In addition to alleviating the tremor, deep brain stimulation has been shown to control other symptoms, such as bradykinesia and rigidity. Other surgical treatments sometimes used involve creating a lesion in specific parts of the brain. The lesion interrupts signals that cause tremor and other symptoms. Experimental treatments Early investigation has begun into procedures that would correct the basic cause of PD – the chemical defect that causes the loss of dopamine production in brain. Known as “restorative” therapy, these investigative procedures includes transplantation of stem cells, gene therapy, and growth factor therapy. At this time such investigation is experimental, at the laboratory level, and restorative therapy is not available as a treatment. Unproven treatments and treatments of no value Many different medicines and vitamins have been suggested for treatment of PD. Some medications that are popular are Vitamin C, NADH, Melatonin and megavitamins. According to the American Parkinson Disease Association, these medications and vitamins have not been proven effective. Vitamin E, is another substance theorized to help. In a large study (the DATATOP trial) sponsored by the National Institutes of Health 5 , researchers failed to find evidence that Vitamin E slows the progression of Parkinson’s or manages symptoms. However, since Vitamin E has very few side-effects, many Parkinson’s patients continue to take it in high doses of 400 IU or more. Life adaptations In addition to medication, patients with PD often receive physical, occupational, or speech therapy to treat secondary symptoms of PD or symptoms that appear because of medication they are taking. Massage for patients with Parkinson’s Don’t be afraid of working with clients who suffer from Parkinson’s disease. For a person with chronic muscle stiffness, massage therapy is a great relief. Being familiar with this disease and welcoming those affected can bring an enormous amount of satisfaction to any compassionate bodyworker. Many massage therapists and individuals with PD have attested to the benefits of massage. Although several different modalities of massage have been reported to improve function in patients with PD, because the disease is neurologic, massage cannot change the progression of the disorder or limit the severity of the symptoms. Massage therapy can relieve stress, temporarily loosen muscles tightened due to that stress, and, as with all massage clients, enhance a sense of well-being. Massage therapists should be sure the individual’s primary clinician is aware that massage is being used. Treatment of Parkinson’s using a multidisciplinary approach, in which the physician, massage therapist, and others involved in the patient’s care work together is especially helpful. Safety concerns Because it can lead to fractures or head injuries, falling is one of the most dangerous complications of PD. Individuals with PD are aware of the risk of falling and have usually been educated in ways to sit, stand, and walk to reduce the risk. Getting on and off a massage table can present a challenge. In addition, dyskinesia may add to the risk of falling. Consider the alternative, if needed, of working with clients with PD on a chair or floor mat. A common side effect of levodopa is dizziness upon rising, caused by orthostatic hypotension, or a drop of blood pressure when getting up. Be alert to this when the client rises from the table, chair, or mat, and provide assistance as needed to help him or her avoid a fall. Research on effects of massage Because Parkinson’s is a neurologic disorder research has appropriately focused on genetic or other causes of the disease, preventive measures, and pharmacologic therapy. Thus,
When individuals are initially diagnosed with PD, they often have fear and anxiety about whom to tell. They may be afraid to tell their boss or coworkers, fearing the disclosure will adversely affect their job security. PD support groups are available in most areas of the country and provide a helpful forum for discussing issues such as these. Psychologists and social workers can provide additional guidance and support for individuals with PD. Exercise Research has shown that regular exercise benefits those with PD. 6 It improves mobility, balance, and gait, and may also reduce depression. A physical therapist may design an individualize exercise program for an individuals with Parkinson’s. It is best for people with PD to exercise when they feel most mobile, which is often about an hour after a dose of medication. Exercises that promote upright posture and that require balance are recommended as the first priority for individuals with PD. Such exercise includes walking, dancing, and most sports and aerobics classes. Alternatives that strengthen muscles are modified squats, pushing onto toes, and wall pushups. Light weights may be used. Exercises that provide good a cardiopulmonary workout but do not promote or require balance, such as swimming or riding a stationary bicycle, are beneficial but are considered a “second tier” choice of exercise. Exercises that help maintain muscle mass are also suggested, but these should not include weight lifting. The American Parkinson Disease Association advises individuals with PD to structure adequate rest periods into their exercise program, wear shoes with good support, maintain normal breathing, and move slowly through each exercise, avoiding bouncing motions. although the benefits of massage are widely known, there is little scientific evidence about massage therapy for patients with PD. A small randomized controlled trial conducted in 2000 showed that massage reduces symptoms of PD. 7 The study divided 16 individuals with PD into two groups. One group received a 30-minute massage twice a week for five weeks, and the other group participated in progressive muscle relaxation exercises for 30 minutes for the same number of sessions. The massage consisted of 15 minutes in the prone position, focusing on the back, buttocks, ribs, thighs, calves, and feet, and 15 minutes in the supine position, focusing on the thighs, lower legs, feet, hands, forearms, upper arms, neck, face, and head. Effects were measured by analysis of stress hormone levels in urine samples, standardized self assessments of daily functioning, sleep, and fatigue, and physician evaluation. Results showed that daily functioning improved for those in the massage therapy group, both as measured by the physician and as measured by the patients. The massage therapy group also had lower norepinephrine and epinephrine (stress hormones) levels in their urine, and reported that they had more effective and less disturbed sleep. Another small study focused on the effects of Trager therapy on patients with PD 8 . The study focused on upper-limb rigidity and involved gentle manipulation of the shoulder, trunk, leg, arm, and hand. Trager therapy uses gentle, nonintrusive movements to facilitate deep relaxation, increased physical mobility, and mental clarity. No oils or lotions are used. While the client lies on the table, the practitioner moves the client in ways that the client naturally move, using rocking, swinging, and stretching motions, and touching the client in a way helps the client experience the feeling of moving effortlessly. Results of the Trager therapy study were measured by electromyographic (EMG) activity of the extensor digitorum communis and flexor carpi radialis before and after therapy. The EMG readings of responses to evoked stretch correlate to
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