the American College of Rheumatology has an article that describes Tai Chi as being beneficial for knee pain. Another research study by a Tufts University group found that Tai Chi was especially helpful for patients that were over 65 and had knee osteoarthritis.

According to another university’s Orthopedics and Sports Medicine department, Tai chi should preferably be done in the morning,  when there is  least pain and stiffness, when you’re not tired and when the arthritis medication is most effective.

Taking a warm shower is always a good idea before exercise if joints are stiff.

One of the most effective exercise programs for arthritis sufferers is by using the TUTOR system of physical therapy products. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR were originally designed to help patients that suffered a stroke, brain injury, Parkinson’s or other upper and lower limb disabilities. However much relief has been gained for arthritis patients as well  who would like a challenging and entertaining system of exercising arthritic joints. The TUTORs are ergonomically designed gloves and braces that contain sensors connected to sophisticated exercise games. The physical and occupational therapists monitor and record the progress made and design a customized exercise program for that patient.

Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are also available in the home through the use of telerehabilitation and can be used by adults and children from the age of 5 and up.

See WWW.MEDITOUCH.CO.IL for further information.

Multiple Sclerosis Symptom Guidelines

People who develop Multiple Sclerosis (MS) are usually between 20 and 40 and display at least two symptoms before being seen by the doctor.

Blurred or double vision

Weakness in one or more limbs

Cognitive difficulties

Sudden onset of paralysis

Slurred speech

Lack of coordination

 Early symptoms of MS include:

Tingling

Loss of balance

Numbness

Later, as the disease progresses, other symptoms may appear such as fatigue, muscle spasms, sensitivity to heat, sexual disturbances and changes in thinking or perception.

Fatigue is typically present in the afternoon and may include increased muscle weakness,  mental fatigue, or sleepiness.  Many patients with MS complain of  fatigue even after a good night’s sleep.

Heat sensitivity which can worsen symptoms  occurs in most people with MS.

Spasticity. Muscle spasms are a common  symptom of MS. Spasticity  affects the muscles of the legs and arms, and may interfere with being able to move those muscles freely.

Dizziness. A feeling of “off balance” or lightheadedness or that the surroundings are spinning is common; this is called vertigo. These symptoms are due to damage in the complex nerve pathways that coordinate vision and  are needed to maintain balance.

Impaired thinking  occurs in about half of the people with MS. This can manifest itself by slowed thinking, decreased concentration, or decreased memory.  10% of people with the disease have it so severe  that they cannot carry out  tasks of daily living.

Vision problems can include blurring or graying of vision or blindness in one eye.

Abnormal sensations. Many  MS patients experience  sensations such as numbness, “pins and needles,”  burning, itching,  stabbing, or tearing pains. Even though these symptoms are aggravating, they are not life-threatening and can be  treated.

Speech and swallowing problems in people with MS are caused by damaged nerves that normally would aid in performing these tasks.

Tremors are fairly common in people with MS and can be debilitating and difficult to treat.

Difficulty walking is among the most common symptoms of MS.  This  is related to muscle weakness and/or spasticity.   Balance problems or numbness in the  feet can also make walking difficult.

There are other rare symptoms which include breathing problems and seizures.

 The symptoms can be divided into three categories: primary, secondary, and tertiary.

Primary symptoms are a result of the  impairment of the transmission of electrical signals to muscles  and the organs of the body.  These symptoms include: tremors, weakness,  tingling, paralysis, loss of balance, numbness, vision impairment and bladder or bowel problems. These can be kept under control through the use of medication and rehabilitation.

Secondary symptoms are a result of primary symptoms. For example, paralysis  can lead to bedsores  and bladder or urinary incontinence  can cause frequent urinary tract infections. Although these symptoms can be treated,  the ideal goal is to  treat the primary symptoms.

Tertiary symptoms include psychological, social,  and vocational complications that are associated with the primary and secondary symptoms. Depression can be a common problem for those  with MS.

Deterioration of the protective sheath (known as Demyelination) that surrounds nerve fibers, can occur anywhere in the brain or spinal cord.  Demyelination in the nerves that communicate with the muscles causes problems with movement (called motor symptoms) and demyelination along the nerves that carry  messages to the brain causes disturbances in sensation.

Multiple sclerosis is a varied and unpredictable disease. For many people, it starts with a single symptom, followed by months or longer without any progression of symptoms. In others, the symptoms can become worse within weeks or months.

There are many symptoms, as stated above, but it is important to know that a given individual may only experience some of the symptoms and not others. With some the symptom may occur and then disappear. It is not wise to compare one MS patient with another.

When the symptoms reach a level where physical rehabilitation can be helpful the most effective solutions should be incorporated into the patient rehabilitation treatment program. Such solutions would include the TUTORs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers,, private clinics and the home supported by telerehabilitation. The TUTORs have been used to create an intensive exercise program for patients who have had MS or stroke, Parkinson’s disease, head or brain injuries, CP and other upper and lower limb disabilities.

Currently in use in leading U..S. and European rehab facilities the TUTORs are fully certified by the FDA and CE.

See WWW.MEDITOUCH.CO.IL for further information.