Small Shuffle Steps in Running World

Having small, shuffling steps are one of the signs of neurodegenerative Parkinson’s Disorder (PD). Also this condition, which is known as Parkinsonian gait, is caused by changes in posture, slow movement and also freezing.

“Gait is our manner or pattern of walking” when we walk our body is normally upright, neither leaning forwards nor backwards, with an even stride and arms swinging at the sides we will have good balance.

Parkinsonian gait is a distinctive, less steady walk. The person who has Parkinsonian gait feels, their feet dragging on the ground; freezing – feeling feet are stuck to the floor. This affects  balance and increase the risk of falling.

Our members have most of these issues. 

To  overcome Freezing

  • Change direction: if you can’t move forward, try stepping sideways and then go forward.
  • Carry a laser pointer in your pocket; when you freeze – shine the laser in front of your foot and step on the light – this cue can help you re-start.
  • Visualize an object on the ground in front of you and try to step over it.
  • Wear a metronome on your belt or carry a small one in your pocket – turn it on and the external beat can help you re-start.
  • Try humming a song and time your re-start with the beat of the music.
  • Count “1-2-3-go” and then step forward.
  • Weight shift side to side to help initiate taking a step.
  • March in place a few times and then step forward

To maintain balance

  • Keep at least one hand free at all times; try using a backpack or fanny pack to hold things rather than carrying them in your hands. Never carry objects in both hands when walking as this interferes with balance.
  • Attempt to swing both arms from front to back while walking. This may require a conscious effort if PD  has diminished your movement. 
  • Consciously lift your feet off of the ground when walking. Shuffling and dragging your feet may cause you to lose your balance.
  • Do one thing at a time! Don’t try to walk and accomplish another task.
  • Do not wear rubber or gripping soled shoes, they may “catch” on the floor and cause tripping.
  • Move slowly when changing positions. 
  • Use deliberate, concentrated movements and if needed, use a grab bar or walking aid. 
  • Count 15 seconds between each movement. For example, when rising from a seated position, wait 15 seconds after standing to begin walking.
  • If balance is a continuous problem, you may want to consider a walking aid such as a cane, walking stick, or walker. 

Once you’ve mastered walking with help, you may be ready to try it on your own again!

Occupational Therapist and Parkinson’s Disorder

What is Occupational Therapy?

Occupational therapy is the one profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability. 

Occupational Therapy for Parkinson’s Disorder  (PD) 

Occupational therapy is used to help people with PD to continue with their daily tasks as the disorder progresses. 

How can an occupational therapist help?

In PD, occupational therapist’s primary objective is to enable patients to participate in the activities of everyday life by working with them to improve their ability to engage in tasks they want to, need to, or are expected to do.

The areas where the Occupational therapist provides treatment in PD are in,

Mobility: Here the therapists help people with PD to concentrate on their walking and standing. Occupational therapists also teach patients how to change direction without abrupt turns to optimize stability. They may also check for the need of walking aids and home modifications.

Prevention of falls: The therapists aims to reduce the risk of falls in PD patients. Also they recommend  people with PD to pay full attention and to concentrate on walking and using alternative equipment when carrying items, such as diagonal shoulder bags, body belts, or trolleys.

Fatigue management: People with PD find that they become tired more quickly, which may be due to the effort of staying upright and inefficient movement strategies. occupational therapists can review routines and help prioritize tasks, restructure activities according to energy levels, and introduce regular resting periods, including good sleep.

Sit-to-stand transfers: Sit-to-stand transfers from chairs, toilets are difficult for people with PD. OT can provide appropriate strategies like equipments to aid transfers including chair risers, riser recliner armchairs, and level-access showers instead of a bath.

Bed mobility: Therapists teach movement methods for turning over in bed, adjusting a position, and getting out of bed.

Domestic skills: Meal preparations, housework, and shopping may be affected due to loss of coordination and balance, and a reduced ability to multitask. Small items of equipment may be introduced to help promote domestic skills, such as non-slip latex for easier jar opening, lever taps to reduce effort when using taps, and a wire mesh to help drain pans or vegetables. Extra assistance for housework such as ironing, maintenance tasks, and management of paperwork may be required.

Eating and drinking: Therapists can recommend good sitting posture, adequate lighting, and ways to have fewer distractions while eating and drinking. Occupational therapists also assess if modified eating and drinking equipment are required to minimize difficulties.

Handwriting: People with PD tend to have micrographia, or handwriting where letters are smaller and sloping toward page corners instead of straight across. Visual or auditory cues as well as sitting comfortably and in an upright position at a table with good lighting may help with handwriting.

Constipation and Parkinson’s Disorder (PD)

Constipation is common in Parkinson’s disease. It refers to bowel movements that are infrequent or hard to pass.

What Causes Constipation in People With PD?

In some people affected by PD, constipation may occur due to the improper functioning of the autonomic nervous system – which is responsible for regulating smooth muscle activity. If this system is not working properly, the intestinal tract may operate slowly, causing constipation.

For those taking Artane (Trihexyphenidyl) which helps to treat and prevent the muscular conditions and Cogentin (Benztropine) treats tremors in Parkinson’s disease. These medication can cause constipation as its side effects.

How Can  You Avoid Getting Constipated?

1. Drink 1½ to 2 litres of water and other fluids a day. (Note: Milk can cause constipation in some people).

2. Liquids that contain caffeine, such as coffee and soft drinks, seem to have a dehydrating effect and may need to be avoided until your bowel habits return to normal.

3. Move your bowels when you feel the urge.

How Is Constipation Treated?

1. Drink two to four extra glasses of water a day.

2. Try warm liquids, especially in the morning.

3. There is an ayurvedic tablet called ‘Kayam’. You can intake one tablet at night which has no side effects.

4. Yoga asanas are also proven to reduce the intensity of constipation

DIET & PARKINSON’S

For a neurological disorder like Parkinson’s, here is no one specific diet. That said, a healthy and balanced diet for Parkinson’s Disorder (PD) can improve the well being of the person suffering from it.

Oxidative stress ((leading to degeneration of dopaminergic neurons & ultimately leading to cell death in PD) will reduce by consuming antioxidant rich diet. Some of the antioxidants presents in vegetables , fruits and nuts.

  Antioxidants in Vegetables

  •       Lady Finger
  •       Kale
  •       Tomatoes
  •       Capsicum
  •       Spinach
  •       Fava beans ( It contains levodopa)

Antioxidants in Fruits

  • Blueberries
  • Cranberries
  • Apples
  • Grapes
  • Pears
  • Blackberries

Antioxidants in Nuts

  • Hazelnuts,
  • Pecans
  • Pistachios

Ensure to include these fruits and vegetables in daily consumption for a balanced and nutritious meal. This need not be applicable for only people affected by PD, others can enjoy and benefit from these as well! Bon Appetit!

Speech Therapy for Parkinson’s Disorder

Speech is compromised for people affected by Parkinson’s Disorder (PD). Usually voice may get softer, breathy or hoarse, causing others difficulty in hearing and comprehending. Speech may be slurred. These symptoms are caused by facial paralysis or tongue or throat muscle weakness.

As PD progresses, swallowing can become severely compromised and food/liquid can get into the lungs, causing aspiration pneumonia. Aspiration pneumonia is the leading cause of death in PD.

Lee Silverman Voice Therapy Program has demonstrated significant value for people with Parkinson’s. It uses improvement in Phonation Time, Loudness increase, Oro-motor exercises, etc.

It is a life-long commitment to approximately 15 minutes of practice per day to maintain lasting results. The key to continued success in therapeutic improvement is practice.

Parivarthan has teamed with SRM Medical College’s Audiology and Speech Language Pathology department to provide speech therapy to its members. About 15 members have opted to undergo the therapy. They were initially assessed at SRM for their problems in Speech and Swallowing. Subsequently, teachers and PG students from the Department come to Annanagar to administer the therapy on the first Saturday of every month. The programme is found to be immensely useful and one case study is given below:

Mr. T.S. Sankaranarayanan  

whatsapp-image-2019-05-23-at-11.49.02-am

1. Voice Exercises Improved Swallowing: Previously he could not swallow even medium sized capsules. Now he is able to confidently swallow medium sized capsules. (For bigger capsules, the internal contents are taken mixed with curd rice without any irritation to the esophagus, as guided by the SRM team. Previously there was irritation even if taken with water, milk, honey and curd alone)

2. There was stiffness around the mouth while speaking in the evenings. After practicing some exercises given by the therapist it is now reducing.

3. The therapy team follows-up on third Saturdays each month over telephone. This has helped him stay motivated and focused on his practice.

யோகா சிகிச்சை

பரிவர்த்தனில் (Parivarthan) , பார்கின்சன் நோயால் பாதிக்கப்பட்ட மக்களுக்கு வழக்கமாக ஒவ்வொரு வாரமும் யோகா பயிற்சி  அளிக்கிறோம்.

நபர்களுக்கு இந்த யோகா திட்டத்தை நடைமுறைப்படுத்தி, யோகா அவர்களின் நிலைப்பாட்டின் நிலைத்தன்மையை மேம்படுத்தவும், நடக்கக்கூடிய திறனை மேம்படுத்தவும், வீழ்ச்சியின் ஆபத்தை குறைக்கவும் கண்டறிந்தது.

இது மூச்சு மற்றும் மூளை மூளைகளுடன் மூச்சுத் திணறல் ஆகியவற்றுடன் ஒருங்கிணைக்கிறது. இந்த வகுப்பு, யோகா தோரணைகள் மற்றும் சுவாசம், உட்கார்ந்து, நின்று, மற்றும் படுத்த நிலைகள் ஆகியவற்றை கொண்டிருக்கும்.

தனிநபர்கள் வாரங்களுக்கு ஒரு முறை சான்றளிக்கப்பட்ட யோகா சிகிச்சையாளர்(யோக வாகினி – ஒரு சிறப்பு யோக மற்றும் பயிற்சி நிறுவனம்‌‌ , பிசண்ட் நகர்)  தலைமையில் ஒரு நபர்கு 45 நிமிடங்கள்

என வகுப்புகளில் கலந்து கொள்வார்கள்.  பின்னர் அவர்கள் அதை வீட்டில்  பயிற்சி  செய்வார்கள்.

அடுத்த வகுப்பில் கடந்த வாரத்தின் பின்னூட்டம் (Feedback) பார்த்து நபரின் தேவையை குறித்து பயிற்சியை மாற்றுவோம்.

Partner for life

In the loving words of Mr. Vasudevan, our dear member, on his wife – parter in health and sickness. 

Vasu and wife (1)

Parkinson’s changes not just the life of the affected person, but also people close to them, especially the primary caregiver, in my case my wife.  I have now been under the under the clutches of PD since past six years and have faced innumerable challenges along the way.

The most trying period since the diagnosis was in 2013-14 when I had an onslaught of medication induced skin problems which pushed PD to back seat.  Those days I was completely dependent on my beloved wife, who dedicated her entire time to me.  Apart from cooking and managing the house, she would help me get dressed, continuously apply creams on my body and ensure I had my medicines.   It is now 3 years since that terrible phase, now with the help of changed medication I am independent and have regained my strength and energy through regular exercise.

I can still never completely get over that tough phase and get emotional whenever I think about it.  Whenever I try to thank my wife or mention to others about her support during those days, she gets emotional as well.   She then would say with a smile that I would’ve done the same for her had she been affected by PD.  God forbid that ever happens.

My wife is a simple and an innocent home maker with a degree in Education and a Masters in Mathematics.  Even these days she reminds me to take medication and restricts my temptations with fried food, ice creams, and bottled drinks.  She also accompanies me for all my overnight stays, even though she personally might not enjoy them, like my college alumni meets!  She sacrifices a lot for me.

These days since I have some energy, I end up fighting a lot with her (I heard someone said so –you fight with people who are close to your heart!).

My simple admission is that I can build a temple for her equating her as a goddesses. I place her in such a high position, but have not expressed this to her.

May God give her adequate strength and courage to battle with me the rest of my PD days in my life, God only knows until when.

Support us attend World Parkinson’s Congress

Parivarthan has been offering customised yoga practice to its members since past one year.  We have seen some heartening improvements in the quality of life of our members.

Watch why Parivarthan was started – our story!

We sent an abstract of our work to the World Parkinson’s Congress. They have accepted it for poster presentation! YAY!  That means we need to be at the congress in Portland, Seattle (September 20th-24th, 2016).  We will be there with our attractive and cool poster to spread the good word of customised yoga with focus on breath!

From the congress we will bring back wealth of information from international Parkinson’s community of researchers, doctors, therapists, caregivers and community workers.  The mere thought of knowledge exchange fills us with excitement!

Support us in this endeavour!

Send in by AUGUST 5th:) 

If you live outside India send in your kindness to

Name: B Sudha Meiyappan
Bank Account: HDFC number – 12251530004345
Branch: Annanagar
SWIFT CODE: HDFCINBBCHE
IFSC CODE: HDFC0001225

If you have a PayPal account in the U.S.,
You can email it tostevehwatkins@gmail.com

If you live IN INDIA 

Name: Parivarthan for Parkinson’s Foundation
Bank: HDFC
Branch: Annanagar
Account No: 50200020565629
                    IFSC code: HDFC0001225
 OR 
You can send a cheque drawn in favour of –

Parivarthan for Parkinson’s Foundation 
P-16, 18th Street, Annanagar, Chennai – 600 040

Note: We are applying for 80G, should we get it this accounting year, you will receive 80G donation receipt. 

May your kindness sweep us off our feet!  Thank you for all the support and love.

 

Yoga and managing PD at current level

I am 74 years old and I was diagnosed with Parkinson’s Disorder (PD) almost 3 years ago.  To maintain my PD at the same level, I consulted 6 Allopathy practitioners, 2 Ayurveda practitioners and one holistic Treatment Centre.   After all this, I was still at cross roads on what steps I should take to maintain the same dosage of medicines without any adverse effects.

It was at this time that Parivarthan organized its first and one of its kind customized yoga therapy.  My yoga therapist is Ms. Lakshmy Narendra, a very committed and passionate yoga teacher.

Yoga helped me in maintaining my PD at almost the same level by lowering some of its symptoms.

Yoga has impacted me physically, mentally & emotionally in the following way –

  1. There is now more awareness and improvement in my posture.
  2. Yoga has restored my appetite to a great extent.
  • I was 69kgs at the time of diagnosis, and due to gradual drop in appetite I started losing weight at the rate of 0.4Kg per month. I was eating only 30% of my normal intake of food. It is well known that Parkinson’s disease often causes weight loss.
  • But since my yoga practice, my consumption of food has increased by 60% and my weight has stabilized at 60.5kgs.
  1. This restoration of appetite and better level of food intake has helped me in tackling the PD effect of  Constipation.

IMG-20160517-WA0018 (1)The committed therapist and student duo: Mr. T.S.Shankarnarayanan and Ms. Lakshmy Narendra 

To get complete benefits from yoga, I feel three things are most necessary.

  1. Regular practice with focus on coordinating breath and movement.
  2. Customised, i.e. one-on-one, yoga sessions as per the condition of each person. No two persons with PD will have the same symptoms.
  3. The effort and expertise of the yoga therapist is highly crucial.

My therapist Ms. Lakshmy keenly observes my practice, notes any inadequacies and makes necessary corrections.  She gives suggestions on diet and life style habits.  She is highly motivated and gives untiring demonstrations of the practice.

All these have helped me to manage PD effectively.

-T.S. Shankarnarayanan, Chennai, India

My ‘Experienced Effects’ of Yoga on PD

I share below some of my experiences in practising yoga for Parkinson Disorder:

  • Relieved me from ‘faster/frequent’ eye winking’
  • To some extent eases constipation
  • Helped me with posture correction
  • Coupled with occupational therapy, the balancing can be improved

Some basic Dos and Donts:

  • Do yoga one hour after prime medication
  • Do not rush up, but enjoy every bit and relax as required by the body
  • Speed in yoga, is not in our dictionary
  • Do not do any element of Yoga if your body does not co-operate
  • It is also true ‘if you can breathe, you can DO Yoga

Some PD members say ‘I am 70 and my age does not permit me all these activities. No, I do not agree with them.

The “starting torque” is the problem. Get over it by a clear control of inner mind, i.e sub conscious . Once you start and feel the clear gains to the body, you  can never ever stop it as it would have become a ‘habit’ by then. This is sheer experienced statement.

Start your yoga practice today and join me in my yoga experience.

– A.L.Vasudevan, Chennai, India

 

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