Understanding
Parkinson’s Disease

A Guide For Those With
PD And Their Families

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What is Parkinson’s?

Understanding, Together.

Parkinson’s disease (PD) belongs to a group of conditions called motor system disorders. It is a neurodegenerative disease which is the most common cause of parkinsonism, or the akinetic-rigid syndrome. Parkinson’s disease is recognized by the presence of at least three of four cardinal signs:

Parkinson’s disease affects approximately 1.5 million people in the United States and 35,000 here in Michigan. Although it most commonly affects people over age 60, Parkinson’s disease can occur as early as age 20. Whatever your age and stage, we are here for you.

The other causes of parkinsonism, or the akinetic-rigid syndrome, include other neurodegenerative diseases besides typical Parkinson’s disease. These include the Parkinson’s Plus diseases, familial forms of Parkinson’s disease, Wilson’s disease and Huntington’s disease in children. In addition, poisons including carbon monoxide, manganese and MPTP, injuries to the basal ganglia including strokes (Vasculogenic Parkinson’s), acute or chronic (Pugilistic Parkinson’s) head trauma, post-encephalitic (Von Economo’s disease) and drug-induced parkinsonism. The main risk factors for Parkinsonism are increasing age and family history.

The basic problem in Parkinson’s disease is loss of dopamine-producing nerve cells in a region of the brain called the substantia nigra pars compacta. The loss of the dopamine these cells release in a region of the brain called the striatum produces the symptoms of the akinetic-rigid syndrome. Everybody has a gradual loss of these dopamine-producing nerve cells as they age, but patients with Parkinson’s disease have lost more of them than other people.

Why these cells die in Parkinson’s disease is unclear, and the focus of much research. Studies of identical twins show that most Parkinson’s disease is not inherited, and epidemiological studies support a multifactorial model in which both genetic and environmental factors play a role. Familial forms of Parkinson’s disease are known but are uncommon and atypical, most often presenting at an earlier age.

Stages of Parkinson’s Disease

Clinicians use 5 stages to describe motor symptom progression in PD. Stages 1-2 are early-stage, 2-3 mid-stage, and 4-5 advanced-stage PD.

The person has mild symptoms that generally don’t interfere with daily activities, such as tremors and changes in posture, walking, and facial expressions.

Tremor, rigidity and other movement symptoms affect both sides of the body. The person is able to live alone, but daily tasks are more difficult.

Falls are more common and motor symptoms worsen. The person is somewhat restricted in their daily activities, but is still physically capable of being independent.

Symptoms are fully developed and severely disabling. The person is able to walk and stand without assistance, but may need a cane/walker for safety.

Stiffness in the legs may make it impossible to stand or walk. The person is bedridden or confined to a wheelchair unless aided and requires around-the-clock care.

Diagnosis

Treating, Together.

There are currently no blood, laboratory or radiological tests to diagnose Parkinson’s disease (PD). In early Parkinson’s, the symptoms are often vague, such as minor tremor in a hand, a change in handwriting, pain in the neck or back, or occasional stumbling. The physician may need to observe the person over time prior to making an accurate diagnosis. Generally, when two of the four cardinal signs occur (tremor at rest, bradykinesia, rigidity or problems with balance), a diagnosis may be made and treatment initiated.

Your doctor may suggest a specific single-photon emission computerized tomography (SPECT) scan called a dopamine transporter (DAT) scan. Although this can help support the suspicion that you have Parkinson’s disease, it is your symptoms and neurological examination that ultimately determine the correct diagnosis. Most people do not require a DAT scan. Your provider may order lab tests, such as blood or imaging tests, to rule out other conditions that may be causing your symptoms.

Managing PD

Get connected with a Movement Disorder Specialist (MDS). An MDS is a neurologist with additional training in Parkinson’s disease and other movement disorders. If you need an MDS referral, give us a call.

Get involved with the Michigan Parkinson Foundation. You are not alone. We will tell you more about Parkinson’s, get you connected with a support group, and get you the information about our free exercise programs.

Exercise daily as part of your routine. It is critical in order to manage symptoms and slow down the course of the disease. Although medication can help with symptoms, it does not slow progression as exercise can.

Take your Parkinson’s-related medication. This will help with your symptoms, keep you active and alert, and improve your Quality of Life.

Get therapy. There’s many kinds, including: physical therapy, speech therapy, occupational therapy, talk therapy, aqua therapy, and massage therapy.

Appreciate and thank your loved ones/care partners. They are with you every step of the way. A compliment or hug could mean so much. Don’t take them for granted!

Tips For Getting Started

Start slow

Everest can’t be climbed in a day. Make small changes one at a time.

Prepare now for later

Prepare meals ahead of time or order groceries online.

Commit to goals

Keep your goals manageable and on a timeline.

Balance diet & exercise

Eating right and movement promotes cognitive function.

Get Involved

Explore information, programs, and resources for people with Parkinson’s and caregivers.

Why Exercise?

Moving, Together.

Studies show that exercise benefits physical and mental function, quality of life, strength, and more. Beyond improvement in PD symptoms, cardiovascular, joint, muscle and other body systems need regular exercise to maintain health. The choice of any particular exercise is not as important as the regularity and duration of the sessions. Exercise promotes brain health through:

Neuron size/speed of transmission increase
Increased corticomotor excitation
Blood flow increases
Increased serum levels of BDNF
Inflammation decreases
Immune system function improves
Dopamine receptors increased
Healthy brains recover faster and can do more with less

Along with exercise, cognitive training improves freezing of gait, processing speed, balance, visuospatial ability, and prioritization.

The Benefits of Exercise for
Parkinson’s Disease

Moving, Together.

Exercise is beneficial for general health and can assist in managing both motor and non-motor symptoms of Parkinson’s disease. For those with Parkinson’s, exercise has been shown to:

The best exercise for Parkinson’s is one that you will enjoy so you’ll stick with it. It’s important to get your body moving, keeping safety in mind. Research shows that a minimum of three days a week is key to help manage the symptoms of PD. Aerobic activity, strength training, balance training, agility, Multitasking, and stretching are all great options with unique benefits.

We offer classes taught by physical therapists who specialize in neurological disorders and instructors certified in Adaptive Yoga.

Alternative Therapy Options

Acupuncture

A system of integrative medicine that involves pricking the skin or tissues with needles, used to alleviate pain and to treat various physical, mental, and emotional conditions. Originating in ancient China, acupuncture is now widely practiced in the West. Acupuncture has been reported to have possible therapeutic effectiveness for PD in clinical trials, as manifested by improvement in clinical symptoms such as tremor, a decrease in the dosage of antiparkinsonian drugs, a decrease in side effects, and improvements in daily life, such as improved sleep.

Guided imagery

The use of words and music to evoke positive imaginary scenarios in a subject with a view to bringing about some beneficial effect. Guided imagery is a relaxation technique that uses positive mental images to influence how you feel. It can enhance your traditional Parkinson’s treatment. But it does not replace traditional treatment. Guided imagery is an ancient practice that includes simple visualization.

Chiropractic

A system of integrative medicine based on the diagnosis and manipulative treatment of misalignments of the joints, especially those of the spinal column, which are held to cause other disorders by affecting the nerves, muscles, and organs. The goal of chiropractic care is to improve the function of the central nervous system, composed of the brain and spinal cord and the driving force behind everything that occurs in the body. Bentonville chiropractor Dr. Tom Niemela will improve spinal health to increase the function of the central nervous system and the brain by removing spinal misalignments that cause nerve interference.

Yoga

A Hindu spiritual and ascetic discipline, a part of which, including breath control, simple meditation, and the adoption of specific bodily postures, is widely practiced for health and relaxation. The Benefits of Yoga for People with Parkinson’s Disease: Increased flexibility, better balance, greater strength, fewer muscle cramps, deeper sleep, easier breathing and greater sense of well-being.

Hypnosis

The induction of a state of consciousness in which a person apparently loses the power of voluntary action and is highly responsive to suggestion or direction. Its use in therapy, typically to recover suppressed memories or to allow modification of behavior by suggestion, has been revived but is still controversial. Hypnosis is a viable therapy for people with Parkinson’s Disease. Stiffness, shakiness, slowness, pain, fear, anxiety, dementia, and sleeplessness can be reduced and sometimes eliminated.

Biofeedback

A process whereby electronic monitoring of a normally automatic bodily function is used to train someone to acquire voluntary control of that function. Results from the current study suggest that real-time visual biofeedback may be effective at modifying specific gait characteristics that are associated with falls in PD.

Aromatherapy

The use of aromatic plant extracts and essential oils in massage or baths. Essential oils are a complementary therapy that may help reduce PD symptoms. Lavender can aid in sleep, sweet orange can help with anxiety, and peppermint eases nausea. In studies, rosemary and cinnamon have been shown to potentially slow down the progression of PD.

Massage

The rubbing and kneading of muscles and joints of the body with the hands, especially to relieve tension or pain. How can it help in Parkinson’s? Research suggests that massage can help to relieve the muscle stiffness and rigidity that is often found in Parkinson’s. It can also help reduce stress, promote relaxation and enable you to identify tension in your body, and so find ways to minimize or reduce this.

Music/Art

It’s a complementary therapy that is used along with other cancer treatments. It helps patients cope mentally and physically with their diagnosis. Music therapy may involve listening to music, making music, singing, and discussing music, along with guided imagery with music. Music therapy, which utilizes rhythm, movement, voice and creativity to try to improve Parkinson’s disease (PD) symptoms, are very popular for people with PD. Music-based therapies may work in a variety of ways to improve Parkinson’s related challenges.

Medication

Currently available PD medications do offer symptomatic relief, but as PD progresses, their use is often associated with significant and sometimes intolerable side effects.

For example, Levodopa, one of the most effective treatments for PD can normalize motor function for years but later cause involuntary muscle movements known as dyskinesia and dystonia (sustained muscle contractions). People in the mid to late stages of PD often experience a wearing-off of the beneficial effects of PD drugs and a re-emergence of motor and non-motor symptoms before their next scheduled dose.

In addition to new therapeutic options, better diagnostic tools are needed to identify PD earlier in the course of the disease. Earlier diagnosis may provide a therapeutic window to slow or prevent the progression of PD prior to the onset of motor impairments.

Speech Therapy

Parkinson’s disease (PD) can affect speech in several ways. Those with PD may speak quietly and in one tone without conveying emotion. They might slur words, mumble, or trail off. Speech problems can make it difficult to communicate with family, friends, co-workers and physicians and can limit social interactions. Parkinson’s medication adjustments sometimes help with speech problems, but speech therapy and sustained practice is typically the best treatment. Vocal exercises can also help with swallowing that can sometimes pose difficulty in the later stages of PD.

The Michigan Parkinson Foundation partners with several programs to help bring you the best option to help you learn the best techniques and practice your speech.

Check out these in-person and virtual (statewide) programs below!

In-Person Speech Therapy

Andrews University Speech and Hearing Clinic
SPEAK OUT!® Therapy (in-person & virtual)

Virtual programming available via Zoom, in-person programming only available in Berrien Springs, MI.

The SPEAK OUT! Therapy Program, developed by Parkinson Voice Project, helps people with Parkinson’s and related disorders REGAIN and RETAIN their speech and swallowing. The program can improve volume, articulation, breath support for speech, vocal quality, intonation, and facial expression. Patients and families also report reduced drooling and improved swallowing. This highly effective, research based treatment combines education, individual and group speech therapy, and daily home practice.

To join, call 269-471-3468 or email  parkinsons@andrews.edu

View Website Here

Currently accepting new clients for individual SPEAK OUT! Therapy for October through December, will take a break over the holidays and then resume January through April.

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Speech Empowerment Solutions LLC (in-person)

Located in Rochester Hills, providing in-home speech therapy to Oakland and Macomb county.

View Website Here

Email Lisa Miodowski: Lisa@speechempowermentsolutions.com

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My Voice Speech Therapy, LLC (in-person & virtual)

Serving Southeast Michigan and Kalamazoo areas in-person.

Andrea Malsom, MA, CCC-SLP, Owner and Speech-Language Pathologist specializing in care for those with Parkinson’s. For over 15 years, she has helped clients navigate their communication, thinking, and swallowing difficulties through tailored speech therapy services including the LSVT LOUD® and SPEAK OUT! Therapy programs.

View Website Here

Phone: (269) 350-4182

Email: andrea@myvoicetherapy.com

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Beyond Speech & Language (in-person & virtual)

Samantha Osborne, Speech-Language Pathologist, certified in SPEAK OUT! Therapy. Located in Metro Detroit.

Phone: 248-701-8090

Email: beyondspeech.slpmi@gmail.com

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Motor City Upbeats (in-person & virtual)

This program is currently paused. We will update when it is running again.

In-person programming located in the Metro Detroit area.

Designed by a speech and language pathologist, the Henry Ford Motor City Upbeats therapeutic choir offers patients the opportunity to apply and practice the techniques learned during voice therapy in a fun, supportive environment.

View Website Here

Phone: (248) 661-7241

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Calvin College (in-person & virtual)

Calvin Speech & Hearing Clinic Calvin University, Grand Rapids, MI

Clinical services are provided by graduate student clinicians under close professional supervision by certified speech-language pathologists. Treatment is provided in individual and small group settings with a focus on developing functional communication skills.

View Website Here

Phone: (616) 526-6070

Email: SPAUD@calvin.edu

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Exercise and Speech Therapy at Corewell West in Grand Rapids (in-person & virtual)

Once participants complete the LSVT or Parkinson Voice Project SPEAK OUT! Therapy programs, they are welcome to join the free Everybody Vs Parkinson’s group exercise classes. They offer in-person classes Monday and Friday at their East Beltline clinic in Grand Rapids, and virtual classes Monday, Wednesday, and Friday.  They also offer a virtual SPEAK OUT! Therapy class on Thursdays.

Two rehab clinics (Corewell Health Care Centers) are located at:

2750 East Beltline NE, Grand Rapids, MI 49525

6105 Wilson Ave SW, Grandville, MI 49418

To find out more information visit their website here. To schedule a session reach out to Corewell Health Central Scheduling for PT/OT/SLP via phone at: (616) 267-2626.

Virtual Speech Therapy

Andrews University Speech and Hearing Clinic
SPEAK OUT!® Therapy (in-person & virtual)

Virtual programming available via Zoom, in-person programming only available in Berrien Springs, MI.

To join, call 269-471-3468 or email  parkinsons@andrews.edu

View Website Here

Currently accepting new clients for individual SPEAK OUT! Therapy for October through December, will take a break over the holidays and then resume January through April.

___________________

Central Michigan University SPEAK OUT! Therapy (virtual only)

Meets virtually every Friday at 10:00 a.m.

Click here to register for this SPEAK OUT! Therapy class.

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My Voice Speech Therapy, LLC (in-person & virtual)

Serving Southeast Michigan and Kalamazoo areas in person.

View Website Here

Phone: (269) 350-4182

Email: andrea@myvoicetherapy.com

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Beyond Speech & Language (in-person & virtual)

Samantha Osborne, Speech-Language Pathologist, certified in SPEAK OUT! Therapy. Located in Metro Detroit.

Phone: 248-701-8090

Email: beyondspeech.slpmi@gmail.com

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Motor City Upbeats (in-person & virtual)

This program is currently paused. We will update when it is running again.

In-person programming located in the Metro Detroit area.

View Website Here

Phone: (248) 661-7241

___________________

Exercise and Speech Therapy at Corewell West in Grand Rapids (in-person & virtual)

Two rehab clinics (Corewell Health Care Centers) are located at:

2750 East Beltline NE, Grand Rapids, MI 49525

6105 Wilson Ave SW, Grandville, MI 49418

To find out more information visit their website here. To schedule a session reach out to Corewell Health Central Scheduling for PT/OT/SLP via phone at: (616) 267-2626

___________________

Calvin College (in-person & virtual)

Calvin Speech & Hearing Clinic Calvin University, Grand Rapids, MI

View Website Here

Phone: (616) 526-6070

Email: SPAUD@calvin.edu

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Understanding Parkinson’s Disease

Navigation

What is Parkinson’s?

Stages of Parkinson’s Disease

Diagnosis

Managing PD

Tips For Getting Started

Why Exercise?

The Benefits of Exercise for Parkinson’s Disease

Alternative Therapy Options

Medication

Speech Therapy

Resources & Research

Contact Us

Understanding
Parkinson’s Disease

The Benefits of Exercise for
Parkinson’s Disease