Parkinson's Disease and Sensory/Motor Awareness

I'm not going to discuss pathophysiology of Parkinson's Disease (PD) in details here, but I'd like to share my experience of working with people with PD.  

Bradykinesia (slow movement) and Akinesia (muscle rigidity) are common motor symptoms of the disease.  The disease slowly affects movement quality and posture over time.  As people start to move more slowly with smaller range of motion, the nervous system starts to adjust its sensory awareness/perception as the movement changes.  Because this change continues gradually, people may not notice such change, even though it may be apparent to other people's eyes. What will happen is that their sensory awareness becomes so distorted that they perceive their abnormally slow and small movements as being "normal."  When they see other people moving at their regular speed, they don't perceive them as moving faster with larger range of motion than they are.  It's like a thermostat that is off.

PD is often considered as a movement disorder, but to be more precise and accurate, it is a sensory-motor disorder.  Movement and sensation are constantly influencing each other and being updated in the brain.  Areas that you don't use much tend to have poor sensory awareness.  Areas that you use very frequently tend to have good sensory awareness.  How accurately can you sense specific parts of your low back without touching and seeing?  How accurately can you sense your individual fingers?  It's much more clear to sense your fingers, correct?  This is very important when working with people with PD because without changing their sensory-motor awareness/perception (calibrating their thermostat), they are much less likely to change their movement quality because their inaccurate perception tells them they are moving just "normal."

Parkinson's Disease and Early Intervention

I've started working with clients with Parkinson's Disease (PD) recently after I went to a LSVT BIG® certification course.  I was very surprised that only a few physicians refer their Parkinson's patients to exercise programs at early stage of disease.  Many physicians wait until patients' symptoms get much worse and their functions are apparently affected.  Although PD is progressive in nature, research has shown that early intervention can slow the progression of the disease or even reverse it.  Specific exercise program is beneficial at any stage, however, the outcomes are much more promising when it's initiated at very early stage.  

I've worked with people with PD of various stages, and I've seen huge improvements even in people with late stage PD.  One gentleman I worked with was initially wheelchair bound and was not able to stand from wheelchair without someone's assistance and not able to ambulate. After working with him for about 6 weeks, he was able to stand from wheelchair without any assistance, and able to walk with a walker.  This was a big deal for him who couldn't do these things for a long time and never imagined that he would be able to do these things again.  Not only the exercise program helped him to improve his functions, but improved his quality of life so much.  He was quite depressed and didn't have much motivation to do anything when I first saw him, but by the end, he was a completely different person.  

I'm hoping that more people with PD start hearing about benefits of early exercise program and initiate a program as soon as a diagnosis was made, and more physicians become aware of this.