Parkinson's Symptom Management

This taken directly from http://en.wikipedia.org/wiki/Parkinson. It's Dad's Parkinson's symptoms that are causing Dad problems at the moment so I went searching for some help..

There are other disorders that are called Parkinson-plus diseases. These include: multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Some include dementia with Lewy bodies (DLB) — while idiopathic Parkinson's disease patients also have Lewy bodies in their brain tissue, the distribution is denser and more widespread in DLB. Even so, the relationship between Parkinson disease, Parkinson disease with dementia (PDD), and dementia with Lewy bodies (DLB) might be most accurately conceptualized as a spectrum, with a discrete area of overlap between each of the three disorders. The natural history and role of Lewy bodies is little understood.

I felt I needed information to help Dad with his Parkinson's symptoms. I found this information at http://www.parkinsons.org.au/about-ps/treatments.htm Parkinson's Australia.


Symptom Management
1. Mobility
Rigidity and slowness of movement are the two most frustrating aspects. Common difficulties are:
Walking
-to help initiate walking gently rock the patient from side to side and then ask to step forward
-encourage to step over an object when freezing occurs
-counting while marching is helpful
-encourage arm-swinging to improve balance
Turning
-encourage to turn in a wide circle rather than pivoting on the spot
-Rising from a chair
-use a high chair with arm rests
-move to the front of the chair, place feet on the floor 8 10 inches apart, put hands on arms of chair, lean forward and push up. If unsuccessful rock forward and re-try
Turning in bed
-may need regular turning
-use Tri-Turn Sheets, bed poles, other aids
Tremor
writing, eating and dressing are difficult
-keep elbow pressed close to side
-use eating utensils from Occupational Therapist
-velcro tabs easier than zips and buttons
2. Eating and Drinking:
-assistance with eating may be necessary
-alter the diet if necessary
-frequent sips of cold water to prevent food sticking
-encourage coughing to prevent aspiration
-watch posture while eating
3. Constipation:
due to poverty of movement and slowing of bowel action also decreasing fluid intake and anticholinergics
4. Urinary Incontinence:
due to difficulty getting to the toilet, and inability to undress and prepare when there
monitor for constipation -- do not allow impaction to occur
-night time is more difficult due to turning and moving
-patients may be unable to initiate voiding -- frustration for nurse and patient
5. Communication
Parkinson's affects the control of muscle co-ordination and therefore a person's ability to communicate. The symptoms of tremor, stiffness and slowness can also impact upon the person's verbal and non-verbal methods of communicating with others.
Verbal Communication Speech:
Approximately 50% of people with Parkinson's experience difficulties with speech.
-the voice becomes softer due to a decreased ability to vocalise during exhalation
-slurring due to decreased tongue control
-difficulty initiating speech or unwanted hesitations due to akinesia
-uncontrollable repetitions of words
-speech may become monotonous and flat sounding, with no variation in the pitch and quality.
Management:
-referral to a speech pathologist
-increase use of non
-verbal communication, shorter sentences, more frequent pauses
-deep breathing and vocal exercises
-practice making sounds i.e. vowels
-don't let others talk for you
-use amplifiers etc if needed
Non-Verbal Communication
Facial Expression:
-due to reduced movement it becomes expressionless and "mask-like"
smiling, frowning, grinning and the ability to express anger, fear and joy require a conscious effort
-the listener may become confused and unable to respond appropriately
Management
facial exercises involving the brow, eyes, cheeks and lips to increase mobility
Limb Movement:
-may be restricted or "frozen" therefore limited non-verbal communication
-tremor of the hands most common
Management:
-general range of motion exercises to stretch the muscles of the limbs
-the tremor occurs at rest and decreases with purposeful movement therefore ensure the hand is doing something e.g. play with a coin, bead, or pen etc.
-arrest the tremor by immobilising the limb e.g. thumb tucked into belt, sit on hand, grab hold of structure, tuck elbow into side
Handwriting:
-due to difficulty with fine motor movements, the handwriting becomes smaller (micrographia)
-the shape of the letters remains the same but the size is smaller
-the smallness is exacerbated when writing a long paragraph compared to a short sentence, or when doing another task at the same time e.g. writing a message while on the phone changes may be noticed when signing cheques
-tremor can impede writing
Management:
-if writing becomes small STOP. Think about what you are writing and rehearse the movement in your mind
-write only small sections at a time
-use lined paper to act as a visual cue
-avoid doing other tasks while writing
-printing instead of writing may be easier
-use a non slip foam grip on the pen
-use other methods e.g. typewriter or computer

Christmas Day 08'

We all had a wonderful day at my cousins for Christmas lunch and dinner. Lots of yummy food and the most amazing professional xmas cake made by cousin's hubby who is a pastry chef...some people have talent. Dad was given a chicken for Oxfam and I, women's support for Oxfam. And I got my favorite, books, from my girls. Thanks family for a lovely day.

Dad had a great day and was happy. His cognitive functions were quite good but his Parkinson symptoms were playing up. It's his bowels again. I have increased the senna tablets to the maximum dosage per day, 2 in the morning 2 at night plus after each meal I give him 10 pitted prunes. After reading more about Parkinson symptoms I have decided to not start the Genlac until I speak to the Geriatrician. The Genlac helps by bulking up which in turn helps the muscles to automatically work but if Dad's muscles aren't following commands and he bulks up and can't expel he will be in worse pain. So throughout Christmas Day Dad was having trouble working his bowels.
When we were leaving and getting into the car his muscles froze but I was able to talk him into position...put your bottom back...lift your leg into the car. On the way home I drove Dad to see some local amazing house all lit up with Xmas lights. When we were children it was a Xmas tradition to go see the decorated houses on the Boulevard.
At 3.00 am Dad was up, naked in the hallway. He had had an incontinence episode. I was soooo tired...strip bed, had wet through mattress protector, turn mattress over, change Dad, don't put any sheets on bed...help him back in to bed. Go back to my room...could hear him shouting out...I could only shout back...you are ok, go to sleep...peace reigned, wonderful.

I have noticed Dad becoming more and more rigid when I help him into bed. He is becoming board like. This evening, he at first knelt on the bed but couldn't swing down to a horizontal position. So I sat him on the edge and helped his torso down, his legs shot up and I swung his legs across onto the mattress. I could have swung him, pivoting on his hip, like the hand of a clock. Even though he was laying down on the mattress, he looked like he was perched and could have fallen.

It was most important that Dad had a great xmas...and he did.