Strategies for
Self-Management

STRATEGIES FOR

SELF-MANAGEMENT

Empowerment is the first step to self-management.

EMPOWER YOURSELF

MANAGE YOUR MOVEMENT DISORDER

Self-management strategies can be effective for many reasons. Not the least of which is the personal satisfaction that comes from actually doing something on your own to help manage your symptoms. Many people find embracing that personal responsibility is a powerful first step toward relief.

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NUTRITION’S IMPORTANT ROLE

AMONG SELF-MANAGEMENT STRATEGIES.

Changes in nutritional status often underlie a variety of seemingly unrelated problems in people with movement disorders, from weakness and weight loss (or gain), to changes in mood, alertness, and general quality of life. Nearly every patient with a mid-stage to advanced stage movement disorder will present with a combination of nutrition problems and disease problems unrelated to nutrition. At first evaluation, the proportion of each of these may not be readily apparent. The crucial difference being that, unlike many symptoms of movement disorders, nutritional issues are often easily corrected.

For most movement disorders, a comprehensive nutrition assessment by a qualified professional (Registered Dietitian) can determine what intervention(s) could optimize that individual’s nutrition.

A simple conversation between the patient and the dietician can determine what interventions could optimize a patient’s nutrition. This conversation typically includes a review of the patient’s eating habits, food allergies and aversions, culinary preferences and any additional health-related problems.

STAYING ACTIVE

CAN HAVE IMMEDIATE AND LONG-TERM BENEFITS.

Movement, slowness and stiffness can be difficult when you live with Parkinson’s disease (PD). Slowness in particular can make you feel weak and is very unsatisfying. Adding regular exercise may improve your overall mobility and quality of life.

What Is the Role of Exercise in PD?

Exercise is a planned, structured and repetitive physical activity. It is a complement to:

  • Other physical activity
  • Medications
  • Surgery
  • Physical therapy
  • Occupational therapy

Exercise programs can help you stay active and support your daily living activities. Be sure to define your goals before you begin a program. It is important for patients to conduct their exercises during an ‘on’ period when possible.

 

How Does Exercise Benefit Thinking and Memory?

The brain can form and reorganize connections. It’s known as neuroplasticity. There is some evidence that exercise may improve neuroplasticity. Exercise can help improve attention, thinking and memory. Physical activities may benefit brain areas related to learning. This effect is more obvious in early disease phases. To increase exercise’s benefit, include:

  • Physical or spoken feedback
  • Attention tasks, such as walking and doing a memory test at the same time
  • Motivational rewards

 

What Motor Symptoms of PD Can Improve With Exercise?

Patients often complain about difficulties with walking, mobility, posture and balance as PD advances. These symptoms may improve with exercise. The risk of falls may also decrease.

 

Does Exercise Have Any Additional Benefits?

Exercise may improve movement, thinking and memory function. You may also find exercise can have a positive impact on your physical appearance, mood and social interactions. You may experience:

  • Better arm and leg strength
  • Core muscle strengt
  • More muscle flexibility

What Type of Exercises Are Recommended?

There is no exercise that clearly is better than another. The most important thing is to do exercise that you enjoy and will continue. This can include cardio exercise (exercise cycle, elliptical machine) and light lifting of weights. Do not overdue exercise or put yourself at risk for falling. Researchers have studied and recommend several exercises for people with PD. Some examples include:

  • Tai Chi
  • Tango dancing
  • Exercising on a treadmill or elliptical machine
  • Cycling

 

What Symptom-Specific Exercises Are Recommended?

  • Tai Chi. This exercise helps posture control. It can also improve control of your center of gravity, reducing the risk and number of falls.
  • Tango dancing. This activity supports your body and brain. It can help increase coordination with a partner, spatial awareness and ability to focu
  • Exercising on a treadmill or elliptical machine. This may improve how you walk, step or run (your gait). It may also help improve your speed, stride length, balance and gait rhythm. Adjust the speed and slope to make this exercise more effective. However, be careful about falling.
  • Cycling. It may help to improve the walking speed and cadence.

It is important that you talk to your doctor before beginning an exercise plan.

BUILD THE CONNECTION

BETWEEN MINDSET AND SELF-MANAGEMENT.

Clinical psychologists provide assessments and psychotherapeutic interventions for a wide range of emotional and social problems to individuals, couples, families or groups. The majority of clinical psychologists use a form of cognitive behaviour therapy (CBT), interpersonal therapy (IPT) or other modern theory-driven evidence-based intervention.

Such therapies can provide an effective alternative to pharmacotherapy, particularly in mild-moderate disorder, or can be used in combination. Neuropsychologists are also clinical psychologists who work specifically with clients with neurological disorder, either for assessment only, or wider rehabilitation and psychotherapy.

Where a service does not include a clinical psychologist in the multidisciplinary team, referral must be made to an appropriate specialist (e.g. elder or dementia care, neurorehabilitation) or adult mental health team that can offer both psychological and psychiatric expertise.

Ideally, the clinical psychologist will have an established link with the referring team and some experience in seeing clients with Parkinson’s disease. However, even if the clinical psychologist more typically works with other client groups, their problem-focused therapeutic techniques are readily applied to many of the symptoms experienced by patients with movement disorders including:

  • Depression and anxiety
  • Interpersonal and relationship problems
  • Fatigue, sleep disorder and pain
  • Apathy and executive dysfunction
  • Anger and irritability
  • Gambling, hypersexuality, compulsive shopping and eating

Clinical psychologists can also offer consultation and training to other health-care professionals in the assessment and management of such problems, and may work jointly with them to deliver group-based interventions to patients and their caregivers.

WORKING WITH

YOUR CAREGIVER

The first step for your caregiver will be to find out just what kind of help you will need. There may not seem to be a “right time” to bring up difficult topics, like tasks you may no longer be able to perform or activities you may have to give up. But as you work with your caregiver, one of the best places you can start is with an open, direct, and honest conversation.

Your caregiver’s plan can be as simple as a list of daily tasks or as challenging as planning for full-time care. Together, you’ll need to create a plan that’s built around your unique needs, specific symptoms, and your plans and goals for your future.

However, there are a few important first steps you should take together no matter what. Taking these steps as early as possible will help set your caregiver up for success – and give you the peace of mind you need to ensure that both you and your caregiver will always have the support they need.

Remember that caregivers need support too. They should aim to make a list of people who are willing and able to help: family members, friends, and community members. It can be helpful to reach out to religious organizations, clubs, and other local resources, too.

For your caregiver, there will be many times when they need to be able to answer important questions and provide critical information on your behalf. Make sure your caregiver has ready access to these key resources and documents: personal information, health information and financial information.

Treatment needs may be very different and may change significantly over time. It’s important for you both to know and remember which treatments you have tried, how those treatments have worked, and which treatments you are currently undertaking.

RX ONLY

Brief Summary: Prior to using these devices, please review the User’s Guide for a complete listing of indications, contraindications, warnings, precautions, potential adverse events, and directions for use. The system is intended to be used with leads and associated extensions that are compatible with the system. Indications for Use: Unilateral or bilateral stimulation of the thalamus, internal globus pallidus (GPi), or subthalamic nucleus (STN) in patients who are at least 18 years old with levodopa-responsive Parkinson’s disease. Unilateral or bilateral stimulation of the ventral intermediate nucleus (VIM) of the thalamus for the management of tremor for patients who are at least 18 years old. Unilateral or bilateral stimulation of the internal globus pallidus (GPi) or the subthalamic nucleus (STN) for the management of intractable, chronic dystonia, including primary and secondary dystonia, for patients who are at least 7 years old.

Contraindications: Patients who are unable to properly operate the system or for whom test stimulation is unsuccessful. Diathermy and magnetic resonance imaging are contraindicated for patients with a deep brain stimulation system.

Warnings/Precautions: Return of symptoms due to abrupt cessation of stimulation (rebound effect), excessive or low frequency stimulation, risk of depression and suicide, implanted cardiac systems or other active implantable devices, magnetic resonance imaging (MRI), electromagnetic interference (EMI), proximity to electrosurgery devices and high-output ultrasonics and lithotripsy, ultrasonic scanning equipment, external defibrillators, and therapeutic radiation, therapeutic magnets, household appliances containing magnets, radiofrequency sources, explosive or flammable gases, theft detectors and metal screening devices, activities requiring excessive twisting or stretching, operation of machinery and equipment, pregnancy, nursing, psychotherapeutic procedures, electrocardiograms, cremation, and case damage. Patients who are poor surgical risks, with multiple illnesses, or with active general infections should not be implanted.

Adverse Effects: Loss of therapeutic benefit or decreased therapeutic response, painful stimulation, persistent pain around the implanted parts (e.g., along the extension path in the neck), worsening of motor impairment, paresis, dystonia, sensory disturbance or impairment, speech or language impairment, and cognitive impairment. Surgical risks include intracranial hemorrhage, stroke, paralysis, and death. Other complications may include seizures and infection. User’s Guide must be reviewed for detailed disclosure.

REFERENCES

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