About Dr Sarah King Pt Dpt
Sarah is a passionate Parkinsons physical therapist whose mission is to help her clients build a personalized Parkinsons Plan of Attack that helps them live a life full of energy and vitality, despite their diagnosis. She lives in Austin, Texas with her husband , Matt. Learn more about Invigorate Physical Therapy & Wellness at www.InvigoratePT.com.
Stooping Or Hunching Over
Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .
What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.
Why Is Expert Care Important
Early expert care can help reduce PD complications. Findings show that 60 percent of people with Parkinson’s fall short of getting the expert care they need. The National Parkinson Foundation has estimated that about 6,400 people with Parkinson’s die unnecessarily each year due to poor care.
Trained neurologists will help you recognize, treat and manage the disease. Common approaches include medication, surgical treatment, lifestyle modifications , physical therapy, support groups, occupational therapy and speech therapy. The best approach is interdisciplinary care, where you are seen by multiple specialists on a regular basis and all of the specialists talk and arrange the best possible coordinated care. This is what is referred to as a patient-centric approach to Parkinson’s care.
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What Can You Do If You Have Pd
- Work with your doctor to create a plan to stay healthy. This might include the following:
- A referral to a neurologist, a doctor who specializes in the brain
- Care from an occupational therapist, physical therapist or speech therapist
- Meeting with a medical social worker to talk about how Parkinson’s will affect your life
For more information, visit our Treatment page.
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
Types Of Pain In Parkinsons
One review classified the types of PD pain as follows:
- musculoskeletal, in which the pain results from problems with the muscles , bones or joints
- dystonic, which is due to abnormal muscle contractions caused by PD or the medications used to treat it
- radicular pain or nerve pain
- central pain, which is poorly understood and thought to be due to abnormalities in the brain itself
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Brain Changes In Essential Tremor
Neuropathologists have studied the brains of people with essential tremor after their death. The results are suggestive but conflicting. Some people have described changes in the cerebellum, a region of the brain commonly associated with movement and coordination. Furthermore, some studies have described a higher chance of finding Lewy bodies, usually considered to be a sign of Parkinson’s disease, in part of the brainstem known as the locus coeruleus.
Some pathologists believe that these are signs that essential tremor may be a neurodegenerative illness along the lines of Parkinson’s disease or Alzheimer’s disease. Other studies have found that people with essential tremor may be at an increased risk of developing Parkinson’s disease, Alzheimer’s disease, and progressive supranuclear palsy. Perhaps there is a common predisposition towards neurodegeneration that links tremor with these other disorders.
On the other hand, others state that the increased risk of developing other diseases may be simple misdiagnosis meaning that perhaps some people who initially were said to have essential tremor had an unusual presentation of Parkinson’s or another known movement disorder. These researchers believe that there is no current need to call essential tremor degenerative itself.
Pain Is A Common But Overlooked Problem In Parkinsons Disease
Pain is an often overlooked non-motor symptom of Parkinsons disease . Studies show that between 40-80% of people with PD report pain, which is likely why it is often suggested as a topic for this blog.
One of the reasons why the topic of pain and PD is difficult to address is that it is sometimes tough to discern whether a particular pain is due to PD or not. Chronic pain is such a common symptom among the general population, and people with PD are not immune to common problems as well. However, there are aspects of PD that may exacerbate the pain experienced from a common problem. In addition, there are particular types of pain that may be unique to people with PD.
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Potential Causes Of Parkinsons Disease
The causes of Parkinsons disease are still unknown, although there is some evidence for the role of genetics, environmental factors, or a combination of both. It is also possible that there may be more than one cause of the disease. Scientists generally believe that both genetics and environment interact to cause Parkinsons disease in most people who have it.
Currently, there is an enormous amount of research directed at producing more answers about what causes Parkinsons disease and how it might be prevented or cured. When physicians diagnose Parkinsons, they often describe it as idiopathic . This simply means that the cause of the disease is not known.
How Are Parkinsons Tremors Treated
Tremor can be unpredictable. Some experts say itâs the toughest symptom to treat with medication. Your doctor may prescribe medication for your tremors:
- Levodopa/carbidopa combination medicines . This treatment is a type of medication called a dopamine agonist. Itâs usually the first treatment for Parkinsonâs.
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How Is Tremor Classified
Tremor can be classified into two main categories:
Resting tremor occurs when the muscle is relaxed, such as when the hands are resting on the lap. With this disorder, a persons hands, arms, or legs may shake even when they are at rest. Often, the tremor only affects the hand or fingers. This type of tremor is often seen in people with Parkinsons disease and is called a pillrolling tremor because the circular finger and hand movements resemble rolling of small objects or pills in the hand.
Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are considered action tremor. There are several sub-classifications of action tremor, many of which overlap.
- Postural tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched.
- Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.
- Intention tremor is produced with purposeful movement toward a target, such as lifting a finger to touch the nose. Typically the tremor will become worse as an individual gets closer to their target.
- Task-specific tremor only appears when performing highly-skilled, goal-oriented tasks such as handwriting or speaking.
- Isometric tremor occurs during a voluntary muscle contraction that is not accompanied by any movement such as holding a heavy book or a dumbbell in the same position.
Diseases That Mimic Essential Tremor
To be diagnosed with essential tremor, one must first exclude known mimics. More serious problems such as multiple sclerosis, traumatic brain injury, tumors, vascular disease, Wilson’s disease, atypical Parkinson’s disease, drugs, toxins, and more can cause a tremor that worsens when the hand and arm are in use. If one of these things is found to be the cause of the tremor, the tremor is not considered “essential,” but part of a more serious medical condition.
The controversy begins after we have excluded as many of those disorders as possible, and only the tremor seems to remain. Even then, there may be hints that the tremor is a sign of a wider, more involved process in the body.
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Surgery And Deep Brain Stimulation
Deep brain stimulation is a treatment for Parkinsonâs disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications , its adjustability , and its reversibility DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic , more than 80,000 patients have undergone DBS surgery worldwide.
Typical candidates are those who have motor fluctuations or periods of âoffâ time with troublesome symptoms alternating with periods of âonâ time with good symptom control, and also with possible periods of excessive movement .
Not all patients with Parkinsonâs disease are good candidates for treatment with DBS. Approximately 10â20% of patients considered for possible treatment with DBS include those:
Confusion With Essential Tremor
The tremor of Parkinsons disease is often confused with the tremor of a condition called Essential Tremor, or Benign Familial Tremor . Katherine Hepburn had Essential Tremor, and was originally misdiagnosed with Parkinsons. Ronald Reagan also had Essential Tremor. Both had a head tremor and a vocal tremor. In Essential Tremor, the hands are most commonly involved, followed by the head and then the voice. Essential Tremor can also cause the jaw to tremor, and it may be difficult to figure out if a jaw tremor is from Essential Tremor or Parkinsons. Unfortunately, some people may have both disorders. Some authorities believe that there is, in fact, an increased association between the two conditions, so that more people with Parkinsons disease have Essential Tremor than would be expected by chance alone, but this has not been established.
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Living With Parkinsons Disease
Depending on severity, life can look very different for a person coping with Parkinsons Disease. As a loved one, your top priority will be their comfort, peace of mind and safety. Dr. Shprecher offered some advice, regardless of the diseases progression. Besides movement issues Parkinsons Disease can cause a wide variety of symptoms including drooling, constipation, low blood pressure when standing up, voice problems, depression, anxiety, sleep problems, hallucinations and dementia. Therefore, regular visits with a neurologist experienced with Parkinsons are important to make sure the diagnosis is on target, and the symptoms are monitored and addressed. Because changes in your other medications can affect your Parkinsons symptoms, you should remind each member of your healthcare team to send a copy of your clinic note after every appointment.
Dr. Shprecher also added that maintaining a healthy diet and getting regular exercise can help improve quality of life. Physical and speech therapists are welcome additions to any caregiving team.
Lewy Body Dementia Vs Parkinsons Disease Dementia
Diagnoses of Lewy body dementia include dementia with Lewy bodies and Parkinsons disease dementia. Symptoms in both of these diagnoses can be similar.
Lewy body dementia is a progressive dementia caused by abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also seen in Parkinsons disease.
The overlap in symptoms between Lewy body dementia and Parkinsons disease dementia include movement symptoms, rigid muscles, and problems with thinking and reasoning.
This seems to indicate that they could be linked to the same abnormalities, though more research is needed to confirm that.
The later stages of Parkinsons disease have more severe symptoms that may require help moving around, around-the-clock care, or a wheelchair. Quality of life can decline rapidly.
Risks of infection, incontinence, pneumonia, falls, insomnia, and choking increase.
Hospice care, memory care, home health aides, social workers, and support counselors can be a help in later stages.
Parkinsons disease itself isnt fatal, but complications can be.
Research has shown a median survival rate of about
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Stooping Or Hunched Posture
People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.
People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.
Can Parkinsons Disease Be Prevented
Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.
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Brain Imaging And Other Tools To Aid Diagnosis Of Parkinsons
In addition to taking a history and performing a detailed neurologic examination, physicians sometimes use brain imaging to help support a particular diagnosis. However, these studies have their limitations in the diagnosis of Parkinsons disease and are typically used only in select patients. Brain imaging is not routinely performed by neurologists or movement disorder specialists when they are considering a diagnosis, especially if the persons symptoms strongly suggest to the physician that idiopathic Parkinsons disease is the correct diagnosis.
Helping diagnose Parkinsons with DaTscan and other tests
Rather, use of imaging is most helpful when the diagnosis is uncertain, or when physicians are looking for changes in the brain that are more typical of one of several Parkinsonian syndromes and other conditions that can mimic Parkinsons. Imaging studies to evaluate Parkinsons disease and Parkinsonian syndromes include magnetic resonance imaging , which examines the structure of the brain, and DaTscan, an imaging test approved by the Food and Drug Administration to detect the dopamine function in the brain. A DaTscan may help differentiate idiopathic Parkinsons disease from certain other neurologic disorders. Most physicians offices will have access to MRI however, DaTscan imaging may only be available at larger hospitals or medical centers.
Medication Side Effects And The Gut
The interactions between PD medication ingestion and the gut can play a major role in motor fluctuations the phenomenon in which a patients response to Levodopa varies widely during the day. A recent APDA webinar helps to explain this interplay.
Delayed gastric emptying
Delayed gastric emptying can interfere with medication absorption. Medication doses that are ingested by mouth may sit in the stomach before being transported to the small intestine where they are absorbed. Delayed gastric emptying could be responsible for dose failures when a dose of medication does not have a robust enough effect.
Protein effect
Levodopa crosses the wall of the small intestine via a molecule in the intestinal wall that transports amino acids, the building blocks of protein. When dietary protein is also present in the small intestine, then there are fewer transporters available for Levodopa to use. A patient may therefore experience the protein effect, in which he or she feels that medication is not as effective after a high-protein meal. Sources of dietary protein include: beef, chicken, pork, fish, eggs, nuts and dairy.
Helicobacter pylori and small intestinal bacterial overgrowth
About a third of PD patients are infected with Helicobacter pylori, a common bacteria which can cause gastritis and ulcers. Infection with Helicobacter pylori has been linked to worsened motor fluctuations. It can be diagnosed with a urea breath test that analyzes exhaled air.
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Tremor In Other Conditions
While tremor is a common symptom of Parkinsons, it can also be a symptom of other conditions, most notably essential tremor. The main difference between Parkinsons tremor and most other types of tremor is that in Parkinsons resting tremor is most common. Other conditions are usually characterized by action tremor, which tends to lessen at rest and increase when youre doing something, like trying to make a phone call or take a drink.
Tremors of the head and voice are also common in essential tremor but rare in Parkinsons.
What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
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Where To Get More Information
- If you’re experiencing any symptoms and are concerned, see your GP.
- To learn more about Parkinson’s disease and to find support, visit Parkinson’s Australia or call the Info Line on 1800 644 189.
- The Shake It Up Australia Foundation partners with The Michael J. Fox Foundation to help raise awareness and funds for Parkinson’s disease research.
- The Garvan Institute of Medical Research is working hard to find ways to diagnose Parkinson’s earlier and repurpose existing drugs to slow its progress. Find out more here.
What Causes Parkinson’s Disease
A substance called dopamine acts as a messenger between two brain areas – the substantia nigra and the corpus striatum – to produce smooth, controlled movements. Most of the movement-related symptoms of Parkinson’s disease are caused by a lack of dopamine due to the loss of dopamine-producing cells in the substantia nigra. When the amount of dopamine is too low, communication between the substantia nigra and corpus striatum becomes ineffective, and movement becomes impaired the greater the loss of dopamine, the worse the movement-related symptoms. Other cells in the brain also degenerate to some degree and may contribute to non-movement-related symptoms of Parkinson’s disease.
Although it is well known that lack of dopamine causes the motor symptoms of Parkinson’s disease, it is not clear why the dopamine-producing brain cells deteriorate.
- Genetic and pathological studies have revealed that various dysfunctional cellular processes, inflammation, and stress can all contribute to cell damage.
- In addition, abnormal clumps called Lewy bodies, which contain the protein alpha-synuclein, are found in many brain cells of individuals with Parkinson’s disease. The function of these clumps in regards to Parkinson’s disease is not understood.
In general, scientists suspect that dopamine loss is due to a combination of genetic and environmental factors.
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