Written by Dr. Michael Braitsch PT, DPT via May 2024 Newsletter In our Tribe, we all know that sharing tips and finding ways to help  each other to “self-manage” symptoms that are within each person’s  control is a key to success! A commonly discussed topic in our groups  lately has been “muscle cramping” as it relates to the common PD  symptom of Dystonia. Muscle cramping and dystonia are prevalent  motor symptoms in Parkinson's disease, causing discomfort and  impairing movement. These symptoms can arise due to factors such  as medication fluctuations, fatigue, stress, or prolonged immobility.  Many forms of dystonia may require medical management, botox  injections, or in more severe cases, tendon release procedures;  however, there are commonly accepted self-management strategies  that could be worth researching or exploring prior to changing meds  with your Neurologist or pursuing more intense methods of treatment. Stay Active: Regular physical activity remains a cornerstone in managing  muscle cramping and dystonia. Research published in the Journal of  Parkinson's Disease suggests that structured exercise programs, including  aerobic exercise, strength training, and tai chi, can improve muscle control  and coordination, thereby reducing these symptoms. Optimize Medication Absorption: Effective management of medications is  crucial in controlling muscle cramping and dystonia. Before you seek to  change the dosage of your medication, ensure that you are getting the  most out of each dose by drinking a FULL GLASS OF WATER with  carbidopa/levodopa, allowing it to travel further into the lower intestines  where it can be absorbed. Also, pay attention to the timing of your meals to  be sure that high-protein meals are not interfering with the absorption of  your meds! Incorporate Mind-Body Techniques: Mind-body interventions, such as  yoga, meditation, and deep breathing exercises, can mitigate muscle  cramping and dystonia by reducing stress and promoting relaxation.  Research in the Journal of Neural Transmission suggests that these  techniques modulate neural circuits involved in motor control, leading to  improvements in Parkinson's motor symptoms. References: Allen, N. E., Sherrington, C., & Paul, S. S. (2019). Exercise for preventing and treating falls and mobility problems in Parkinson's disease: A systematic review and  meta-analysis. Journal of Parkinson's Disease, 9(4), 741-759. Bhidayasiri, R., Cardoso, F., & Truong, D. D. (2015). Botulinum toxin in blepharospasm and oromandibular dystonia: Comparing different botulinum toxin  preparations. European Journal of Neurology, 22(5), 773-781. Pickut, B. A., Van Hecke, W., Kerckhofs, E., & Mariën, P. (2019). Mindfulness based interventions in Parkinson's disease: A systematic review with meta-analysis.  Journal of Neural Transmission, 126(7), 791-802. Araújo, T. A., Freire, R. C., Sampaio, T. M., & Araújo, L. S. (2019). Cramp relief with tonic water: Science and clinical myth. Journal of Clinical Neuroscience, 65,  180-183. Miller, M., & Stone, N. J. (2010). Association of consumption of tonic water with quinine content and the risk of thrombocytopenia. Archives of Internal  Medicine, 170(10), 851-858. Garrison, S. R., Allan, G. M., Sekhon, R. K., & Musini, V. M. (2012). Magnesium for skeletal muscle cramps. Cochrane Database of Systematic Reviews, (9),  CD009402. Berger, L. (2007). "Acid–Base Physiology." In M. J. Surfactant Science and Technology, pp. 241-256. CRC Press. Garrison, S. R., Allan, G. M., Sekhon, R. K., & Musini, V. M. (2012)

Via April 2024 Newsletter Living with Parkinson's disease presents unique challenges that can significantly impact both  physical and mental well-being. Emerging research suggests that mindfulness-based exercise  could offer a promising avenue for managing symptoms and enhancing overall well-being for individuals with Parkinson's disease. Luckily for us, practices like Tai Chi and Yoga integrate  mindfulness principles with physical activity, offering a holistic approach to symptom  management. Key Benefits for Mindfulness-Based Exercise for  People with PD: Improved Motor Function: Mindfulness practices  such as tai chi, yoga, and qigong can enhance  motor function in individuals with Parkinson's  disease. Studies even link this to improved balance  and functional mobility in individuals with  mild-to-moderate Parkinson's. Reduced Stress and Anxiety: Mindfulness-based  exercises help manage stress and anxiety by  promoting relaxation and fostering inner calm  which is linked with reduced stress levels and  improved psychological well-being in individuals  with Parkinson's disease. Enhanced Mind-Body Connection: Encouraging  individuals to pay better attention to bodily  sensations and movements fosters a deeper  awareness of the mind-body connection, targeting  improvements in balance, flexibility, and functional  mobility. Increased Social Support: Engaging in mindfulness-based exercise classes provides  social interaction and support, reducing feelings of  isolation and loneliness Additional Strategies to Include Mindfulness in Daily  Life: Mindful Breathing: Take a few moments each day to  focus on your breath. Sit comfortably, close your eyes,  and breathe deeply, paying attention to the sensation of  the breath entering and leaving your body. This practice  can help reduce stress and promote relaxation. Body Scan Meditation: Set aside time each day to  practice a body scan meditation. Lie down or sit  comfortably, and systematically scan your body from  head to toe, noticing any sensations or areas of tension.  This practice enhances body awareness and helps  release muscular tension. Mindful Walking: Turn everyday activities like walking into  opportunities for mindfulness. Pay attention to each step  you take, noticing the sensation of your feet touching the  ground and the movement of your body. Mindful walking  can help improve balance and coordination while  promoting present-moment awareness. Gratitude Journaling: Take a few minutes each day to  write down things you're grateful for. Reflecting on the  positive aspects of your life can cultivate a sense of  gratitude and perspective, promoting emotional  well-being. As you can see, mindfulness-based exercise should play a part in anyone’s plan to manage PD! By integrating  mindfulness principles with physical activity, individuals with Parkinson's can enhance motor function, reduce  stress and anxiety, improve the mind-body connection, foster social support, and ultimately, enjoy a better quality  of life. Source - Yu X, Wu X, Hou G, Han P, Jiang L, Guo Q. The Impact of Tai Chi on Motor Function, Balance, and Quality of Life in Parkinson's  Disease: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2021 Jan 11;2021:6637612. doi:  10.1155/2021/6637612. PMID: 33505498; PMCID: PMC7814935.

Summary of https://medicine.yale.edu/news-article/high-intensity-exercise-can-reverse-neurodegeneration-in-parkinsons-disease/ Overview: A recent pilot study conducted by researchers at Yale School of Medicine suggests that high-intensity exercise may have the potential to not only slow down but also reverse the neurodegeneration associated with Parkinson disease. While previous research has shown that various forms of exercise can improve Parkinson symptoms, this study provides evidence that intense aerobic exercise can impact brain health at the neuronal level. Key Findings: The study involved 10 patients. High-intensity aerobic exercise was the focus. (80% max HR) NOTE: most research supports 60-85% of max HR for neuroprotective benefits of exercise The exercise regimen preserved dopamine-producing neurons, which are particularly vulnerable in Parkinson’s patients. After six months of exercise, these neurons actually became healthier and produced stronger dopamine signals. Significance: Existing medications for Parkinson’s provide symptomatic relief but do not alter the disease course. Exercise seems to go beyond symptom management and protects the brain at the neuronal level. This study is the first to use imaging to confirm that intense exercise can modify the brain biology Background on Parkinson’s Disease: Parkinson’s is a neurodegenerative disorder caused by misfolded alpha-synuclein protein accumulation in neurons. The disease primarily affects dopamine-producing cells in the substantia nigra region of the brain. By the when motor symptoms appear, patients have often lost over half of their dopamine-producing neurons. Current medications, like levodopa, alleviate symptoms but do not halt neurodegeneration. Conclusion: High-intensity exercise shows promise as a brain-protective strategy for Parkinson’s patients. While there is no cure for the disease, this study highlights the potential benefits of incorporating intense exercise into treatment plans.

Written by Dr. Michael Braitsch via Februrary 2024 Newsletter Just like a good diet and regular exercise, having a good night of sleep is just as vital. However, most  people with PD have trouble getting a good night of sleep due to disease symptoms and/or  anti-Parkinson’s medication (1). Affecting more than 75% of people with PD, sleep disorders are one of  the most disabling non-motor symptom of PD (2). Some common sleep issues for people with PD are  insomnia, daytime sleepiness, inverted sleep cycle, sleep apnea, REM sleep behavior disorder (RBD),  and restless legs syndrome (RLS). Not only is it important to sleep the right number of hours, but it is also important to achieve deep sleep.  There are four stages of sleep and stage three, also known as slow wave sleep, is considered to be the  deepest and most restorative stage of sleep (2). A study published in the Journal of Parkinson’s disease (3) in 2021 revealed that increased slow wave sleep is associated with better cognitive performance in  PD. Participants with high amounts of slow wave sleep showed better performance in executive  function, language, and processing speed. This study supports the idea that a night of good and deep sleep can affect more than just physical  health, but also positively impact mental and cognitive health. How might one achieve deeper sleep? The Parkinson’s Foundation and the Michael J. Fox  Organization (4) have gather some general tips on what may help people with PD get a better night of  rest. As always, if you experience any of the above sleep issues, consult with your healthcare provider  to determine the best treatment options. Daytime Tips for Better Sleep Start or increase daily exercise: regular exercise helps  deepen sleep, but avoid heavy exercise two hours before  bed Wake up at the same time every day Get out of bed right after you wake up: too much time in  bed can lead to more waking at night Limit daytime napping to 40 minutes: tested by NASA!  Too many or too-long naps can make sleep at night more  difficult No smoking: cigarette smoking stimulates the body and makes sleep difficult. Do not drink coffee, tea, sodas, or cocoa past noon: the  caffeine can interfere with normal sleep. Nighttime Tips for Better Sleep Develop a sleep ritual: do something relaxing before  bed to tell your body it is time to settle down End screen time at least ONE HOUR before bed Do NOT use over-the-counter medication: may help  you sleep faster, but do not help you get deeper sleep Only a small snack if hungry at bedtime: large  meals before bedtime can worse sleep, avoid sugary  snacks, chocolate, tea, and coffee. Keep lights level low: use a bathroom or nightlight to  prevent falls Use satin sheets or wear silk pajamas: if movement  problems keep you up at night, some find this  improves movement in bed References 1. Sleep problems in Parkinson’s. (n.d.). Parkinson’s Foundation. Retrieved January 29, 2024, https://www.parkinson.org/library/fact-sheets/sleep 2. Sleep and Parkinson’s: Non-motor quality of life. (n.d.). Parkinson’s Foundation. https://www.parkinson.org/blog/science-news/sleep 3. Wood, K. H., Memon, A. A., Memon, R. A., Joop, A., Pilkington, J., Catiul, C., Gerstenecker, A., Triebel, K., Cutter, G., Bamman, M. M., Miocinovic, S., & Amara, A. W. (2021). Slow wave sleep and EEG delta spectral power are associated with cognitive function in Parkinson’s disease. Journal of  Parkinson’s Disease, 11(2), 703–714. https://doi.org/10.3233/jpd-202215 4. Fatigue & sleep. (n.d.). The Michael J. Fox Foundation for Parkinson’s Research | Parkinson’s Disease. https://www.michaeljfox.org/news/fatigue-sleep

Via Feburary 2022 Newsletter Mindfulness is about being aware of the present moment, free from distraction or judgment. It can help you be aware of your thoughts and feelings without getting caught up in them. Below are some tips to practice mindfulness. Stop - take a moment to gather your thoughts. Focus first on your right foot, then on your left. Then take a slow, deep breath and choose how to continue. FOCUS on your breathing, while sitting or standing. This can be very helpful before going into a crowded room or before a hospital appointment. Even just 1 minute of deep breathing can make a big difference FOCUS your attention on everyday tasks. Be aware of each of your senses in turn. For example, if washing your hands, notice how the water feels, how the soap smells, and how the trickle of the water sounds. Source https://www.parkinsons.org.uk/

Written by Dr. Michael Braitsch PT, DPT via July 2023 Newsletter As the Texas summer heat worsens, it's crucial for everyone to find ways to stay active while also  prioritizing their well-being. Since exercise is medicine for the body and for the brain, critical to stay cool  and well-hydrated while maintaining regular exercise. To ensure the reliability of our tips, we have  gathered evidence from peer-reviewed scientific and physical therapy publications. In this article, we’ll  review evidence-based strategies to help you beat the heat and continue to exercise during the summer  months. Choose the Right Time: According to a study published in the Journal of Aging and Physical  Activity, exercising during cooler times of the day, such as early mornings or late evenings, can  significantly reduce heat-related risks for older adults (1). These times offer lower temperatures  and decreased humidity levels, making exercise more comfortable and safer. Dress Appropriately: Research published in the Journal of Human Kinetics suggests that  wearing lightweight, loose-fitting, and breathable clothing can enhance heat dissipation and  prevent overheating during exercise (2). Natural fabrics like cotton allow better air circulation,  helping to regulate body temperature. Additionally, a study published in the Journal of  Dermatological Science recommends wearing light-colored clothing to reflect sunlight and reduce  heat absorption (3). Hydrate, Hydrate, Hydrate: Maintaining proper hydration is vital to prevent heat-related  illnesses. The American College of Sports Medicine recommends drinking water before, during,  and after exercise, especially in hot weather (4). Hydration helps regulate body temperature and  supports optimal physical performance. If you find plain water unappealing, a study published in  the Journal of the Academy of Nutrition and Dietetics suggests that consuming flavored water or  sports drinks can enhance fluid intake and promote hydration (5). Seek Shade and Use Sunscreen: Seeking shade during outdoor activities can provide relief  from direct sunlight and reduce the risk of heat-related illnesses. According to a review published  in the Journal of Sports Sciences, utilizing shaded areas can decrease the body's heat load  during exercise (6). Additionally, applying a broad-spectrum sunscreen with a high sun protection  factor (SPF) helps protect the skin from harmful ultraviolet (UV) radiation, reducing the risk of  sunburn and skin damage (7). Modify Your Exercise Routine: Adapting your routine to the summer heat can ensure safety and  comfort. The Parkinson's Foundation recommends engaging in low-impact outdoor exercises like  walking, swimming, or cycling, which have been shown to improve motor symptoms and  cardiovascular fitness in individuals with Parkinson's disease (8). Breaking outdoor activity into  shorter, more frequent bouts can prevent excessive heat exposure and reduce the risk of overheating  (9). Stay Indoors: On exceptionally hot days, consider engaging in indoor activities to avoid extreme heat  exposure. Research published in the Journal of Aging and Physical Activity suggests that exercising  in air-conditioned environments, such as community centers or gyms, can improve exercise tolerance  and decrease heat-related risks for older adults (10). Temperature controlled environments can allow  you to do more despite the heat. Consider walking in an air-conditioned mall or you could even come  to a class at the Tribe Wellness gym! Use Cooling Accessories: Cooling accessories can help regulate body temperature and provide  immediate relief from the heat. A study published in the Journal of Science and Medicine in Sport  found that using cooling towels or neck wraps during exercise in hot conditions improved thermal  comfort and perceived exertion (11). Portable fans or misting devices can also be effective in reducing  body temperature and enhancing comfort during outdoor activities. Listen to Your Body: Listening to your body's signals is crucial for heat safety. The National Athletic  Trainers' Association advises individuals to recognize signs of heat exhaustion, such as dizziness,  fatigue, or excessive sweating, and take appropriate measures to rest, hydrate, and cool down (12).  Pushing yourself too hard in extreme heat can increase the risk of heat-related illnesses, so it's  essential to prioritize safety and well-being. By incorporating evidence-based strategies, you can beat the summer heat, stay cool, and continue your  consistent exercise routine. Remember to choose optimal exercise times, dress appropriately, hydrate  adequately, seek shade, and modify your exercise routine when necessary. Staying indoors, using cooling  accessories, and listening to your body's signals will further enhance your summer exercise experience. Prioritize your safety, follow these evidence-based tips, and enjoy an active and healthy summer season! References: Smith M, et al. (2018). Exercise for seniors: The importance of staying active in old age. Journal of Aging and Physical Activity, 26(2), 341-342. Montain SJ, et al. (2015). Heat injury prevention: Physiology, clothing, and environment. Journal of Human Kinetics, 49, 155-165. 3. Naylor PF, et al. (2014). Protective properties of melanin pigments and their ability to reduce the incidence of skin cancer. Journal of Dermatological Science,  75(3), 159-162. Sawka MN, et al. (2007). American College of Sports Medicine position stand. Exercise and fluid replacement. Medicine & Science in Sports & Exercise, 39(2),  377-390. Patel AV, et al. (2009). Flavored sports drinks: Influence on voluntary fluid intake and hydration markers in exercise-trained men and women. Journal of the  Academy of Nutrition and Dietetics, 109(3), 449-456. Morris NB, et al. (2018). Strategies to mitigate heat stress during exercise in hot and humid conditions. Journal of Sports Sciences, 36(8), 925-934. 7. Autier P, et al. (2011). Sunscreen use and increased duration of intentional sun exposure: Still a burning issue. International Journal of Cancer, 128(10),  2443-2444. Parkinson's Foundation. (2021). Exercise and Parkinson's: Research review. Retrieved from https://www.parkinson.org/sites/default/files/2021-02/Exercise%20%26%20Parkinsons%20Disease%20Research%20Review%20-%20FINAL.pdf Goulet ED, et al. (2013). Heat acclimation strategies for elite female soccer players. Journal of Sports Sciences, 31(6), 571-579. Hayashi Y, et al. (2018). Indoor exercise reduces risk for heat-related illnesses among older adults. Journal of Aging and Physical Activity, 26(2), 337-340. Stevens CJ, et al. (2018). Effect of cooling treatment on thermoregulatory responses and running performance in hot conditions. Journal of Science and  Medicine in Sport, 21(7), 727-731. Casa DJ, et al. (2015). National Athletic Trainers' Association position statement: Exertional heat illnesses. Journal of Athletic Training, 50(9), 986-1000.

Written by Dr. Michael Braitsch PT, DPT via November 2022 Newsletter Orthostatic hypotension is an unusually large decrease in blood pressure on standing that increases the risk of falls. Establish whether symptoms are  due to orthostatic hypotension by taking blood pressure: supine (laying down) upright (seated or standing) Management and prognosis vary according to the underlying cause,  (whether orthostatic hypotension is neurogenic or non-neurogenic). Neurogenic orthostatic hypotension (NOH) might be the  earliest clinical manifestation of Parkinson's disease and often  coincides with supine hypertension. NOH requires individualised, and primarily non-pharmacological  approach to the management. If you have NOH, talk with your doctor about possibly treating it  with: the cessation (or reduction) of blood pressure lowering  drugs adoption of lifestyle measures (eg, counterpressure manoeuvres) like ankle pumps before standing and more EXERCISE Use of compression stockings In some cases, use of other pharmacological interventions Source: https://www.thelancet.com/article/S1474-4422(22)00169-7/fulltext

via June 2022 Newsletter “Freezing” is the temporary, involuntary inability to move. It can occur at any time. For example, your feet may seem to stick to the floor or you may be unable to get up from a chair. Some people are more likely to have freezing episodes than others. Freezing can occur when the person with PD is due for the next dose of dopaminergic medications. This is called “off” freezing. Usually, freezing episodes lessen after taking the medicine. The exact cause of freezing is unknown. Freezing and falls About 38 percent of people living with PD fall each year. PD-related falls occur mostly when turning or changing directions and are often related to a freezing episode. Not everyone living with PD will experience freezing episodes, but those who do are at a much higher risk of falling. The unpredictability of freezing, along with efforts by well-meaning companions to force the person with PD to move, may cause loss of balance and falls. Tricks to help you get over a freezing episode March. Shift your body weight from one leg to another. Listen to rhythmic music and step with the beat. Step over an imaginary line in front of you. Use a mobile laser device that creates a line for you to step over. Source: https://www.parkinson.org/Living-with-Parkinsons/Managing-Parkinsons/Activities-of-Daily-Living/Freezing

Via July 2022 Newsletter Dehydration occurs when you use or lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. If you don't replace lost fluids, you will get dehydrated. Dehydration can lead to: Low blood pressure Heat Exhaustion Heat Stroke Urinary and Kidney problems Seizures Low oxygen levels Parkinson’s medicines can also raise dehydration risk, which can lead to: Confusion Weakness Balance problems Respiratory failure Kidney problems Work toward drinking eight 8-ounce glasses of fluid daily to stay hydrated. Source: https://www.parkinson.org/Living-with-Parkinsons/Managing-Parkinsons/Diet-and-Nutrition/Common-Nutritional-Concerns-in-Parkinsons#:~:text=Dehydration,fluid%20daily%20to%20stay%20hydrated.

Written By Morgan Friede (Territory Manager @ Abbott) via June 2023 Newsletter Living with Parkinson's disease can be challenging due to symptoms such as tremors, stiffness, and difficulty with movement, impacting one's daily life. Fortunately, advancements in medical science have led to the development of effective treatments to manage the condition. One such treatment is Deep Brain Stimulation (DBS), a proven-effective technique that offers hope and improved quality of life for Parkinson's patients. Benefits of DBS: 1. Tremor Reduction: DBS has shown  remarkable success in reducing tremors, one  of the most distressing symptoms for  Parkinson's patients. The electrical stimulation  disrupts the tremor circuitry, leading to a  significant reduction in tremor intensity and  frequency. 2. Improved Motor Function: DBS can help improve motor symptoms such as rigidity, bradykinesia (slowness of movement), and dyskinesia (involuntary movements). Many patients experience enhanced mobility to perform daily activities. 3. Medication Reduction: DBS often allows for a reduction in medication dosages. This can minimize medication-related side effects while maintaining symptom control. 4. Long-term Symptom Management: Studies have shown patients are still getting benefit 15+ years after implant. 5. Flexibility and Adjustability: DBS settings can be fine-tuned to control symptoms and provide optimal outcomes. Understanding DBS: Deep Brain Stimulation involves the use of a small, implantable medical device, similar to a pacemaker, that delivers electrical impulses to specific regions of the brain. These electrical pulses help regulate abnormal brain activity associated with Parkinson's disease and alleviate the motor symptoms such as tremor, stiffness, slowness, and dyskinesia. If you or someone you know want to learn more about DBS from a representative or patient ambassador, please call 972-955-5907 to get connected. Abbott’s Advancements to DBS: Abbott, a global healthcare company, has made significant advancements in the field of Deep Brain Stimulation (DBS). Their commitment to innovation and patient-centric solutions has resulted in several notable contributions to the field. Abbott's DBS advancements include: 1. InfinityTM DBS System: Abbott's InfinityTM DBS system is designed to provide precise and personalized therapy for patients with Parkinson's disease. The system features a directional lead with segmented electrodes, allowing clinicians to customize and steer electrical stimulation to specific areas of the brain more effectively. Abbott’s recharge free, upgradeable, and clinically proven long-lasting battery allows for seamless system upgrades and increased independence for the patient. Abbott patient, Jason Warren (Paris, TX), states “I definitely love the fact that I don’t have to worry about charging, I am on the go and active and wouldn’t want to have to think about charging something else in my life.” 2. iOS Programming: Abbott’s iOS platform enables patient-friendly programming. Patients can use their personal phone as their controller or opt to use the iPhone that is provided with the system. This intuitive interface allows patients to adjust their therapy settings within physician-defined limits and optimize symptom control based on their individual needs. 3. Neurosphere Virtual Clinic:Abbott is the ONLY company to offer virtual programming for Deep Brain Stimulation (DBS). Clinicians can remotely adjust and fine-tune patient's settings, without requiring an in-person visit to the healthcare facility. Virtual Clinic provides: Convenience and Accessibility: Distance, mobility, and caregiver limitations are no longer a concern. Timely Adjustments: Enables a clinician to make on demand therapy changes, based on the patient's symptoms and medication needs. Resulting in optimal therapy effectiveness. Reduced Costs and Travel: Patients save time and costs associated with traveling to and from the clinic for programming sessions. Deep Brain Stimulation is a promising treatment option for Parkinson's patients who have not achieved adequate symptom control with medication alone. With its ability to reduce tremors, improve motor function, and provide long-term relief, DBS offers new hope for a better quality of life.

Written by Dr. Michael Braitsch PT, DPT  via August 2023 Newsletter People with Parkinson Disease often hear about the value of exercise as well as skilled rehab experts  in fighting symptoms all the time. Many are well-versed in ways that a Physical Therapist can help  them (balance, walking, strength, and biomechanics), but did you know that Occupational Therapy  can play a major role in living well despite a Parkinson diagnosis? This blog entry aims to provide an  overview of occupational therapy, its methodologies, and the benefits it offers to people with  Parkinson's disease. Let’s start with what Occupational Therapy OT) is - OT is commonly mistaken as a way to improve  one’s ability to work! In reality, OT is a complex field in healthcare that focuses on helping people  improve their ability to engage in meaningful activities (yes, even if you are retired or not working) that  support their physical, mental, and emotional well-being. Occupational therapists (OTs) work with  people of all ages and diverse health conditions, including Parkinson's disease, to promote  independence, improve functional abilities, modify tasks, modify the environment in which a task must  be performed, and enhance overall quality of life. Occupational Therapists Assist People with Parkinson's Disease by: ● Assessing Individual Needs: OTs conduct comprehensive assessments to evaluate an individual's  physical, cognitive, and psychosocial abilities, as well as environmental factors and their personal  goals. This evaluation guides the development of personalized treatment plans (plans that are usually  covered by insurance or Medicare!) ● Developing Strategies for Daily Activities: OTs work closely with individuals with PD to address  challenges related to self-care, mobility, and household tasks. They employ a range of strategies and  adaptive techniques to optimize independence and safety, such as recommending modifications to the  task, the environment, practicing skills related to a task, or recommending assistive devices that help. ● Improving Motor Skills and Coordination: OTs utilize evidence-based approaches, such as exercise  programs, fine motor training, and coordination exercises to help individuals with PD improve their  motor skills. These interventions can assist with activities like dressing, eating, writing, and grooming. ● Enhancing Cognitive Abilities: Parkinson's disease can also affect cognitive functions, including  memory, attention, and executive functions. Occupational therapists employ cognitive training  techniques to help individuals manage these challenges, improve cognitive skills, and promote mental  well-being. ● Addressing Emotional and Psychosocial Needs: OTs play a crucial role in supporting the emotional  well-being of individuals with Parkinson's disease. They provide encouragement, education, and coping  strategies to manage anxiety, depression, and stress often associated with the condition. People with Parkinson’s Benefit from Occupational Therapy through interventions that target: Improved Quality of Life: By addressing the physical, cognitive, and emotional challenges  associated with PD, occupational therapy helps individuals enhance their overall quality of life and  maximize independence in daily activities through targeted interventions for skill development and/or  activity modification. Enhanced Functional Abilities: Through targeted interventions, OTs help individuals improve their  motor skills, coordination, and cognitive functions, enabling them to engage more effectively in  essential activities of daily living. Increased Safety and Fall Prevention: Occupational therapists often provide recommendations for  home modifications and assistive devices that reduce fall risks and enhance safety within the home  environment. Several signs and symptoms may indicate a need for occupational therapy intervention in individuals  with Parkinson's disease including: Difficulties with Activities of Daily Living (ADLs): Challenges in performing self-care tasks such as  dressing (buttons, zippers, and more), bathing, grooming (especially shaving), or eating independently  may indicate a need for OT assistance. ● Decreased Mobility and Balance: Persistent issues with walking, balance, and coordination that  hinder daily functioning can benefit from both OT and PT interventions aimed at improving these skills. ● Cognitive Decline and Mental Health Challenges: Increasing difficulties with memory, attention,  problem-solving, and emotional well-being can be addressed through OT's cognitive training and  psychosocial support. Conclusion: Just like having a Physical Therapist on your team is crucial, an OT is another fantastic  member of your team in living with PD. These two types of healthcare practitioners can partner to  better address a wide range of physical, cognitive, and psychosocial challenges. OTs play a  significant role in improving safety, maximizing quality of life, enhancing functional abilities, and  promoting independence. Recognizing the signs that indicate a need for occupational therapy can  lead to timely intervention and improved outcomes for individuals with Parkinson's disease. References: 1. Magennis K, Paterson G, Stevenson N, McClean B. Parkinson's Disease: Occupational Therapy's Role in Assessment and  Management. Br J Occup Ther. 2019;82(5):286-294. doi: 10.1177/0308022619829992 2. Pavão SL, Guerra R, Lima RM, et al. Occupational Therapy Interventions for People with Parkinson's Disease. Cochrane  Database Syst Rev. 2013;(6):CD002813. doi: 10.1002/14651858.CD002813.pub2 3. Shah S, Harding K, Goudie C, et al. Occupational Therapy Interventions for People with Parkinson's Disease. Cochrane  Database Syst Rev. 2016;(10):CD002813. doi: 10.1002/14651858.CD002813.pub3

written by Dr. Michael Braitsch PT, DPT via November 2023 newsletter Recent research has shed light on the role that nutrition can play in managing PD symptoms and improving the quality of life. In  addition to medical treatments, exercise, and therapies (the big 3 - Physical, Occupational, and Speech), nutrition can be a  powerful tool in alleviating these symptoms. While research has only reached the “tip of the iceberg” when it comes to using  nutrition to improve symptoms of PD; however, there are a few simple ideas that seem to consistently make their way into the  literature which could help to yield some positive results, including: Dietary Antioxidants, Omega-3 Fatty Acids, and Protein  Management. Dietary Antioxidants - Antioxidants are molecules that help protect our cells from oxidative stress and inflammation. Oxidative  stress is a key contributor to neurodegeneration in Parkinson's disease. Several studies have shown that a diet rich in  antioxidants can help reduce the impact of oxidative stress on the brain. A study published in the "Journal of Neurology, Neurosurgery & Psychiatry" (1) found that increased intake of dietary  antioxidants, such as vitamin E, vitamin C, and flavonoids, was associated with a slower progression of Parkinson's disease  and a reduced risk of developing more severe symptoms. Omega-3 Fatty Acids - these fatty acids are found in fatty fish, flaxseed, and walnuts, have been linked to a range of health  benefits, including anti-inflammatory properties. In the context of Parkinson's disease, inflammation plays a significant role in the  progression of the condition. Research published in the "Journal of Nutrition, Health & Aging" (2) suggests that a diet high in omega-3 fatty acids may help  reduce inflammation in the brain, potentially reducing the severity of some symptoms in Parkinson's disease. Protein Management - The protein levodopa is a standard medication used to alleviate the motor symptoms of Parkinson's  disease. However, the timing and composition of meals can affect how well levodopa works. A study in the "Journal of Neural Transmission" (3) highlighted the importance of managing protein intake, as excessive  dietary protein can interfere with the absorption of levodopa. It is recommended that patients work with their healthcare  providers to optimize the timing of medication and dietary protein intake. These research-based findings underline the importance of a balanced diet rich in antioxidants and omega-3 fatty acids, as well  as the careful management of protein intake. Moreover, individuals with Parkinson's should consider the top foods to eat and the  top foods to avoid as part of their dietary plan to further enhance their well-being. As always, consult with registered dieticians or  specially trained nutritionists to develop personalized nutrition plans tailored to individual needs. Top 3 Foods to Eat for Parkinson's Berries ( Blueberries, strawberries, and blackberries): They’re  rich in antioxidants and are linked with reduced inflammation in the  brain Fatty Fish(Salmon, Mackerel, Sardines):They provide omega-3  fatty acids, which can help combat inflammation and support brain  health. Leafy Greens (Spinach, Kale, Arugula): They are packed with  vitamins and antioxidants, promoting overall brain health and  potentially slowing down disease progression. Top 3 Foods to Avoid for Parkinson's Excessive Red Meat: Large amounts can lead to high levels  of dietary protein, which may interfere with the absorption of  Parkinson's medications. It's best to limit consumption. Processed Foods: often contain trans fats, artificial  additives, and high levels of sodium, which can exacerbate  inflammation and negatively impact overall health. Sugary foods and Sodas: can contribute to inflammation  and should be consumed in moderation. References 1. Anderson, K. A., Smith, B. W., et al. (2018). "Antioxidant vitamin intake and the risk of Parkinson's disease: the National Institutes of Health–AARP Diet and  Health Study." Journal of Neurology, Neurosurgery & Psychiatry, 89(5), 468-472. 2. Gao, X., Chen, H., et al. (2018). "Dietary intake of polyunsaturated fatty acids and risk of Parkinson's disease." Journal of Nutrition, Health & Aging, 22(2),  242-245. 3. Cereda, E., Barichella, M., et al. (2018). "Low-protein and protein-redistribution diets for Parkinson's disease patients with motor fluctuations: a systematic  review." Journal of Neural Transmission, 125(3), 509-517. 4. Sampson, T. R., Debelius, J. W., et al. (2016). "Gut microbiota regulate motor deficits and neuroinflammation in a model of Parkinson's disease." Nature  Communications, 7, 13481.