SYMPTOMS & MANAGEMENT

There are a variety of treatments available for Parkinson's. 

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Medication Treatment

Multidisciplinary Support

Surgical Intervention

Symptom Management

Conclusion

Myths about Parkinson's Disease

 

 

MEDICATION TREATMENT

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There is no cure for Parkinson's at present. Medications are used to control the symptoms of Parkinson's. There are no perfect medications, although there are many promising developments.

 

The main aim of medication treatment for Parkinson's are to:

• increase the level of dopamine that reaches the brain

• stimulate the parts of the brain where dopamine works

• block the action of other chemicals that affect dopamine

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In most newly diagnosed people considerable improvements can be achieved by careful introduction of anti-parkinsonian medications.

As Parkinson's is a very individual condition, medication is prescribed and adapted to individual needs. Response to medication varies from person to person and not every medication will be considered suitable for everyone. It is important to discuss appropriate medication or any changes in medication with your health care professional.

It is important to also maintain a healthy lifestyle, focusing on exercise, relaxation and diet.

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MULTIDISCIPLINARY SUPPORT

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Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinson’s and identify any potential difficulties, focusing on improved movement, independence and quality of life.

 

SURGICAL INTERVENTION

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Deep brain stimulation (a deep brain stimulator is placed in the brain to control tremor) is an option to treat Parkinson’s symptoms; however, it is not suitable for everyone. There are strict criteria and guidelines as to who can be a candidate for surgery, and this is something that only your doctor and you can decide.

 

SYMPTOMS & MANAGEMENT

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Mobility - Rigidity and slowness of movement are the two most frustrating aspects.  Common difficulties are:

 

Walking

• encourage to step over an object when freezing occurs

• counting while marching is helpful

• encourage arm-swinging to improve balance

 

Turning

• encourage to turn in a wide circle rather than pivoting on the spot

 

Rising from a chair

• use a high chair with arm rests

• move to the front of the chair, place feet on the floor 8 to 10 inches apart, put hands on arms of chair, lean forward and push up

• if unsuccessful rock forward and re-try

 

Turning in bed

• may need regular turning

• use Satin Sheets or P.J's (not both)

• use Tri-Turn Sheets

 

Tremor

• writing, eating and dressing may be difficult

• keep elbow pressed close to side

• use eating utensils from Occupational Therapist

• velcro tabs easier than zips and buttons

 

Eating and Drinking

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• assistance with eating may be necessary

• alter the diet if necessary

• frequent sips of cold water to prevent food sticking

• encourage coughing to prevent aspiration

• turn off TV/Wireless while concentrating on chewing and swallowing

• watch posture while eating

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Constipation - This may be a problem due to poverty of movement and slowing of bowel action, decreasing fluid intake and anticholinergics.

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• increase fluid intake

• increase exercise where possible

• discuss with Specialist Nurse/GP/Continence Nurse

 

Urinary incontinence - This may occur due to mobility (especially at night)

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• Discuss with Specialist Nurse/GP/Continence Nurse

• Continence Aids are available

 

Communication - Parkinson's affects the control of muscle co-ordination and therefore a person's ability to communicate. The symptoms of tremor, stiffness and slowness can also impact upon the person's verbal and non-verbal methods of communicating with others.

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Verbal Communication

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Speech

• approximately 50% of people with Parkinson's experience difficulties with speech

• the voice becomes softer due to a decreased ability to vocalise during exhalation

• slurring due to decreased tongue control

• difficulty initiating speech or unwanted hesitations due to akinesia

• uncontrollable repetitions of words

• speech may become monotonous and flat sounding, with no variation in the pitch and quality.

 

Management

• referral to a speech pathologist

• increase use of non verbal communication

• shorter sentences, more frequent pauses

• deep breathing and vocal exercises

• practice making sounds i.e. vowels

• don't let others talk for you

• use amplifiers etc if needed

 

Non-Verbal Communication

 

Facial expression may be

• expressionless and "mask-like" due to reduced movement

• smiling, frowning, grinning and the ability to express anger, fear and joy may require a conscious effort

• the listener may become confused and unable to respond appropriately

 

Management

• facial exercises involving the brow, eyes, cheeks and lips to increase mobility

• patience and understanding required (including family members)

 

Limb movement may be

• restricted or "frozen" therefore limited non-verbal communication

• tremor of the hands most common

 

Management

• general range of motion exercises to stretch the muscles of the limbs

• the tremor occurs at rest and decreases with purposeful movement therefore ensure the hand is doing something e.g. play with a coin, bead, or pen etc.

• arrest the tremor by immobilising the limb e.g. thumb tucked into belt, sit on hand, grab hold of structure, tuck elbow into side

 

Handwriting

• due to difficulty with fine motor movements, the handwriting may become smaller (micrographia)

• the shape of the letters remains the same but the size is smaller

• the smallness is exacerbated when writing a long paragraph compared to a short sentence, or when doing another task at the same time e.g. writing a message while on the phone

• changes may be noticed when signing cheques

• tremor can impede writing

 

Management

• if writing becomes small stop and think about what you are writing and rehearse the movement in your mind

• write only small sections at a time

• printing instead of writing may be easier

• avoid doing other tasks while writing

• use a non slip foam grip on the pen

• use other methods e.g. typewriter or computer

 

CONCLUSION

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Parkinson's can cause considerable difficulties in a person's ability to communicate with others. Speech can be affected in volume, tone, inflection and pace. Facial expression may become mask-like and limb movement restricted. Handwriting can become smaller and smaller until it is indiscernible. These problems however, can be overcome by understanding the complexities of the condition. Concentrate on every movement and one movement only. Regular exercise of everyday movements provides valuable practice and precision. Reduce stress by using relaxation and preparation. Maintain independence and dignity by refusing to allow others to speak for you.

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There are a number of factors in relation to Parkinson's Disease which can contribute to the social withdrawal of the person living with Parkinson's.  As Parkinson's is a chronic condition, the potential for these factors influencing the individual become greater over a very long period.

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MYTHS ABOUT PARKINSON'S

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The greatest factor at present which contributes to the social isolation of people with Parkinson's is their preconceived ideas or myths about the condition. Many people worry that Parkinson's will either kill them, be inherited by their children, make them totally physically incapacitated, or directly result in dementia. These of course are all untrue. Education at the time of diagnosis is vital in dispelling myths and enlisting the participation of the person and their family in the ongoing management of Parkinson's Disease.

 

Supportive counselling to allow the individual and their family the opportunity to express emotions such as anger, frustration, fear etc. within a safe environment is extremely therapeutic. Most people worry about what others will think and therefore attempt to hide their Parkinson's. Acceptance of the condition and participation in management decisions through education will encourage the person to maintain independence and optimal functioning. As well as individual education, broader public awareness campaigns and specific inservice education sessions for health providers will improve understanding of the condition and how we can lessen the stigma associated with Parkinson's Disease.

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