Accommodating Employees With Parkinson’s Disease
People with Parkinsons disease may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with Parkinsons disease will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
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The Oral Microbiome Of Early Stage Parkinsons Disease And Its Relationship With Functional Measures Of Motor And Non
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Contributed equally to this work with: Dragos Mihaila, Jordan Donegan
Roles Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Writing review & editing
Affiliation Department of Neurology, SUNY Upstate Medical University, Syracuse, New York, United States of America
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Contributed equally to this work with: Dragos Mihaila, Jordan Donegan
Roles Data curation, Formal analysis, Writing original draft, Writing review & editing
Affiliation Department of Neuroscience & Physiology, SUNY Upstate Medical University, Syracuse, New York, United States of America
Sidebar: Ninds Steps Up Pursuit Of Pd Biomarkers
In 2012, the NINDS dramatically accelerated efforts to identify biomarkers by establishing the Parkinsons Disease Biomarkers Program . This unprecedented program unites a range of stakeholders from basic and clinical researchers to healthcare professionals, the NINDS staff, information technology experts, and people living with PD and their families.
PDBP supports research and builds resources aimed at accelerating the discovery of biomarkers to ultimately slow the progression of PD. For example, the program has established a repository of biological specimens and a Data Management Resource system maintained by the NIH Center for Information Technology. The DMR allows researchers to access clinical, imaging, genetic, and biologic data, while a complementary PDBP-supported project develops statistical tools to analyze vast quantities of data so that patterns can be identified across these diverse sources of information.
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How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
Primary Outcome: Generic Adl At T2
To capture generic ADL, the ADL Staircase was used to assess five personal and four instrumental activities by interview and observation at the home visit. ADL items at T2 were assessed as independent, partly dependent or dependent, with dependence defined as assistance from another person. For those who were rated as independent in an activity, the data collector asked whether the participant performed the specific task with difficulty . For each item, an ordinal variable based on the ADL Staircase assessment and perceived difficulty in ADL was created as independent with no difficulty independent with difficulty partly dependent or dependent . The ADL Staircase is reliable and valid for the assessment of functional ability in people of 7484years old as well as the general population . To our knowledge, its psychometric properties have not been evaluated in people with PD. Because the assumptions to use the outcomes as continuous measures in linear regression models were not met for this study, generic ADL scores were dichotomised with a cut-off value of < =9, representing the lowest 33% of the scores at T2.
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Demographic And Clinical Assessments
A total of 227 participants were recruited to the study 147 of which were diagnosed with idiopathic PD and 80 healthy older adults . Of those with PD, 66 were classified as FOG+ and 81 were classified as FOG. Demographic and clinical assessments are shown in Table . When comparing OA and PD, there were no differences for age or gender but those with PD had a poorer MoCA score . When comparing FOG+ and FOG, there was no significant difference for age, gender or MoCA . However, motor disease severity, as measured by the MDS-UPDRS III, was significantly greater in the FOG+ group compared to the FOG group . The FOG+ group had significantly greater FOG severity, as demonstrated by the FOG ratio score compared to FOG .
Table 1 Demographic and clinical characteristics for controls, PD and PD without freezing and PD with freezing .
Secondary Outcome: Adl Specific To Pd At T2
ADL specific to PD was assessed at T2 with the self-reported Parkinsons Diseases Activities of Daily Living Scale . The respondents were asked to tick the one of five descriptions, which best described how Parkinsons disease had affected their day-to-day activities in the last month . PADLS is a reliable and valid measure of ADL in people with PD . For this study, PADLS scores were dichotomised into no/mild difficulties or moderate/severe/extreme difficulties , which is a principle used in previous studies .
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Parkinson’s Disease And The Americans With Disabilities Act
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act .
Stages Of Parkinsons Disease And How To Treat Them
Parkinsons Disease is a progressive disease, meaning the symptoms develop slowly over the course of several years. Although there are four main motor symptoms that occur with Parkinsons, not every patient will experience symptoms in the same order and in the same way. However, there are patterns of symptom progression that most patients will experience.
The most commonly used scale to assess the stage of Parkinsons disease is the Hoehn and Yahr scale. Named for its authors, Margaret Hoehn and Melvin Yahr, the scale was originally published in 1967 in the journal Neurology and described the progression of Parkinsonism, collection of signs and symptoms found in Parkinsons disease, in five stages. The scale has since been modified to include stage 1.5 and stage 2.5 to account for the intermediate course of Parkinsons.
The Hoehn and Yahr scale originally classified the five stages in the following manner:
- Stage I. Unilateral involvement only, usually with minimal or no functional impairment.
- Stage II. Bilateral or midline involvement, without impairment of balance.
- Stage III. Mild to moderate bilateral impairment with some postural instability.
- Stage IV. Fully developed, severely disabling disease the patient is still able to walk and stand unassisted but is markedly incapacitated.
- Stage V. Confinement to bed or wheelchair unless aided.
Stages I.5 and 2.5 were later added and described as:
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Functional Improvements In Parkinsons Disease Following A Randomized Trial Of Yoga
1Clemson University, Clemson, South Carolina, USA
2Colorado State University, Fort Collins, Colorado, USA
3Bon Secours Neurology, Greenville, South Carolina, USA
4Greenville Health System, Greenville, South Carolina, USA
Academic Editor:
Abstract
1. Introduction
Consequently, there remains a critical need for innovative programming designed to specifically address fall reductions in people with PD . Balance control is recognized as a complex process that requires an integration of the brain and multiple body systems , thus an intervention capable of effectively connecting the brain and body while targeting multiple body systems has significant potential to improve balance. Yoga is a well-established intervention, known to connect the mind and body, to address multiple systems, and to significantly improve overall balance in people with impaired balance . Yoga is a complementary health approach it is becoming more common for patients to ask their physicians and rehabilitation therapists about complementary and integrative health treatment options . This is often due to concerns regarding costs of conventional medicine, increased side effects from medications, or an attempt to avoid medications or surgery . Integrative health treatment options are frequently lower in cost, have minimal physical and emotional risks, and allow people to take a more active role in their treatment .
2. Methods
2.1. Experimental Group
2.2. Wait-List Control
2.3. Data Collection
Pd Symptoms And Severity
Parkinson disease was diagnosed in each patient by a neurologist with fellowship training in movement disorders, with the exception of the small sample from Duke University, in which a general neurologist made the diagnosis. Severity of PD was measured using the UPDRS motor and total scores and the modified H& Y scale. The on-state UPDRS and modified H& Y scores were determined by a movement disorder specialist or by another professional trained by the study’s movement disorder specialist. The UPDRS motor score provides a measure of severity of signs and symptoms of PD. The modified H& Y scale describes disease severity more broadly, with stages 1 to 2 indicating mild disease, stages 2.5 to 3 indicating moderate disease, and stages 4 to 5 indicating severe disease.
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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
Sidebar: Advances In Circuitry Research
The brain contains numerous connections among neurons known as neural circuits.
Research on such connections and networks within the brain have advanced rapidly in the past few years. A wide spectrum of tools and techniques can now map connections between neural circuits. Using animal models, scientists have shown how circuits in the brain can be turned on and off. For example, researchers can see correlations between the firing patterns of neurons in a zebrafishs brain and precise behavioral responses such as seeking and capturing food.
Potential opportunities to influence the brains circuitry are starting to emerge. Optogenetics is an experimental technique that involves the delivery of light-sensitive proteins to specific populations of brain cells. Once in place, these light-sensitive proteins can be inhibited or stimulated by exposure to light delivered via fiber optics. Optogenetics has never been used in people, however the success of the approach in animal models demonstrates a proof of principal: A neural network can be precisely targeted.
Thanks in part to the BRAIN Initiative, research on neural circuitry is gaining momentum. The Brain Research through Advancing Innovative Neurotechnologies Initiative is accelerating the development and application of new technologies that enable researchers to produce dynamic pictures of the brain that show how individual brain cells and complex neural circuits interact at the speed of thought.
NIH Publication No. 15-5595
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Functional Limitations Research In Rehabilitation Science And Engineering
Although rehabilitation interventions can effectively target impairments that can be remediated, little is known about the relationship between impairment and functional limitations . This chapter reviews knowledge and research in the area of functional limitation in the context of the enabling-disabling model . In this conceptual framework, the functional limitations result from impairment, and functional limitation may result in a disability. Reduction of functional limitation from arthritis alone by only 0.5 percent per year over 50 years could reduce disability by 4 million person-years, a savings of nearly $100 billion in 1993 dollars . Proper measurement of functional limitations is difficult and expensive, and many clinicians are not aware of the extraordinary deficiencies that exist in the functional limitations literature. For example, the functional benefits of strengthening exercises for older people with one or more weakness-producing impairments are essentially unknown, despite the obvious appeal of such a commonsensical notion. Although intervention strategies may be offered by the clinician, valid treatment outcomes have not been reported. Strength may have a nonlinear relationship to functional locomotion, because strength changes beyond some threshold may not engender further gait improvement .
Suggested Citation:Enabling America: Assessing the Role of Rehabilitation Science and Engineering
Testing Functional Performance In People With Parkinson Disease
All authors provided concept/research design, writing, and data collection and analysis. Dr Steffen provided project management, fund procurement, subject recruitment, facilities/equipment, and consultation. The authors acknowledge the work done by Kathleen Cashin, PT, MPT, and Lisa Sheldon, PT, MPT, for assistance with data collection, Lina La Licata for clerical support, and Louise Mollinger-Reiman for manuscript review.
Physical Therapy
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How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
Alff Differences Of The Voxel
As shown in , the voxel-wise meta-analysis identified increased ALFFs in the right inferior temporal gyrus extending to the middle temporal, fusiform, and parahippocampal gyri, right inferior parietal gyrus, right inferior parietal gyrus, brainstem , and right orbitofrontal cortex in patients with PD compared to healthy controls. In contrast, decreased ALFFs were observed in the bilateral cuneus cortices, bilateral cuneus cortices, bilateral supplementary motor areas , left putamen, left inferior parietal gyrus, and left lateral premotor cortex. The details of the results are presented in .
Figure 2: ALFF differences in patients with PD compared to healthy controls.
Key: Red and green colors indicate increased and decreased ALFFs in patients with PD compared to healthy controls, respectively. ALFF, amplitude of low-frequency fluctuations , Right inferior temporal/middle temporal/fusiform/parahippocampal gyri , Right inferior parietal gyrus , Brainstem , Right orbitofrontal cortex , Left/Right cuneus cortices , Left/Right supplementary motor areas , Left putamen , Left cuneus cortex , Left inferior parietal gyrus , Left lateral premotor cortex.
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