Human Performance and Rehabilitation Centers, Inc.

All About Parkinson’s

Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in the area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.  The specific group of symptoms that an individual experiences varies from person to person.

Symptoms

Primary motor (movement) signs of Parkinson’s disease include the following:
Tremor of the hands, arms, legs, jaw and face
Bradykinesia or slowness of movement
Rigidity or stiffness of the limbs and trunk
Postural instability or impaired balance and coordination

Each person with Parkinson’s will experience symptoms differently. For example, many people experience tremor as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly, and in others it does not. By definition, Parkinson’s is a progressive disease. Although some people with Parkinson’s only have symptoms on one side of the body for many years, eventually the symptoms begin on the other side. Symptoms on the other side of the body often do not become as severe as symptoms on the initial side.

Progression

The progression of Parkinson’s disease varies among different individuals. Parkinson’s is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years, but is not considered a fatal disease. Movement symptoms vary from person to person, and so does the rate at which they progress. Some are more bothersome than others depending on what a person normally does during the day. Some people with Parkinson’s live with mild symptoms for many years, whereas others develop movement difficulties more quickly.

Non-motor symptoms also are very individualized, and they affect most people with Parkinson’s at all stages of disease. Some people with Parkinson’s find that symptoms such as depression or fatigue interfere more with daily life than do problems with movement.

Since Parkinson’s disease (PD) is a chronic condition, it is important to develop and maintain a solid PD management plan. Research has shown that those who take an active role in their care see an improvement in their Parkinson’s symptoms.

Management

Managing your care means not only finding the right doctor, but ensuring you are prepared for your visit and talking to your doctors about the right issues. It means, not just taking your medications, but keeping track of when you need to take them. People with Parkinson’s are best served by a multi-disciplinary approach that provides not only the expertise of a PD specialist, but also the help of a physical therapist, occupational therapist, speech therapist, nutritionist and social worker. Some people also require medical consultants in areas such as psychiatry and neurosurgery. It is important that these healthcare professionals are aware of each other and communicate regularly, and that they all know the full list of treatments and medications that each is prescribing.
Physical and Occupational therapy focus upon restoring the ability to move effectively and safely by instructing and facilitating normal movement patterns and providing safety education and adaptive equipment to facilitate a person’s ability to maximize independence with mobility, self-care and activities of daily living.

Speech therapy focuses upon restoring swallowing, speech and language production and understanding and cognitive (thinking/memory) functions.

National HelpLine:
Ask the experts at PDF your questions
Are you looking for a support group? Call us at (800) 457-6676 or email info@pdf.org to find a group in your area

The toll-free HelpLine/email service – staffed by a team of information specialists – can:
Answer your questions about Parkinson’s disease: symptoms, treatments, complementary and alternative therapies and the latest scientific studies reported by the media.

Identify financial, legal and other resources to help you live well with Parkinson’s.
Provide access to an interpreter for non-English speaking callers.

Good Posture Provides Tangible Benefits

We have probably all been told at some point in our lives, more often than not by mom or grandma, that we should fix our posture or stand up straight. Well grandma was on to something there! More often than not, while working with patients who are experiencing back, neck, or shoulder pain, I will identify one or more postural deviations which are likely contributing to their symptoms. Some of the most common postural deviations that I see on a regular basis include forward head, anterior pelvic tilt, and rounded shoulders.

Ideal posture gives our body a solid foundation from which to move. The spine is naturally made up of curves with the neck and the low back arching slightly and the mid back rounding slightly. Proper posture minimizes the strain on our muscles and joints and decreases the amount of work that our muscles need to do in order to fight gravity and keep us upright. In ideal standing posture from a side view our ears should line up with our shoulders, hips and knees and there should be a slight curve outward at the mid back and inward at the low back. In a sitting position, our bottoms should be near the back of the chair with our backs supported by the chair. The knees should be bent at approximately 90 degrees (meaning many of us need to adjust our chair height) and our shoulders and neck should be relaxed.

A postural deviation that is increasing in prevalence is forward head posture. This is what it’s called when our chins are sticking out and our ears line up in front of our shoulders. This commonly occurs with reading, computer work, television viewing, and texting. We have a tendency to bring the neck/chin forward in an attempt to get our eyes closer to whatever is holding our attention. Unfortunately, prolonged forward head posture can contribute to neck tension and soreness, headaches, and tingling in the arms. Cell phones tend to bring out the worst neck posture because we often bend our necks down at significant angles while also bringing the chin forward as we read, text or play games on the relatively small screen. The perceived weight of the head increases significantly the more we bend our heads forward. An exercise that you can do to correct forward head posture is cervical retraction with a chin tilt. To perform this exercise nod your chin down just a tiny bit then bring your neck straight back as you think about lifting the base of your skull as if it were being pulled by a string tied to the ceiling. Hold for a few seconds and then relax.

A second common postural deviation is excessive anterior pelvic tilt. This often occurs as a result of tight hip flexor muscles. As a culture, we spend more time sitting than what is ideal for our bodies. We often sit for extended periods for transportation, work, and recreation/relaxation. This can enable the muscles at the front of our hips to shorten and get tight, pulling our pelvis forward. When we stand with anterior tilt, we often increase the arch in our low back as a compensation to stay upright. This can put excessive strain on the low back over time. By pulling the hips forward and the pelvis into a neutral position the back can return to its natural position. An exercise to correct excessive anterior pelvic tilt is the posterior pelvic tilt. This can be performed in multiple positions. One way to do a posterior pelvic tilt is to start lying on your back with your knees bent and the bottoms of your feet flat on the floor. From this position gently press your low back down to the floor and use your abdominal muscles to gently rock your hips back or “tuck your tail”. Another exercise which may be necessary to correct excessive anterior pelvic tilt is to stretch the front of the hips or hip flexor muscles if they are tight.

The final postural deviation that I see very frequently is rounding of the shoulders. This often shows up as a combination of the shoulder blades being far apart and the arms being rotated in so that if a person is standing with their arms relaxed by their sides their palms would be facing behind them. It is also common for people with rounded shoulders to also have a greater than usual bend in the upper back. People with this posture commonly report neck or shoulder pain. This posture puts the body in a poor position for reaching or lifting overhead. Try rounding your shoulders and slumping your upper back, then try to raise your arms overhead from that position. Now try raising your arms while sitting up tall and gently pulling your shoulder blades back. Your arms should be much easier to raise from the second position. Not only is it harder to move your arms from the rounded position but this posture makes it easier for your rotator cuff tendons to be pinched. People with proper posture have the lowest incidence of rotator cuff tears. An exercise to correct this postural deviation is scapula or shoulder blade retractions. To do this exercise stand with your arms by your sides and gently pull your shoulder blades back and together with your thumbs facing out. Hold for a few seconds then relax. Be sure that your shoulders aren’t coming up toward your ears when you do this exercise.

In order to efficiently move our limbs, it is essential to have good posture. We can decrease the strain on our muscles and joints by making small adjustments in our static and dynamic positions. Proper alignment can be one step toward decreasing pain in the neck, back, or shoulder.

Hurt on the Job? You May Need a Functional Capacity Evaluation

Functional Capacity Evaluations (FCE) are full body assessments that are performed to determine an individual’s ability to safely return to work at pre-injury status or to determine if work modifications are necessary to allow the employee to safely resume their job. FCE’s are commonly used for:

  • Employees that have suffered musculoskeletal work related injuries and an evaluation is requested to determine their physical abilities in comparison to the demands of a target job
  • Establishing a disability claim
  • A generic test to assess an individual’s current physical ability when the job goal is unknown

The Process

Your therapist or trainer will request a job description for review to assure all job demands are evaluated. The results of the FCE are then compared to the job description. If the client does not meet all the job demands, the evaluator will determine if the employee is a candidate for a work reconditioning program and recommendations will be made to the physician ordering the exam.

The length of the test and the number of days required to complete testing will vary depending on the injured body part. Hand, elbow, and shoulder exams are performed on one day and take approximately 4 hours to complete. Spine, hip, knee, foot, and ankle exams are performed over two separate days, taking approximately a total of 6-8 hours to complete. Clients are asked to dress in clothing and shoes that permit them to safely perform the presented tasks, and that information is provided prior to the day of testing.

The test may be executed by a physical therapist, occupational therapist, athletic trainer, or a kinesiologist. The test items are designed to determine cardiovascular fitness, lifting capabilities, strength, balance, and hand coordination. In order to perform the test, the individual must be medically stable and have met maximum medical improvement as determined by their physician.