Helping people with Parkinsons disease to live well Dr Natalie - - PowerPoint PPT Presentation

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Helping people with Parkinson’s disease to live well

Dr Natalie Allen

natalie.allen@sydney.edu.au

Parkinson’s NSW Public Forum September 2019

Image from Queensland Health

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Background – As PD progresses, people develop a variety of motor and non-motor problems, including – trouble walking – falls – pain – Overall research aim: To help people with PD and their families live better by maintaining safe mobility and managing pain

Image from Queensland Health

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Background - pain – People with more pain undertook less exercise (Allen et al,

2015, Movement Disorders Clinical Practice)

– Systematic review – carefully prescribed exercise might be effective in reducing pain through neurochemical and neuroplastic changes (Allen et al,

2015, Journal of Parkinson’s Disease)

– In some chronic pain conditions (eg fibromyalgia), exercise can increase pain sensitivity

Image from: http://painpatient.com/2014/07/30/relieving-elderly- aches-pains/

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Grant

PNSW Grant 2016:

Towards effective exercise prescription to reduce pain in people with Parkinson’ s disease AIMS:

• 1. To determine if exercise had an immediate

reduction in pain sensitivity (exercise-induced hypoalgesia)

• 2. To explore relationships between pain, physical

activity, sleep and mood

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Publication

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• Measurement of pressure pain thresholds before

and after:

• 3 minutes of arm exercise (isometric elbow

flexor contraction at 40% 1RM)

• Treadmill walking at light intensity
• Treadmill walking at moderate intensity

Exercise sensitivity and pain in people with Parkinson’s disease.

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Exercise leads to an immediate reduction in pain sensitivity in most people

• Overall increase in pressure-pain threshold

following both isometric arm exercise and aerobic treadmill walking (showing exercise induced hypoalgesia)

• In people with PD
• In people without PD

BUT

• Some individuals did not have this response

No difference between people with and without PD

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Increased physical activity, poor sleep and low mood were associated with increased pain

• Increased physical activity
• Sleep disturbance
• Anxiety and depression

These variables accounted for up to 56% of the variance in the pain scale measure Increased pain

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association ≠ causation

• Increased activity to manage pain?
• Inappropriate activity?

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Exercise for pain management

• Most people with PD have the

usual immediate analgesic response to exercise.

• The analgesic response occurs

after both aerobic and resistance exercise.

• People with PD and pain

should consult a physiotherapist to assist them to establish, monitor and progress an appropriate exercise program

https://www.painmanagementdenverco.com/pain-management.html

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Background – safe mobility – Exercise reduces fall rates in people with mild to moderate PD (Canning et al, 2015, Neurology) – Despite this, the rate of falls remains unacceptably high – Exercise alone does not reduce falls in people with more severe disease. – Cognitive problems are associated with increased falls, but most studies exclude people with cognitive problems. One size does not fit all!

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Grant

PNSW Grant 2018:

Integrate: a tailored and multifactorial program for safe mobility in people with more advanced Parkinson’s disease AIMS: Does the 6 month Integrate program improve:

• 1. Mobility and safe mobility behaviours

and

• 2. Walking, freezing, leg muscle strength, concern

about falling, activities of daily living, fatigue and care-partner burden in people with Parkinson’s disease?

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Pilot study

4 month trial (7 people and their care-partners) People found the program helpful and liked that it was:

• Home based
• Combined OT and physiotherapy, tailored for the

individual

• Therapists who are experts in Parkinson’s

disease

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Integrate study 40 volunteers with Parkinson’s disease

Keep a falls diary for 2 months Initial assessment (at home) RANDOM ALLOCATION Usual care group

• Usual activities and

treatment

• Keep a falls diary

Integrate group

• OT and physiotherapy

home visits (8 to 12)

• Home modifications
• Safe mobility strategies
• Exercise 3 to 5 times per

week

• Keep a falls diary

6 months Final assessment (at home) Keep a falls diary for 6 months

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Integrate group – home-based OT and Physio for 6 months

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Who can participate?  Diagnosis of idiopathic Parkinson’s disease  Able to walk 10m on your own (walking aids are permitted)  Have fallen at least 2 times in the last 6 months  People with significant thinking problems will need a care-partner to participate with them Sydney greater-metropolitan area

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Acknowledgments

– Participants – Collaborators – Ben Barry, Matt Brodie, Colleen Canning, Lindy Clemson, Jacqueline Close, Leanne Hassett, Simon Lewis, Niklas Lofgren, Stephen Lord, Niamh Moloney, Vanessa Nguy, Serene Paul, Cathie Sherrington, therapy staff – Parkinson’s NSW funding