Massage Today
April, 2013, Vol. 13, Issue 04

Help in Understanding Parkinson's Disease, Part 1

By Ann Catlin, LMT, NCTMB, OTR

More people over the age of 60 are turning to massage therapy for self-care and to help ease symptoms associated with chronic ailments. If you have clientele in this age group, it's possible that you will eventually have a client who is living with Parkinson's disease (PD).

It's estimated that at least 500,000 people are diagnosed in the United States. It's important to have at least a basic understanding about this disease, what to expect and how you can best serve your client. Here, I will offer an overview of PD and how it impacts daily functioning of the persons who have it.

What is Parkinson's disease?

Parkinson's disease is a chronic and progressive disorder of the central nervous system. In other words, the symptoms of PD grow worse over a long period of time. PD is classified as a movement disorder. It's called Parkinson's disease because in 1817 a British physician named James Parkinson first described the symptoms. Such symptoms are caused when neurons in brain stem known as the substantia nigra die or degenerate. When functioning properly these neurons produce a chemical called dopamine. Dopamine carries signals between the substantia nigra to an area of the brain responsible for movement. When dopamine levels are depleted, impaired movement results. Other changes in the brain may occur as well, such as Lewy Bodies, an abnormal protein deposit that impairs cell function. It's not known what actually causes these neuron changes. Experts believe that genetics and exposure to environmental toxins are possible culprits.

Symptoms and Function

People who have PD experience a wide range of symptoms that affect people in many different ways. Here I'll focus on common movement symptoms and illustrate how these might affect a person's function in daily activities.

Early in the progression of PD these motor symptoms are considered classic.

Tremor: The limbs are mostly affected and the shaking is non-intentional, meaning the tremor is pronounced when the limb is at rest and goes away when moving. During intentional movement, such as reaching for a glass on the table, the tremor becomes much less apparent. A classic type of tremor is called pill-rolling where the finger and thumb rubs together. Mercifully, tremor in PD is quiet during sleep.
Bradykinesia: Brady means slow and kinesia is movement. People have difficulty starting to walk or getting up from a chair or turning over in bed. Rapid repetitive motions are also difficult such as during combing one's hair or petting a cat. Eventually, small hand movements are affected making writing, eating and buttoning a shirt difficult.
Hypokinesia: Hypo means low or decreased and, again, kinesia is movement. People with PD have decreased arm swing when walking and what's referred to as a "mask-like face." This happens when the muscles of the face are affected. People appear to be staring, blink slowly and don't have normal spontaneous facial expressions, for example smiling or frowning.

As the disease progresses into advanced stages these symptoms emerge.

Rigidity: Muscle rigidity is the result of abnormal, involuntary muscle contraction producing abnormal tone and stiffness in the trunk and extremities. If you were to passively move the person's arm through its range of motion you would feel a mild jerking, known as cog-wheel rigidity.
Postural instability: People with PD experience decreased trunk strength which causes a stooped posture when walking. Unsteady balance is common and safety becomes a concern because of the risk for falling.

It's easy to see how a person with these movement impairments would have trouble with daily tasks. What was routine becomes a frustrating and time-consuming challenge. People with advanced PD need a great deal of assistance from caregivers for day-to-day activities and may even require nursing home care.

Treatment

Treatment for PD typically consists of a combination of medications that help control symptoms and lifestyle changes. Some people have surgical interventions as well. Commonly prescribed medications decrease movement symptoms by increasing the levels of dopamine in the brain. One such drug is called Levodopa (L-dopa). Other drug therapies may be used for other symptoms such as depression, sleep disturbance and pain. Many of these drugs can cause severe side effects that negatively impact quality of life even further. Recommended lifestyle changes include diet modifications, regular exercise, balancing rest and activity, stress management and participation in a support group. Physical, occupational and speech therapies are commonly prescribed. Surgical interventions have been found to help manage symptoms in some people. One example is called deep brain stimulation where electrical stimulators are placed in the areas of the brain that control movement. Clinical trials for stem cell transplants are being studied.

I encourage you to take a look at these two short videos on Youtube to gain a better understanding of Parkinson's disease and how it impacts people's lives. This first video, is Joseph H. Friedman, MD, is chief of Butler Hospital's Movement Disorders Program and an international expert in Parkinson's disease (www.youtube.com/watch?v=IHDFQfmkKlg). The second video is called: A look into Parkinson's: what it is and how it affects the lives of my parents by Tommy Dimmel (www.youtube.com/watch?v=ggNlPYGuAAg).

In part II, I will explore how massage therapy can contribute an important approach in easing symptoms and improving quality of life for the person living with Parkinson's disease.

Sources:

Larson, K. (1996) Role of Occupational Therapy with the Elderly, American Occupational Therapy Association, Bethesda, MD.
Cochrane Database of Systematic Reviews: Monoamine oxidase B inhibitors for early Parkinson's disease.
National Institute of Health: National Institute of Neurological Disorders and Stroke, www.ninds.nih.gov.
Parkinson's Disease Health Center, www.webmd.com.

Click here for more information about Ann Catlin, LMT, NCTMB, OTR.