7 minute read
Parkinson’s
By Anne M. Pott The Continuum: Part Three
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In this third segment on the nature of Parkinson's disease (PD), we will provide a brief overview of PD, explore the benefits of an interdisciplinary team, describe some of the most common non-motor symptoms, and share some evidence-based interventions and activities. We hope to offer helpful information that, when shared, may lead to a better quality of life for people with Parkinson's disease (PD) and greater awareness within our community.
Overview
According to the American Parkinson Disease Association, almost one million people in the U.S. live with PD. This number will continue to rise with global aging. Parkinson’s disease interrupts dopamine’s ability to regulate movement. Over time, its symptoms become more debilitating. While the cause and cure for PD are unknown, research projects such as those sponsored by the Michael J. Fox Foundation offer promise. A primary research goal is to protect and restore dopamine receptors in the brain from Parkinson’s destructive path.
Interdisciplinary Team Approach
How PD affects one’s physiological and psychological health across the disease course is different for each individual. Jackie Hunt Christiansen explains it in the very title of her article Your Symptoms are Unique to You found on the Parkinson Foundation website. Another point of diversity to remember, according to Christiansen, is what Richard describes, “The only predictable thing about this disease is that it is unpredictable.” Specialists in PD widely acknowledge the complex and progressive changes in an individual’s overall health. With the extensive knowledge, experience, and creative collaboration of a movement disorder specialist and a team of PD-related specialists, an individual, and their care partner/family can develop flexible treatment plans across the disease’s progression.
Non-Motor Symptoms
While the motor symptoms of tremors, slow movements, and muscle rigidity are PD’s most recognized symptoms, this article focuses on the varied and often-overlooked non-motor symptoms. Paul on the Davis Phinney Foundation website explains, “It’s a lot harder to explain the Parkinson’s that people don’t see.” Losses in taste or smell, trouble sleeping, constipation, and depression often appear years earlier than motor symptoms. The Parkinson’s Foundation describes other common types of non-motor symptoms: anxiety, apathy, breathing, and respiratory difficulties, cognitive changes, nausea, dementia, fatigue, hallucinations/delusions, pain, skeletal & bone health, skin changes, small handwriting, speech and swallowing problems, urinary incontinence, vertigo and dizziness, vision changes, and weight management. Many of these problematic symptoms are not readily apparent to friends and families. Healthcare providers may misattribute them to other common health conditions.
Surprisingly, non-motor symptoms take a more substantial toll on everyday quality of life than the more visible motor symptoms. Specialists and people living with PD often share that the non-motor symptoms outnumber and cause more significant disabilities than motor symptoms. According to the Parkinson’s Foundation, non-motor symptoms may become dominant in PD, ultimately requiring complex treatments, hospitalization, and potentially institutionalization. Five overarching health conditions caused by PD, as described by Pfeiffer (2019) in his expert briefing for the Parkinson’s Foundation, are a) sensation abnormalities, b) sleep disorders, c) automatic dysfunction, d) fatigue, and e) behavioral changes. With this article’s scope, we will focus on PD’s automatic dysfunctions that affect communication and eating.
Speech, Voice, and Swallowing Problems
As mentioned above, family, friends, and medical providers may miss the early development of some internal non-motor symptoms. On the other hand, they consistently recognize a series of noticeable automatic changes in one’s voice and speech patterns before the person with PD. The Michael J. Fox Foundation describes voice and speech symptoms as a soft or hoarse, monotone voice, mumbling, slurring words, trailing off at the end of sentences, stammering, stuttering, and difficulty regulating speech cadence. Other non-motor symptoms such as losses in facial expression, called “masking,” and cognition complicate communication efforts with mixed non-verbal cues and word retrieval problems.
In the same domain, losses in autonomic muscular function affect how well one can eat and drink. Coughing becomes more frequent when swallowing, chewing food, or managing excess saliva. Dysphagia is the medical term for swallowing dysfunctions. The Parkinson’s Foundation explains how choking, dehydration, malnutrition, and aspiration are dangerous complications that may develop from dysphagia. Aspiration pneumonia which develops from aspirating food or liquid into your lungs instead of down your throat is the leading cause
The Benefits of Speech Therapy
The Parkinson’s Foundation states that 89 percent of individuals with PD experience a speech or voice impairment, while only 3-4 percent of these individuals receive speech therapy. A primary reason for the lack of participation in speech therapy is that many people with PD cannot recognize changes in their speech and voice. Speech therapy is necessary to improve speech, voice, swallowing, and cognitive function. The Davis Phinney Foundation for Parkinson’s offers a very informative Ask the Parkinson’s Expert segment on Why do I need a speech therapist? In her video, Kathleen Donahue explains that speech and language pathologists can also help with cognition, the “knowing, thinking, learning, understanding, and reasoning” processing difficulties. According to speech and language pathologist Leticia Alvizo of The Continuum, speech therapy helps prevent “a lack of quality of life and social isola-
A woman receiving speech therapy at The Continuum.
tion, which leads to significant cognitive and memory decline, and higher mortality.”
Evidence-Based Speech Therapy Programs
When searching for a speech and language pathologist, it is essential to find one certified by the American Speech-Language-Hearing Association (ASHA). Additional certifications in specialized evidence-based programs to treat PD are highly beneficial. One such program is The Lee Silverman Voice Treatment (LSVT) Loud. With 25 years of experience, it utilizes specific exercises to improve speech volume. The Parkinson Voice Project SPEAK OUT® program comprises 12 weeks of individualized training. Their LOUD Crowd® program offers ongoing treatments through at-home exercises, singing and speech groups, and six-month evaluations with the therapist. Specialized wellness activities can be fun and support positive communication outcomes. A few popular ones include Singing with Parkinson’s, Laughter Yoga, and Improv.
Conclusion
Research shows that non-motor symptoms can be more problematic for people living with PD. They can alter sensations, sleep, automatic function, energy levels, thinking, and behavior. People with PD learn to speak with greater intention and combat other non-motor health conditions’ adverse effects with early and ongoing evidence-based interventions. With the support of friends, family, care partners, and a specialized PD interdisciplinary team, people with PD can experience a better quality of life. For more questions regarding Parkinson’s Disease, please contact Diane Ross at the Continuum, 3700 Grant Drive, Suite A. Reno, NV 89509. (775) 829-4700.
Veterans Guest House CEO, Noreen Leary, Retires
Noreen Leary, of the Veterans Guest House, retired on February 12, 2021, ending a long career as CEO. Sylvia DuBeau, a Navy veteran and non-profit executive, has been named the new CEO. “It’s time for me to start writing the next chapter of my life,” said Leary. “The past 16 years serving as CEO of the Veterans Guest House have been some of the most humbling and rewarding years of my life. But I am ready to sleep in, not worry about being ready for an early meeting and spending more time with family and friends.” Leary has served in many roles at the Veterans Guest House. In her early years she was the director, house manager, maintenance worker and chief cheerleader all while residing in a 500 square foot apartment in the basement of the guest house building. Mark Cameron, President of the Veterans Guest House Board of Directors, has worked alongside Leary. “Noreen’s commitment and dedication has helped build a treasure in our community that would make the original founders very proud. We are grateful for the passion and determination that Noreen displayed over the years - it has been the driving factor in making the Guest House what it is today.” Through her unwavering gusto, community outreach, and sincere love of veterans, her vision of a ‘home away from home’ for veterans and their families, evolved from a small humble structure to a modern state of the art house where guests are treated with the respect, care, and love they deserve. “During our search for a new CEO, we wanted to make sure the person we hired had a strong non-profit background and an affinity for the community we serve.” said Cameron. DuBeau brings more than 10 years of non-profit executive experience, most recently serving as the Chief Development Officer for Second Chance based in San Diego. Her professional and military background have positioned her well for the role.
