Care Partners and Role Reversals

Family is not an important thing. It’s everything.

Michael J Fox
Ali Elder, Sharon Krischer and
Adrienne Keener MD

In Jnuary, 2018, I had the privilege of working with two amazing young women, Adrienne Keener MD and Ali Elder PT DPT, to plan the Los Angeles Forum for the Parkinson’s Foundation’s Women and PD TALK study. The end result was the creation of the first patient-centered action agenda to maximize quality of life for women with Parkinson’s disease. We worked together again to present a follow up program, Closing the Gender Gap, on Sunday at a local hospital. The event, sponsored by the Parkinson’s Foundation and [re+active] physical therapy, presented the research agenda for Women with Parkinsons based on the findings of the study.

An interesting thing occurred. We had originally planned to present this only to women with Parkinson’s. However, a significant number of spouses and carepartners came. So we decided that while the women were doing a reflective writing exercise, we would meet with the care partners. They were so happy to have a chance to talk about their issues that it became clear that having a support system for the care partners is just as important as having a support system for the women with PD. Before we could even ask a question,they immediately started talking, looking for answers and help.

It was an interesting group. Two young men were there with their mother and did not know where to turn for information or help. They were doing the best that they could, but really did not understand what their mother needed. They came looking to learn more about Parkinson’s Disease and how they could take better care of their mother. In contrast, there was a retired doctor who was very knowledgeable about Parkinson’s, but was at a loss about the dementia that seemed to be coming more and more of a problem for his wife. Different issues, same solution. They all needed to find out where THEY could get help so that they could be better care partners.

Many of the care partners were taking copious notes and it was clear that no one had asked them what they needed before. Our planned 10 minutes turned into 20 and the discussion could have continued the rest of the afternoon. We were very happy to help them in whatever way we could.

We had been so intent on talking about what is different for Women with Parkinson’s at our program that we forgot that the issues for their care partners are different too. The only thing that we said during our presentation is that the carepartners need to make time to take care of themselves. We did not consider how watching their spouse or mother with PD slowly decline would have such a profound effect on them. Just as the women experienced the role reversal of going from being the nurturer of their parents, spouse or children, the people we spoke to were also going through a change of identity in their new role as carepartner. Many of them were not ready for this.

There is some help on the horizon. When I spoke about the Facebook group for Women with Parkinson’s called Strongher Women, as a good resource for women with PD, founder Jen Parkinson noted that she will be setting up a companion site for carepartners in the near future.

And when I got home, catching up on my neglected emails, I saw an invitation from the PMD Alliance for an event for Care Partners, Adult Children and family or friends of those with PD and PSP next month in the Los Angeles area. How serendipitous! This was exactly what is needed. Just this morning I received an email from the Parkinson’s Foundation that they will be having a webinar on Coping with Dementia for Care Partners on November 5. It just shows that once you identify a problem, the means for a solution will turn up soon.

The main message that we stated over and over throughout the program, is that no one needs to be alone when fighting Parkinson’s Disease. We are there to support each other. And that applies to the Care Partners, too.

Exercise, Exercise, Exercise

Exercise is your medicine!  Do it EVERYDAY

[re+active] physical therapy and wellness

By now, you know that I am a big fan of exercise.  It has been a daily part of my life since I was young.  Since my diagnosis with Parkinson’s, it has become not just something I enjoy, but something that I must do to keep on moving.  I am sure that many of you feel that way as well.  But for those of you who have never embarked on an exercise program, you need to speak to your Movement Disorders Specialist about how to begin.  You may think that you cannot exercise because of limited movement or pain caused by PD.  That was the prevailing theory 50 years ago.  Today,  however, we know that lack of exercise only makes things worse.  You know the old adage:  use it or lose it.

Scientists, such as Dr. Jay Alberts from the Cleveland Clinic Lerner Research Institute, have shown the benefits of forced exercise on PD.  As a result, many physical therapists and trainers work with PD patients to improve motor function using forced exercise.

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We have been told that Neuroplasticity is crucial to either change or delay the progression of PD.  And exercise is one of those activities that allows the brain to change. Exercise enables more of the dopamine in the brain to be used.  It is important to exercise outside of your comfort zone.  It increases blood flow to the brain and allows the neuroplasticity to occur.  Goal directed exercise allows for these changes in the brain to occur.  It improves the circuitry and improves the connection of the basal ganglia to the cortex.

Physical therapist, Allie Southam, from [re+active] physical therapy & wellness explained all of this in a fascinating talk last Sunday.  Briefly:

  • #1 reason for exercise:  potential to slow the progression of PD through neuroplasticiy
  • Find exercise that you love – otherwise you won’t do it
  • Goal-directed motor skill training through acquisition of skills
  • Learning a skill is hard, practice drives skill aquisition
  • Getting feedback during exercise – allows us to challenge ourselves
    and make ourselves aware ofour movements.  What used to be automatic now requires us to think about what we are doing.  It is also motivational

You can read a summary of her talk here.

Exercise for PD Handout

Tom McLaughlin, a personal trainer whose wife, Linda, has PD, has been working on a training program to improve PD symptoms.   He says that the brain is a learning machine.  Because of dopamine depletion, we have cut off the connection between the brain and our muscles.  The brain doesn’t know the connection is gone, so you have to go back and have your cognitive brain focus on motor function and motor skills.  You have to overcome the “defect” in the brain through exercise.

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Tom’s exercise program tries to activate all of the muscles, and challenge them, in order to improve neuroplasticity in the brain.  There are 16 steps to his program with the goal to work on 8 muscular functions on the top half of the body and 8 on the bottom. Those steps include working with each muscle group to move out to the side, the middle, forward and back, and to the 4 corners.   Focusing on these 16 steps will help the brain reconnect with the body to return to more normal function.

Both Allie and Tom stressed the words Focus and Learning.  To improve your PD symptoms, you must focus on your movements to make them become automatic again, and you must learn new skills to increase the neuroplasticity in your brain.

 

Some related articles:

Study: Biking Restores Brain Connectivity in Parkinson’s

Brain Connectivity

 

PT or not PT?

On Sunday, our Inspired Women with Parkinson’s in Los Angeles group met with Dr. Ali Elder of [re+active] physical therapy and wellness in Los Angeles.  Dr. Elder spoke to us about the benefits of exercise for People with Parkinson’s (PWP) and showed slides of dopamine in the brain before and after exercise.  Exercises can delay the progression of the disease and the release of dopamine in our brains can make us happier.

The bottom line:  Exercise is medicine, don’t forget your daily dose!  Exercise on a regular basis, but make sure that it is something that you enjoy.  The fact that you enjoy it is a result of the increased dopamine in your brain.  And the exercise does not have to be limited to just doing cardio on a bike.  Dancing, hiking, walking, yoga, boxing, tennis and more have been shown to not only increase our dopamine, but also our flexibility, balance and general well being.

So when and why should you see a physical therapist?  According to Dr. Elder, you should be seen immediately after diagnosis.  An assessment will help determine how the PD is affecting your gait, your reflexes, balance and much more.  Exercises can be assigned to address your issues and help to slow to the progression of the disease.  It was recommended to start with one visit to get a baseline of physical function and then the frequency of follow-ups can vary from once per week, once every six month and everything in between.

A physical therapist can also talk to you about taking your medications properly and the effects of food on your medications.  Only a few women in the room had actually gone to a physical therapist.  Most of us did not know that this was an option for us.

Finally, Dr. Elder and her assistant, Jazzy led us through a PWR!Moves workout.   PWR!Moves is a PD-specific skill training program to maintain or restore skills that deteriorate and interfere with everyday movements.  There are 4 basic exercises designed to address symptoms related to Parkinson’s. PWR!Up, PWR!Rock, PWR!Twist and  PWR!Step.  After going through different versions of each of the 4 exercises fairly confidently, we then had to walk across the room throwing a scarf in the air and catching it with the opposite hand.  Chaos ensued.  Just when you think you have figured it out, your balance is affected.  Try it and see what happens.

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Photo courtesy of PWR!