Group Therapeutic Singing via Telemedicine Improved Respiratory Function of Parkinson’s Patients in Rural Iowa, Study Finds

singing, telemedicine

Parkinson’s disease patients living in rural areas in Iowa show improved respiratory function with group therapeutic singing delivered via telemedicine, according to a pilot study.

The study, “The Feasibility of Group Therapeutic Singing Telehealth for Persons with Parkinson’s Disease in Rural Iowa,” was published in the journal Telemedicine and e-Health.

Voice impairment affects most patients with Parkinson’s, but only a small minority undergo speech therapy. That is why new approaches to help improve voice and respiratory impairments in Parkinson’s patients are needed, especially for those living in rural areas where access to care is limited.

Telemedicine may be an effective answer, as it has led to positive results in the treatment of depression in Parkinson’s patients, as well as in group therapy, and education and support sessions.

Previous studies have suggested that singing may ease voice and respiratory impairments in people with Parkinson’s. In particular, researchers at Iowa State University have shown that group therapeutic singing effectively maintains the voice and significantly improves respiratory control in these  patients. However, whether it can be delivered through telemedicine — and whether it would lead to similar results as in-person group therapeutic singing — remains to be determined.

Aiming to address this topic, researchers tested an eight-week prerecorded group therapeutic singing program in nine idiopathic (of unknown cause) Parkinson’s patients (eight men, age 67-82) living in the rural Iowa towns of Rockwell City and Storm Lake.

All participants were on a stable regimen of antiparkinsonian medications for 30 days, did not smoke, and had received no speech therapy within the past two years. None had significant cognitive impairment, major psychiatric disorders, history of head or neck cancer, asthma, chronic obstructive pulmonary disease, or untreated hypertension.

The group therapeutic singing program was filmed before recruitment, with Parkinson’s patients who attended weekly in-person sessions. Each session included vocal exercises followed by group singing of familiar songs. The intervention targeted breath support, vocal intensity, and frequency range.

The assessments were made one week prior and one week after the intervention at the same time of day to avoid fluctuations in medication. Voice outcome measures included phonation (vocalization) duration and range, and vocal intensity, each tested in three trials.

Specifically, phonation duration was assessed as the total time a participant sustained the vowel sounds ‘‘ah’’ and ‘‘ee.’’ To determine phonation range, the team recorded the lowest and highest pitch with an iPad app, then calculated the difference. The loudest sound produced on a sustained ‘‘ah’’ indicated vocal intensity.

Respiratory outcome measures included maximal inspiratory and expiratory pressures (breathing in or out as forcefully as possible for two seconds)   recorded with a portable respiratory pressure meter.

One participant dropped out at week three. Five attended all eight sessions, two completed seven sessions, and one participant attended six sessions. The overall compliance was 93.75%.

Analysis of the eight patients completing all sessions revealed that the changes in phonation range and vocal intensity were not statistically significant. However, both respiratory outcome measures improved significantly.

The results were in line with those of in-person sessions, suggesting similar effectiveness with the two approaches, the team noted. The different results seen in phonation duration — an increase with in-person, but a slight decrease with the pre-recorded program — may have been due to the small number of participants in the study using telemedicine, the team noted.

“This study has established that using a prerecorded GTS [group therapeutic singing] program is feasible and effective for persons with [Parkinson’s] in rural areas,” researchers wrote. “Thus, this pilot work suggests that the use of prerecorded GTS may be a viable treatment option for those with limited access to care,” they added.

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Changes in Fatty Acid Metabolism May be Linked to Parkinson’s Severity, Rat Study Finds

fatty acid metabolism

The metabolism of certain types of fats, namely palmitic acid and stearic acid commonly found in animal and vegetable fats and oils, may be altered in Parkinson’s disease, according to a study in rats.

The study, “Palmitate and Stearate are Increased in the Plasma in a 6-OHDA Model of Parkinson’s Disease,” was published in the journal Metabolites.

Studying small molecules produced by metabolism — commonly known as metabolites — within cells, biofluids, tissues, or organisms holds promise for the discovery of potential diagnostic biomarkers, which may shed light on susceptibility to Parkinson’s, disease prognosis, and therapeutic response to treatment.

In fact, an increase in metabolites of fatty acid-related molecular pathways has been reported in the plasma and cerebrospinal fluid of Parkinson’s patients, which correlated with disease progression. An increase in amino acid (protein’s building blocks) metabolism in urine samples of Parkinson’s patients has also been reported.

Evidence also suggests that metabolic profiling of cerebrospinal fluid is useful for distinguishing between newly diagnosed Parkinson’s patients and healthy individuals.

Although studies indicate that an array of molecular changes have the potential to become disease biomarkers, there is still no consensus on which markers are more informative from a diagnostic, prognostic, or even therapeutic point of view.

King’s College London researchers set out to investigate changes in brain, plasma, and liver metabolism of a rat model of Parkinson’s to discover small molecules that are associated with dopaminergic cell loss — a hallmark of the disease.

Thirteen rats were injected on one side of the brain only (unilaterally) with 6-hydroxydopamine (6-OHDA), a neurotoxin that causes the death of dopamine-producing (dopaminergic) neurons. Another 13 animals were injected with saline into the same brain region and used as a control sample.

Two weeks after injection, the animals were given two behavioral tests for researchers to assess their motor function.

“Unilateral lesions of 6-OHDA successfully resulted in the manifestation of motor symptoms, as observed by [behavioral tests] indicating the intensity of the lesions,” the researchers wrote.

Tissue analysis of the animals’ substantia nigra — a midbrain area important for muscle control that is commonly damaged in Parkinson’s disease — revealed that rats injected with 6-OHDA only had 28% of dopaminergic neurons on the injection side, compared with the other side that was not injected. Control samples had similar dopaminergic neuronal cell count on both brain sides.

Scientists then performed a metabolic analysis on the animals’ plasma, midbrain, cerebellum, and liver samples.

Results showed significantly high plasma levels of palmitic acid and stearic acid, both saturated fatty acids, within the Parkinson’s disease modeling group, which were found to be associated with motor dysfunction.

Lipid metabolism involves the degradation of triglycerides, a type of fat, into smaller chain fatty acids and subsequently into monoglycerides (glycerol molecule combined with a fatty acid) by specific enzymes.

Monoglyceride forms of palmitic acid and stearic acid, also known as monopalmitin and monostearin, respectively, were reduced in the midbrain of animals injected with 6-OHDA. Low levels of myo-inositol, a sugar alcohol molecule that has been used to decrease hormonal changes in polycystic ovary syndrome, were also found in the midbrain.

Compared with the control group, 6-OHDA rats showed a tendency toward lower levels of monopalmitin, monostearin, and myo-inositol in the cerebellum, but statistical significance was not reached.

No fatty acid-related molecular changes were observed in the animals’ livers.

“Our results show that saturated free fatty acids, their monoglycerides and myo-inositol metabolism in the midbrain and enteric circulation are associated with 6-OHDA-induced [Parkinson’s disease] pathology,” the researchers wrote.

“Changes of the midbrain metabolites may be associated with neuronal loss elicited by 6-OHDA while palmitic acid and stearic acid showed a high correlation with behaviour tests, indicating a possible association with disease severity,” they said.

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Wives of Parkinson’s Patients are More Impaired in Postural Stability from Caretaking, Study Finds

postural stability, wives of Parkinson's patients

Wives who take care of husbands with Parkinson’s disease have greater impairments in their stability while standing than housewives or more active women of the same age, a study shows.

The research, “Postural stability in Parkinson’s disease patients’ wives and in elderly women leading different lifestyles,” appeared in the journal Health Care for Women International.

Increased impairment of posture and gait that comes with aging results from alterations in the central nervous system — brain and spinal cord — muscle and joint dysfunction, deteriorated physical capability, and other health issues.

The level of physical activity in the elderly is varied and associated with their lifestyle, responsibilities, and support. While some are able to participate in various forms of physical activity, others spend significant time doing housework or caretaking, and so don’t have opportunities to be physically active.

“This type of activity (housework) certainly is not conducive to the health of the caregivers and some aspects of it can be destructive both physically and mentally,” the study stated.

Parkinson’s patients require permanent care as their movements are unstable and slow. Their caregivers’ own stability may be affected, especially if the patient’s postural balance in impaired, and there’s an increased risk for falls.

“The (Parkinson’s) patient is hunchbacked and leans forward, making rising and sitting difficult,” the researchers wrote.

In the study, Polish researchers compared the postural stability of wives of Parkinson’s patients to that of women doing higher physical activity — students of the University of the Third Age (U3A; adult education movement for retired individuals) — or average physical activity (housewives).

A total of 128 unemployed women were included: 44 were wives of Parkinson’s patients (with a mean age of 66.5 years), 43 were U3A students (68.0 years), and 41 were housewives (65.6 years).

When not housekeeping, the wives of Parkinson’s patients spent their time caring for their husbands and resting. U3A students participated in organized activities twice a week, such as dance, exercises, nordic walking, or swimming. Housewives preferred to spend their time resting passively, which could be watching TV, reading, or chatting with family and friends.

Scientists assessed the women’s balance using a so-called stabilometric platform. Each participant was tested twice for 30 seconds. While one test included complete postural control with eyes open, the second was under conditions that limited postural control, with eyes closed.

The women stood on the platform in a relaxed and upright position, with their upper limbs hanging loosely. They were barefoot and dressed lightly. During the trial with eyes open, the women were asked to focus on a fixed point — a circle with a 15-centimeter diameter and a line through it, which was hanging on the wall three meters away.

No woman had difficulty standing due to neurological, orthopedic, or other issues. An assistant stood behind the participants to prevent falls.

The stability parameters analyzed were the mean velocity of center of pressure (COP) displacement (which measures postural balance); COP velocity in the sagittal plane (the one that divides the body into left and right halves) and frontal plane (front and back); and sway range in sagittal plane — mainly controlled by the ankles — and frontal plane directions, which depends mainly on the control of hip joints. The COP is the point where the sum of all forces on the body act, including gravity.

The wives of Parkinson’s patients were the tallest, and each had a lower body mass index, with none obese, than the other participants. Nearly 30% of housewives and U3A students were overweight.

As for postural balance, the wives of Parkinson’s patients had significantly higher values of mean velocity, displacement velocity, and sway range than housewives and students, which means they had greater impairment in balance. In contrast, U3A students, who engaged in regular organized physical activities, had the slowest velocity and lowest sway.

“It can be thus supposed that engagement in physical activity has positive effect on balance of older adults,” the scientists wrote.

However, the housewives and students showed greater differences in displacement velocity with eyes closed versus open, compared with the wives of patients.

“Surprisingly, compared to the other women, the wives of (Parkinson’s) patients did very well with eyes closed in terms of frontal plane sway,” the researchers said. “This may be the ‘practice effect’ of the long-term strength as well as the motion coordination required for caring for the (Parkinson’s) patients, who are typically characterized by instability.”

“The study results clearly point to the fact that the Parkinson’s disease patients’ wives require support in the form of balance enhancing training,” the team concluded. “Therefore, undertaking any form of physical activity aiming at redressing postural stability deficits would be beneficial for (this) group of women.”

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Educating the Educated About Parkinson’s Disease

EDUCATING

Sherri Journeying Through

I went to the dermatologist yesterday for a skin check. Those of us who have Parkinson’s disease (PD) should make a habit of getting a yearly check because our condition increases the odds of getting skin cancer. The Mayo Clinic reported that patients with Parkinson’s “were roughly four times likelier to have had a history of melanoma than those without Parkinson’s, and people with melanoma had a fourfold higher risk of developing Parkinson’s. …”

So, I had an appointment with the dermatologist.

After a thorough body check and five biopsies, I was free to leave. The nurse stayed back with me after the doctor left because I struggled to move. She asked when I was diagnosed with Parkinson’s. After I answered “2004,” she replied, “Isn’t that young for Parkinson’s?” Not as young as when the symptoms began 10 years before that, I wanted to answer. 

She followed that question with another: “Did it run in my family?”

No.

“Not even one relative?”

No.

“Are you sure?”

Yes.

While I dressed and walked out to where my husband waited in the car, I shook terribly. That’s something I hadn’t done in quite a while. I was sure it was the combination of numbing five different areas with an intrusive needle and the anxious feeling that came over me with the news that spots could be cancerous. However, what caught me almost more off guard was the nurse’s questioning. 

I guess what surprised me is how uninformed so many still are.

I have spoken to groups about my 20-year journey with Parkinson’s disease. I write about it on my blog. I am open about it with others. I have written articles for several different publications. I am a PD advocate. I know a lot about the disease. I just figure others do, too. What surprised me most about her questions was that she worked for a dermatologist who should be very familiar with PD since the disease can highly affect the skin.

As patients, our job is far from finished.

As long as we live with PD, we are responsible for getting information about this disease out to everyone we can, as best we can. Not just to newbies in the patient club, but also those in the medical fields. Perhaps the patients and caregivers should hold a conference for medical professionals instead of the opposite. After all, we are living PD day to day, feeling it moment by moment. As my movement disability specialist once told me, “You patients are the experts. The doctors take their cue from you.”

If that is true then we need to be proactive with the hand we’re dealt. We must educate those around us, whether they’re a patient, nurse, caregiver, doctor, dental hygienist, or medical transporter. It’s going to take a whole lot more than answering the question of whether Parkinson’s disease is hereditary — it was obvious to me the nurse wasn’t buying my answers.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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AbbVie, Voyager Team Up to Develop Antibodies for Parkinson’s, Other Diseases

antibodies

AbbVie and Voyager Therapeutics have extended their collaboration to co-develop and commercialize antibodies that target the toxic forms of alpha-synuclein to treat Parkinson’s disease and other synucleinopathies.

The collaboration will combine AbbVie’s expertise in monoclonal antibodies with Voyager’s gene therapy platform to deliver antibodies across the blood-brain barrier using a one-time injection into the blood. The blood-brain barrier is a semipermeable membrane that protects the brain against the external environment, and is a major barrier for the efficient delivery of certain therapeutics that need to reach the brain and central nervous system.

Researchers will use a modified and harmless adeno-associated virus (AAV) with a high capacity to penetrate the blood-brain barrier to deliver genes that carry the information for producing therapeutic antibodies against toxic forms of alpha-synuclein.

“The expansion of AbbVie’s partnership with Voyager represents the potential we see in the ability of its vectorized antibody platform to surpass the blood-brain barrier and more effectively deliver biologic therapies,” Jim Summers, PhD, vice president, discovery neuroscience research, AbbVie said in a press release. “We are hopeful that Voyager’s technology will enable further development of transformative treatments for patients with neurodegenerative diseases,” Summers said.

Parkinson’s disease belongs to a class of neurodegenerative disorders called synucleinopathies, characterized by the accumulation of misfolded alpha-synuclein aggregates. These abnormal protein aggregates are toxic and trigger the death of dopamine producing-nerve cells — those responsible for releasing the neurotransmitter dopamine, a critical neurotransmitter that regulates brain cell activity and function.

Given the key role of alpha-synuclein in the development and progression of Parkinson’s disease, many efforts have been made to find ways to effectively prevent its toxicity, such as using antibodies targeting the toxic forms of alpha-synuclein.

However, delivering antibodies to the brain is not an easy task. This is because the central nervous system (CNS) — comprised by the brain and spinal cord — is protected from the circulatory blood system by the very selective blood-brain barrier.

Current delivery of antibodies to the brain requires frequent injections and large amounts of antibodies. This new approach is expected to result in higher therapeutic antibody levels in the brain.

“Our scientific platform allows us to develop unique AAV gene therapies that are designed to knock down disease-causing gene expression, increase the expression of missing proteins, or enable the expression of therapeutic antibodies through vectorization,” said Andre Turenne, president and CEO of Voyager Therapeutics.

“We are excited to expand our efforts towards pathological species of alpha-synuclein given its role in the progression of disease, and AbbVie is the ideal partner to advance this new target and therapeutic modality,” Turenne added.

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The Day Parkinson’s Disease Left the Room

rock steady boxing

“… [T]he power for creating a better future is contained in the present moment: You create a good future by creating a good present.” –Eckhart Tolle

Rock Steady Boxing is not just about boxing, sweating, moving, and exercise. More than once, the classes have allowed me to recapture a part of my former self from before my Parkinson’s disease’s (PD) onset. In the past, this has always been very personal and unique to me. In a recent class, I observed the other participants experiencing something similar in their own way. It was a sight to behold, truly an empowering feeling of joy shared by all.

Living in the moment

“If you aren’t in the moment, you are either looking forward to uncertainty, or back to pain and regret.” –Jim Carrey

The class was united for a few moments — I truly believed none of us thought about PD. During our warmup, Bob Dylan’s “Like a Rolling Stone” started playing. Spontaneously, we all started singing the lyrics. There were smiles all around and one of the boxers took out his harmonica and played along. The feeling was palpable. For those moments in time, none of the participants had PD. We were fellow athletes having fun, singing along to the music (yes, even I sang despite being unable to hold a tune), and living in the moment. The feelings I experienced in that class still resonated with me days later.

Click here for a video clip of the magic moments. Thank you, Sensei Michelle and assistant coaches Rita and Michael, for giving the boxers a respite from our troubles that day.

We shouldn’t underestimate the power of music and the camaraderie fostered by Rock Steady Boxing. What happened in class that day could not be scripted. We were all caught up in the moment, oblivious to any burdens we walked into the room with.

Who are we?

Rock Steady Boxing is a community of people — coaches, patients, and volunteers — who share collective experiences. We are all united in fighting back against an incurable and progressive disease. The moments like those experienced in that particular class keep me coming back. This is what makes Rock Steady Boxing such a healing and unique experience.

“Alone, we can do so little. Together, we can do so much.” –Helen Keller

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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MJFF and Silverstein Foundation Jointly Award $3M Supporting Research into GBA Mutations

Parkinson's grant awards

Some 10 percent of Parkinson’s patients carry a mutation in the GBA gene, making it the most common genetic risk for this disease. With a goal of learning more about these mutations, The Michael J. Fox Foundation for Parkinson’s Research (MJFF) and the Silverstein Foundation for Parkinson’s with GBA is awarding $3 million in grants.

Specifically, projects chosen aim to shed more light on the effect of glucocerebrosidase beta acid (GBA) mutations, and GBA’s overall function. They also hope to advance treatments against this target.

“Defining the GBA pathway and its role in disease, including in patients without a GBA mutation, could point to new therapeutic approaches that may slow or stop Parkinson’s,” Todd Sherer, MJFF’s chief executive officer, said in a press release. “This partnership with the Silverstein Foundation streamlined the grant process to more quickly direct funding to these promising projects.”

GBA mutations impede activity of the glucocerebrosidase (GCase) enzyme that breaks down damaged or excess cell parts, such as lipids and cellular proteins. Accumulations of cell parts can be toxic, leading to the cell damage seen in Parkinson’s disease.

While directly associated with GBA gene mutations, GCase hindrance is also found in patients without mutations. That’s why treatments to rouse the enzyme’s activities or imitate its effects may benefit people with Parkinson’s in general, the MJFF said.

MJFF and the Silverstein Foundation winnowed 92 proposals to 16. In the area of GBA biology, the following projects hope to find novel biomarker candidates or treatment targets by studying the role of GCase and effect of GBA mutations:

  • Two projects that look at other genetic factors that influence Parkinson’s risk with a GBA mutation.  Tim Ahfeldt, PhD, at the Icahn School of Medicine at Mount Sinai is using gene-editing technologies (CRISPR) to alter the expression of GBA and other genes, in the hopes of identifying additional risk factors. Justin Martin O’Sullivan, PhD, at the University of Auckland will use computer technology to identify genes controlled by certain mechanisms within the GBA gene and how these contribute to Parkinson’s disease.
  • Two projects are using other technologies to study the cellular effects of GBA mutations. One, led by Ricardo Feldman, PhD, at the University of Maryland, uses induced pluripotent stem cells; the other, led by Anthony Futerman, PhD, at the Weizmann Institute of Science in Israel, is applying advanced RNA sequencing and proteomics analysis to brain tissue samples from those with idiopathic (of unknown cause) Parkinson’s, those with GBA-associated Parkinson’s and healthy volunteers.
  • A study led by Manoj Kumar Pandey, PhD, at the Cincinnati Children’s Hospital Medical Center will investigate about how GBA mutations may lead to inflammation, while another led by Michel Desjardins, PhD, at the Université de Montréal, will fuse on the role of GCase in autoimmune mechanisms.
  • Research led by Emily M. Rocha, PhD, and J. Timothy Greenamyre, MD, PhD, at the University of Pittsburgh will focus on connecting deficits in GCase with another top genetic target — LRRK2 — while exploring the potential of LRKK inhibitors in Parkinson’s patients.
  • Three projects are investigating other cellular players — prospective treatment targets — in the GBA pathway.

In the category of GBA biomarkers, two projects are hoping to aid in subject selection and therapeutic impact assessment through objective measures that may benefit patient care as well as research.

The area of GBA therapies has three projects testing compounds against GCase, and one project — led by researchers at Rheostat Therapeutics — testing to see whether activators of the ion channel TRPML1 can repair lysosomal malfunctions associated with GBA mutations. Lysosomes are special compartments within cells that digest and recycle different types of molecules. 

“We are very pleased with the collaboration with the Michael J. Fox Foundation and feel confident that the projects chosen will significantly add to the library of knowledge around GBA and propel new treatments for people living with Parkinson’s and, perhaps, individuals at risk for the disease,” said Jonathan Silverstein, founder of the Silverstein Foundation.

The non-profit Silverstein Foundation invests mainly in promising new ways to treat and prevent Parkinson’s disease in GBA mutation carriers. The MJFF is the globe’s largest non-profit founder of Parkinson’s research. It has supported both pre-clinical and clinical work in GBA1 since 2006.

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Deep Brain Stimulation System Aimed at More Precise, Safer Targeting in Parkinson’s Patients

deep brain expectations, Versice

A tool called Vercise Cartesia Directional Lead is intended to provide more precise deep brain stimulation (DBS) treatment for people with Parkinson’s disease.

Researchers at UHealth — University of Miami Health System recently became the first in the Eastern U.S. and the second in the country to adopt the system.

DBS is a surgical approach used to treat Parkinson’s motor symptoms, normally in patients who no longer respond effectively to medications and show a reappearance or worsening of symptoms such as tremors and dyskinesia — involuntary, jerky movements.

In DBS, leads, or wires with electrodes at the tips, are implanted in selected regions of the brain. They are connected to a pacemaker-like neurostimulator to provide electrical impulses.

Vercise Cartesia Directional Lead, an implantable pulse generator manufactured by Boston Scientific, contains eight individually controlled electrodes on each lead for more precise control of the shape, range, position, and direction of electrical stimulation to the brain.

The device’s precise stimulation is also key for lessening side effects. The pulse generator has contoured edges designed to minimize erosion and increase patient comfort. It comes with a rechargeable system with a battery longevity of a minimum of 15 years. Compatible with the directional lead, the Vercise PC DBS System offers the same stimulation ability, with a projected battery duration of at least three years with standard settings.

“As technology advances, we are able to further fine tune and enhance DBS for people with Parkinson’s,” Corneliu Luca, MD, PhD, a professor of neurology and director of UHealth’s Deep Brain Stimulation Program, said in a press release.

Software called Neural Navigator 2 was designed for flexible programming, suitable for patients throughout their disease course. In addition, Clinical Effects Mapping software provides a summary of therapeutic benefits and side effects, while keeping track of the patient’s history on the pulse generator.

“Our mission is to offer Parkinson’s patients throughout Florida the latest treatment and most cutting-edge technology to improve their quality of life. It’s always exciting to add new therapies to our comprehensive treatment program.” said Jonathan R. Jagid, MD, a neurosurgeon at UHealth and an associate professor of neurological surgery who has performed more than 1,000 DBS surgeries.

Both Luca and Jagid have played a key role in clinical trials of this DBS system for approval by the U.S. Food and Drug Administration, as part of UHealth’s Center for Parkinson’s Disease and Movement Disorders. Europe and Australia have also already approved the system.

Two trials — one called INTREPID (NCT01839396) conducted in the U.S. and another called VANTAGE (NCT01221948), which took place in Europe — showed that the Vercise system improved movement control in most patients, while also being associated with better quality of life.

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I Have Parkinson’s, and Life Is Still Beautiful

mammogram

Sherri Journeying Through

 

“Life is beautiful.” “The best is yet to come.” Two small plaques inscribed with these words of wisdom stared back at me as I sat in a cubicle waiting for the technician to come and get me. I was booked to have a mammogram and an ultrasound. As if having Parkinson’s disease wasn’t enough, I was being tested for “concerning tissue,” as my doctor called it.

Life is beautiful, but sometimes a gray cloud casts its dark shadow over us, causing us to fear. “The best is yet to come,” beautifully scrawled on a sign, may soothe us temporarily until we are facing the possibility of a new and troubling diagnosis. In that case, these words may seem like mocking whispers in the background noise of our minds. What we hope for may not come to pass, and fear, if it hasn’t already done so, soon takes over.

President Franklin D. Roosevelt once said, “The only thing we have to fear is fear itself.”

One thing we all have in common is fear. But in times of uncertainty, some of us fall short of hope. We can jump to conclusions about what our future may look like while we await our test results. Our minds run rampant and we have our funeral service mapped out before we even receive the findings due to our tendency to fear what may not exist.

Drawing on fear when facing an ambiguous situation can be easier than relying on hope because it is natural to fear the unknown. Hope is an attitude of optimism that believes good things are possible. It comes from within.

To hope is to believe the best is yet to come, no matter what the diagnosis or prognosis.

And so I sat there in that cubicle waiting, and then it was time. I followed the technician into the mammogram room, my “cape” blowing behind me. The machine trampled over my breasts like a Mack truck slowly rolling over a rubber ball. Next stop was the ultrasound room. After that, I returned to my cubicle, where life is beautiful and the best is yet to come. 

And the best did come. There was nothing abnormal to report, and the radiologist didn’t see anything to be concerned about. I could go.

I only had Parkinson’s and the need to get my hands on a tire pump. No cancer.

Life is beautiful.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Palm-Worn Device May Help in Tracking Changes in Rigidity in Parkinson’s Patients, Study Says

measuring rigidity

A palm-worn device can quantify joint stiffness in Parkinson’s disease patients by tracking changes in rigidity following deep brain stimulation treatment, and may be of use in measuring fluctuations in motor symptoms,  scientists who created the tool report.

Their study, “A Palm-Worn Device to Quantify Rigidity in Parkinson’s Disease,” was published in the Journal of Neuroscience Methods.

Most Parkinson’s patients — at least 89%, the study states — have problems with rigidity, which results in stiffness and makes movement arduous.

Clinically, rigidity is defined as resistance to passive movement — movement that is performed by another person without voluntary motion by the patient — and measured by an expert who moves the “wrist, elbow, and knee joints about their full range of motion and subjectively grades resistive force,” the researchers wrote.

Clinical assessment of rigidity in Parkinson’s patients is largely subjective, due to observer-dependent scoring of muscle stiffness based on The International Parkinson and Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS).

Automatic devices hold the potential of objectively measure a patient’s increased resistance to passive movement.

Researchers at the Bionics Institute and the University of Melbourne in Australia developed the Bionics Institute Rigidity Device (BiRD), a palm-worn apparatus that uses a miniature motor to trigger an automatic flexion of the hand’s third digit at the metacarpophalangeal joint — the joint at the base of each finger.  Transducers then record data on flexion and extension forces, allowing investigators to quantify rigidity.

Their intent was to establish a more objective measure of a patient’s resistance to passive movement.

The team chose to validate the device against the MDS-UPDRS and demonstrate BiRD’s sensitivity to the therapeutic impact of deep brain stimulation (DBS), a surgical treatment of motor symptoms.

Eight Parkinson’s patients (six men and two women, ages 47–59) and 16 healthy individuals, serving as controls, were recruited to test the device.

Two experienced physiotherapists assessed patients’ rigidity according to the MDS-UPDRS. Individuals were instructed to draw a large imaginary circle in the air using their contralateral arm. Evidence shows that contralateral movement, i.e. moving the side of the body that’s not being evaluated — for instance, moving the right hand instead of the left — substantially increases rigidity in Parkinson’s patients.

Patients had their DBS device on, but were off dopaminergic medication; each had stopped such medication the night before the test.

“Participants were familiarized with the device [BiRD] and a practice trial was conducted prior to formal assessment. Each rigidity assessment consisted of 15 continuous extension/flexion cycles applied without removing the device,” the study said.

In the Parkinson’s group, rigidity of both arms was measured first using the BiRD, and then by the two physiotherapists (using the MDS-UPDRS). Patients’ deep brain stimulation device was then turned off, and rigidity quantified using the new device every 10 minutes for an hour.

DBS treatment was then resumed, and rigidity was measured by BiRD at five-minute intervals for half an hour. “At the last trial within this period, the two raters also assessed rigidity,” researchers wrote.

In the control group, dominant hand stiffness was assessed using BiRD while people were at rest or performing a contralateral activation task. In these people, 10 evaluation cycles were performed: five at rest and five during activation maneuver (movement).

Measurements obtained with BiRD were moderately similar to those recorded with MDS-UPDRS. The device was able to identify the impact of DBS therapy on rigidity by detecting differences between on- and off-DBS states.

The device was also able to distinguish differences between contralateral activation exercises, as well as among participants with and without Parkinson’s disease.

Stiffness in Parkinson’s patients gradually increase during an hour after the DBS device was turned off. Rigidity was almost immediately eased by resumption of deep brain stimulation treatment.

“Given its ability to track changes in rigidity due to therapeutic intervention, our technique could have applications where continuous measurement is required or where a suitably qualified rater is absent,” the researchers concluded.

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