ROLE OF PRIMARY CARE PHYSICIAN IN TREATING PARKINSON’S DISEASE

Non-contact boxing inspired classes can delay, reduce, and even reverse the symptoms of Parkinsons Disease.We are learning every day that there are ways in which people with Parkinsons disease can enhance their quality of life and even build strength, flexibility and speed! By exercising with coaches who know the ropes, you can fight your way out of the corner and start to feel and function better.These classes have proven that anyone, at any level of Parkinsons, can actually lessen their symptoms and lead a healthier and happier life.Why Boxing for Parkinsons?Various studies in the 1980s and 1990s supported the notion that rigorous exercise, emphasizing gross motor movement, balance, core strength, and rhythm, could favorably impact range of motion, flexibility, posture, gait, and activities of daily living. More recent studies, most notably at Cleveland Clinic, focus on the concept of intense forced exercise, and have begun to suggest that certain kinds of exercise may be neuro-protective, i.e., actually slowing disease progression. Discovery of a cure may be many years away but there is evidence that progress is made in all stages of the disease by those participating in the Rock Steady Boxing program.The Parkinsons ChallengeParkinsons disease is a degenerative movement disorder which can cause deterioration of motor skills, balance, speech and sensory function. Rock Steady Boxing is the first program in the country dedicated to the fight against Parkinsons. In our program, exercises are largely adapted from boxing drills. Boxers condition for optimal agility, speed, muscular endurance, accuracy, hand-eye coordination, footwork and overall strength to defend against and overcome opponents. At Rock Steady Boxing, Parkinsons disease is the opponent. Exercises vary in purpose and form but share one common trait: they are rigorous and intended to extend the perceived capabilities of the participant.Types of Rock Steady Boxing ClassesTraining classes include an exercise program that attacks Parkinsons at its vulnerable neurological points. While focusing on overall fitness, workouts include: focus mitts, heavy bags, speed bags, double-ended bags, water bags, core work, cognitive activities, voice activation and circuit weight training. No boxing experience is necessary and people of all ages are invited to participate. There are four levels of classes offered, depending on the participants level or Parkinsons and overall fitness. All classes at Rock Steady Boxing SRQ are mixed-level at this time.Medical Evidence Supporting Rock Steady BoxingThe value of exercise has been corroborated in several studies, including some at Lakehead University in Ontario and University of Utah in Salt Lake City. According to a Cleveland Clinic study, aerobic fitness can be improved in Parkinsons patients following forced and/or voluntary exercise. Studies are showing that exercise induces brain repair and accompanying behavioral recovery. Some suggest that continuous, intensive training may confer neuro-protection, and subsequently, slow, stop or reverse the progression of Parkinsons or promote neuro-restoration. (References to any studies are for informational purposes only and do not imply endorsement of Rock Steady Boxing by the researchers.)Because of the promising results seen through Rock Steady Boxing, the organization was selected to be a part of research to document the impact of boxing and rigorous exercise on the progression of Parkinsons. Rock Steady Boxing has also drawn the attention of university researchers who are in the process of quantifying and evaluating the results in people who have continued with Rock Steady Boxing.Can Anyone with Parkinsons Participate?Nearly everyone with Parkinsons disease can participate and receive benefit from Rock Steady Boxing. An intake evaluation process is conducted prior to the first class to determine the boxers ability and evaluate balance risks. Some participants will require a caregiver partner to assist in class. Individuals of all ages are benefiting from the Rock Steady Boxing program.We strongly encourage you to discuss Rock Steady Boxing participation with your physician prior to your first workout.Rock Steady SRQ Class FormatOur typical class has the following format:Warm-up including voice activation. We warm up our bodies and voices together.Glove up while coach Leslie goes through the boxing combos for the day.Go to bags and start punching. We normally stay at each bag for four rounds, consisting of two punching and two body-weight exercise rounds.Take off gloves, get some water and rest a few minutes.Strength workout consisting of gross motor movements, balance, cardio and core work with a fun station or two mixed in!We end class down on the floor with stretching and a short meditation for the last 15 minutes of class.Circle up together for our cheesy cheer and head out the door.Rock Steady Boxing HistoryRock Steady Boxing, the first boxing program of its kind in the country, was founded in 2006 by former Marion County (Indiana) Prosecutor, Scott C. Newman, who is living with Parkinsons. Rock Steady Boxing initially began through the friendship of two men, Scott Newman and Vince Perez, after Scott had been diagnosed with early-onset Parkinsons at the age of 40. Refusing to let his friend go down without a fight, Vince turned to his experience as a Golden Gloves boxer to design a program that attacks Parkinsons at its vulnerable neurological points. His intuitive insight is now proven to have merit through an increasing body of medical research. Realizing that their experience might be replicated for others, Scott and Vince founded Rock Steady Boxing as a 501 (c)(3) nonprofit organization. As word of this unique program spread and the demand for the classes increased, Rock Steady Boxing created classes to meet the fitness levels at all stages of Parkinsons from the newly diagnosed to those who had been living with it for decades plus.

Parkinsons: What do I need to know?April is Parkinsons Awareness month, with April 11 being World Parkinsons Day.  Parkinsons is a type of dementia that impacts motor function and is degenerative.  Currently there is still no known cure for Parkinsons disease.   What is Parkinsons disease?According to the International Parkinson and Movement Disorder Society (movementdisorders.org), Parkinsons disease is a neurogenerative disorder characterized primarily by the loss of dopamine neurons in the substantia nigra part of the brain. SymptomsGenerally, symptoms develop on one side slowly over years, but the progression may differ due to the diversity of the disease.  People with PD may experience the following:   tremor, mainly at rest (described as pill rolling tremor in hands  bradykinesia  limb rigidity  gait and balance problems.Non-motor symptomsCommon Neuropsychiatric symptoms are:   mood disturbances  cognitive changes  autonomic dysfunction  pain  sleep issues  anxiety  apathyPrevalence is approx. 200 cases in 100K population, and about 25 cases per 100,000 population.  When motor manifestations appear, people with PD have lost more than 50% of nigral dopamine cells suggesting that pathological changes may begin several decades before the appearance of clinical signs.  Causes of Parkinsons diseaseIt is believed that Parkinsons disease is multifactorial. Contributing factors are:  Hereditary predisposition  Environmental toxins  Aging  Genetic mutations (GBA, LRRK2, PRKN, SNCA)DiagnosisDiagnosis is still clinical and based on motor manifestations.  A brain MRI or CT and molecular imaging of the striatum may be performed to support clinical evaluation.TreatmentLevodopa has remained the cornerstone of PD treatment for more than 50 years.  The challenge is after a few years of treatment the benefit lessons and motor complications appear in many patients due to disease progression.  The introduction of many other medications including inhibitors and dopamine agonists have been developed due to this decline.  More recently, surgical and infusion therapies have become available to improve management in selective patients with motor complications. Surgery options include:  deep brain stimulation.  drug infusions based on the possibility to deliver continuously either levodopa or apomorphine.Treatment noted is based on research according to Marcello Merello, MD Director of Neuroscience Dept. Head Movement Disorders Section Institute for Neurological Research Raul Carrea (FLENI) 2019 Updated by Angelo Antonini, MD, PhD Professor, Department of Neuroscience University of Padula, Italy.Parkinsonism (movementdisorders.org)A defining feature of Parkinsonism is bradykinesia (slowness with decrement and degradation of repetitive movements (Fatigue). Subtle bradykinesia is known to occur in the normal elderly population. The most common neuro degenerative cause of parkinsonism is Parkinsons disease.  Other causes include multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration.  Often called Parkinson-plus syndromes, they do not respond as well to dopaminergic treatments and generally have worse prognosis compared to typical PD. Parkinsonism can also be symptomatic because of various vascular drug related, infectious, toxic, structural, and other known secondary causes.  Vascular Parkinsonism tends to have a lower body emphasis with gait disturbance and concomitant cognitive impairment.Where to get helpWe are fortunate to have a Dallas Area Parkinsons Society (DAPS).  The DAPS provides not only information, but also hosts exercise groups and activities throughout the metroplex.  Several churches and senior centers also host Parkinson support groups and wellness classes. Dallas Area Parkinson Society | Home (daps.org)Parkinson's Disease Support Groups (verywellhealth.com)  American Parkinson Disease Association  DailyStrength Parkinsons Disease Support Group  Parkinsons Foundation  PatientsLikeMe  Parkinsons Movement Disorder and Alliance  Parkinsons Community  NeuroTalkAdult Day Cares and Assisted Living Communities often provide respite services for those with Parkinsons or other conditions requiring activities of daily living (ADL) care support.How can I help?The Michael J Fox organization provides free scratch and sniff tests that help researchers learn more about Parkinsons risks and contribute to research on the disease. (michaeljfox.org)Regardless of if you are reading this because you or a loved one has been impacted by Parkinsons disease or if you are just wanting to learn more, we hope that you are able to get the support you need and/or find ways to help cope Britt Hemsell  Ruby Care Senior Living Advisor & Blog ContributorResources:International and Movement Disorder Society https://www.movementdisorders.org7 Parkinson's Disease Support Groups of 2023 (verywellhealth.com)American Parkinson Disease Association  https://www.apdaparkinson.org/community/Dallas Area Parkinson Society | Home (daps.org)Some Adult Day Cares in DFW:  Friends Place Adult Day Care Richardson 972-437-2940

April is Parkinsons Awareness Month. The second most common neuro-degenerative disease in the country behind Alzheimers, Parkinsons disease affects millions of Americans. While there is no cure, it is possible to live a full life with the disease.Commonly known for its movement or motor-related symptoms, such as tremors, abnormally slow movements, shaking, lack of facial expression, involuntary movements or freezing, Parkinsons disease also has non-motor symptoms like apathy, depression, sleep behavior disorders, loss of sense of smell and cognitive impairment.One of the most difficult aspects of dealing with Parkinsons is that everyones disease progresses differently. Symptoms can develop slowly over years and the order in which they appear can vary from person to person. That often makes it hard to diagnose, which can be very frustrating. Symptoms to be aware of include slowness of movement and rigidity; difficulty with balance, swallowing, chewing, and speaking; cognitive impairment and dementia; and mood disorders.The good news is that there are ways to slow the progression of Parkinsons and preserve a high quality of life. As a gerontologist someone who specializes in aging and owner of a non-medical homecare company, Ive made it a point to help spread awareness of Parkinsons and share ways to help people with Parkinsons. SYNERGY Homecare has an educational partnership with the Parkinsons Foundation and we are fortunate to have access to tremendous information and resources.One of the most important things to know is that exercise and activity are key. According to the Parkinsons Outcomes Project, the largest clinical study of Parkinsons disease through the foundations Centers of Excellence network, increasing physical activity to at least 2.5 hours a week can help slow decline in quality of life.People living with Parkinsons disease should also keep up with their therapy regiments. Caregivers can help them stick to prescribed physical therapy exercises, occupational therapy, recommended daily living modifications and speech exercises. This can include gait and balance training, resistance training and regular exercise.Having a physical as well as emotional support system can make a huge difference for people with Parkinsons. In the early stages of Parkinsons, people typically require emotional support more than anything else as they get a handle on having a progressive disease.In order to preserve a high quality of life, its important to let someone with Parkinsons disease maintain their independence for as long as possible. As the disease progresses, some activities of daily living, such as dressing, eating and bathing, may require workarounds and there are multiple ideas and suggestions for adaptations on the Parkinsons Foundations website such as:Movement Tremors can make walking difficult Take care of the home, clear things off the floors, arrange furniture in a way that promotes easy access and safety Encourage doctor recommended exercises as well as facial exercises Activities like singing, dancing, or reading aloudBasic grooming Daily hygiene is greatly affected by hand tremors Opt for an electric toothbrush over a manual one Opt for an electric razor over a manual one If balance is off, try sitting down while brushing or shaving.Bathing Stand-in showers are much easier to access than tubs Shower stools also help, especially when unsteadyDressing Opt for clothes that are easier to put on Elastic waistbands Velcro Dress the side most affected first Avoid button-ups and lacesEnsuring a high quality of life with Parkinsons is possible thanks to a complementary approach that includes medications, regular activity and modifications for activities of daily living. If you have any questions, please call Synergy HomeCare - Boulder at 303-465-4663.