​Everyone presents differently with their Parkinson’s disease it is therefore important that you are working on the aspects of these exercise principals that are pertinent to you.
 
Some people have trouble with tremor or anxiety or it may be that you have trouble with falls or bradykinesia. It is important to really think about what your biggest challenges are and apply the principals of exercises to help your needs not the persons next to you.
 
We try to teach you all the same information so that you can use it to help you, and tailor your exercises, so that way you do an exercise it will be different to how someone else does their exercises.
 
If your main problem is tremor, you may find it helpful to focus on the force component of the training so power and high effort principals. These principals help adapt your body to stress, which can be a factor that affects tremor, therefore if your body is better able to cope with stress it could help reduce your tremor
 
If your main problem is bradykinesia or small movements it may be helpful to work on the principal of amplitude, so focusing on big movements to help recalibrate the brain and change what the brain sees as normal movement.
 
If your main problem is co-ordination, it may be helpful to work on dual tasking as this will help you complexity of tasks.
 
If your main concerns is balance it may be helpful to complete more balance tasks and work on power to help with muscle strength.
 
Ultimately it is about you using the knowledge we give you to help empower you to make the choices for your exercise to help improve your daily living.

 
Have you noticed yourself feeling weaker? There is evidence that weakness is one of the primary impairments in Parkinson’s disease. The thought behind this weakness is that there is a signaling problem from the brain to your muscles.
 
In a normal muscle our brain tells a motor unit in our muscles to move and this in turn tells the muscle fibres to contract so we can move our limbs. It is felt in Parkinson’s that there is a weak signal to the motor unit which causes inefficient recruitment of the muscle fibres and a decrease in speed of muscle contraction. This over time leads to slow movements and a loss of power in the muscles and the muscles not being used to their full potential again contributing to the slow and small movements that occur.
 
So it is important that we are bringing power back into our exercises and generating force behind our movements. And this needs to be brought into everything you do.
 
A great example is racket sports or cricket since is current the cricket world cup. If you do not put enough effort in to swinging your racket or bat the ball will go nowhere.
 
Last week we focused on amplitude and today we are working on making our movements powerful and big so I want to see force behind your big movements it will be challenging and difficult but with practice it will get easier we are working to change your brain and be at your best.

Amplitude refers to the size or range of movement. What we see with Parkinson’s disease is movements become small; and small movements make movements hard to do, think small shuffling steps, difficulty writing or doing up buttons,  reduced arm swing.
 
So when you are exercising you need to concentrate on making your movements as big as your full available range of movement in your body, and this will be much bigger than what you actually perceive.
 
Over time your movements are likely to or have become under scaled and research is indicating that this is caused by sensory changes within the brain and that you perceive that your movements are normal size when they are small.
 
By focusing on the size of your movements you can overide these changes but it takes a lot of effort and concentration on a regular basis. Sometimes it requires a friend or family member to help you see if you are changing how you move. Often when we move big it feels abnormal as if you are moving too big, but this is a normal response as your sensory perception has changed. SO remember if it feels too big its probably just right. 

Research is now showing that people with hearing loss are more likely to develop dementia that those with normal hearing. 
READ MORE HERE  Hearing loss and dementia or untreated hearing loss makes the brain shrink.

While this is been shown it has been shown that the use of hearing aids reduced cognitive decline and could delay the onset of dementia. 
READ MORE HERE Hearing aid reduces cognitive decline or hearing aids stimulate brain activity.

Why may hearing loss cause decline in brain health and function? 
The auditory process of hearing is processed in your brain, when a sound is heard and registered messages are sent by a network of neurons and synapses in your brain to recognition centre so you register and comprehend sounds and conversations.
When you no longer hear well you are not stimulating these pathways in the normal way, these pathways can become inactive, which causes changes within the brain, in the same way the loss of a limb affects the brain function. Loss of hearing can also cause social isolation, which leads to a cascade of other health issues both in mental health and physical function. With an overall impact on quality of life. 
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If you or your loved ones suspect hearing loss it is best to have your hearing tested early and regularly as restoring hearing will impact your overall brain health and quality of life. 

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While being a physiotherapist I advocate physical activity over brain training for brain health. I definitely believe there are benefits to completing brain games and puzzles. Now this does not mean endless sessions on the play station or solitaire on the computer. The research is definitely stacking up in favour of researched and carefully planned activities. One great website I have found is BrainHQ which is heavily based on research in the field of neuroplasticity.  New research is also showing that specific brain training is having an impact on dementia and improvements in executive functioning. 

Brain HQ was started by Michael Merzencih, he is the founder of a great website Posit Science and prominent neuroscientist that works in the field of Neuroplasticity.

One study called the ACTIVE trial has shown that with just 10 hours of speed training ( a type of brain exercise offered by BrainHQ) dementia risk is almost halved. There was a 33% reduction in the incidence of dementia with 10 hours training and 48% reduction in the study participants that practised for longer than 10 hours. For more information on Speed training you can read the results on Posit Sciences Blog here, for full details do check out the FAQ. 

Other studies have also shown how the use of brain training from Posit science have had benefits in executive functioning including speed, attention, working memory and useful field of view. This independent research was published in Plos one. For a summary and information on other research into BrainHQ brain training exercise read this blog article on Posit science. 

See what you think is it time to add some brain training to your day on top of your physical activity.  

Information Day for Carers of those affected by Stroke 
Organised by the Stroke Foundation
An event with:
•    Guest speakers
•    Workshops & Information tables covering:
o    Carers experiences and connecting with other carers
o    Grief adjustment and self-care
o    Entitlements and access to services
o    Continence and Pharmacology

Date:        Wednesday, 2 November 2016
Venue:     Commerce Club of Auckland, 27-33 Ohinerau Street, Remuera
Time:        9.30am to 3.00pm
Cost:        $10 per person – includes registration, tea/coffee and lunch

Please contact Tracey Dealey for a registration form
Telephone:  09 475 0070 or  Email:  northern@stroke.org.nz

​Neurological rehabilitation is a specialised area of medicine and health with many different expert professionals involved all striving towards one common goal…

To improve the quality of life of the individual living with the neurological condition.

Health modules have presented for decades that close team work with good communication and a client centered approach are vital to achieve and maintain goals. However in reality this can often be difficult to achieve and even more so when outside of a hospital setting and in the community. With more and more health care systems turning towards different types of private set ups clients can get easily lost in the system and be completely unaware of the amazing professional skills out there.

Also as a health professional our quality of service is highly lifted when I am able to referrer and suggest all types of other professionals that would be able to assist my client. For example, neurological orthotists, clinical psychologists, dietions, speech and lanuage therapists, yoga instructors, equipment companies and even engineers who can help create leading technology.

With all this in mind we have set up the NZ Neuro Rehab Networking Group, we will have an informal get together in Auckland one evening once a quarter which is open to any professional working in the field of neurological rehabilitation. This will provide a platform for some fantastic networking and relationship building with all the same goal in mind…

Please like and follow the facebook page below to join the group and be kept up to date for when the first meeting will be.  FACEBOOK GROUP

A neurological condition is with you for life and it is important that you take steps to manage your condition.
 
A Neurological physiotherapist is well placed to help set you up to maintain and improve your quality of life. Often we see a physio when we have had an injury or we are struggling with our condition. We advocate that you take a more proactive approach to therapy and check in regularly to a neurological physiotherapist to ensure that you are on the right path and addressing any concerns before they start to impact your quality of life.
 
You should be booking a review with your therapist at least every 6 months, you may find that it is easier to stay accountable, motivated and ahead of major changes before they happen.
 
It is also highly beneficial to participate in an intensive program periodically, for example;
 

• If you have been newly diagnosed  
• If you want to make significant change and improvement
• If you want the increased power of self-management
• If there has been a change in your symptoms
• If you have had a change of medication
• If your goals have changed
• If you have slipped backwards due to unforeseen life event – which happen…that’s life 

​We recommend that if you are participating in an intensive program that you book a review for 6 weeks after completing the program to ensure you are still tracking towards your long term goals and then 3-6 monthly after that.

​LSVT BIG is  an exercise therapy program designed for people with Parkinson's disease.
 
It is an intensive treatment program delivered by specifically trained physiotherapist or occupational therapist over a one month period with a total of 16 one hour sessions.
 
The training specifically focuses on increasing amplitude of movement “bigness” to enhance overall mobility and function.
 
It is based on the principles of LSVT Loud a speech therapy technique for Parkinsons disease.
 
LSVT BIG is designed to be prescribed to patients at initial diagnosis is research is showing lifestyle modification and exercise has a huge impact on quality-of-life but it is never too late to start exercising and should be a priority for all patients.
 
Starting therapy early is viatally important to patients with Parkinson’s disease as this gives the best chance of maintaining function and neuroprotection.
 
If you would like further information or an assessment to see if LSVT BIG is suitable for you contact Sarah on  09 424 3254 or 0221270098. You can also email sarah@hibisucusneurorehab.co.nz

Further information is also avaliable at LSVT GLobal and LSVT New Zealand
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