Parkinson's Disease - Lifestyle Changes

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• Take large steps when walking forward, raising the toes at the forward step, and hitting the ground with the heel.
• Take small steps while turning.
• When walking or turning, have the legs 12 to 15 inches apart to provide a wide base.
• Do not wear rubber or crepe-soled shoes because they grip the floor and may cause the patient to fall forward.
• Using devices that keep a rhythmic beat, such a metronome (a simple device used by musicians to keep time), may be very effective, possibly more than music itself, in helping patients to walk faster and take longer steps. One study found that setting a metronome rhythm to about 10% faster than the patient's fastest gait offers significant improvement over walking to no rhythm at all or to a rhythm that matches the gait.

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Reducing Muscle Freezing. The patient should practice regular daily activities that simplify actions and reduce the incidence of muscle freezing. Most often, freezing occurs when a patient begins to move or is presented with an obstacle. The following tips may be helpful:

• Rock from side to side.
• If the legs feel frozen, lift the toes. This simple action may free spasm in some cases.
• Hum marching tunes. In fact, music has been shown to help people move and to get out of bed in the morning. Some studies report that wearing a Walkman and turning music on in situations associated with freezing, such as crossing a street, is helpful.
• Divide actions into separate events, which may prevent freezing that occurs from trying to coordinate too many physical operations at one time. For instance, when going through a doorway, approach the door, stop at the door, open it, stop, and then walk through the doorway.
• A cane equipped with a laser pointer may be helpful, at least temporarily.
• Simply being touched by another person can sometimes release the patient (although a patient with PD should never be pulled or pushed).

Sleep Deprivation Therapy. Sleep deprivation therapy may have a role in treating some cases of depression and some studies are finding some benefits on the depression, tremor, and rigidity experienced by patients. Scientists believe that sleep deprivation produces certain anticholinergic effects, which may improve both depression and Parkinson's symptoms.

Mental Tasks. Mental training may increase dopamine in the brain. Some studies indicate that being mentally fit may be as important for patients as being physically fit. Helpful approaches include:

• Select and learn new hobbies that require finger and hand mobility, such as sewing, carpentry, fishing, or playing cards.
• Practice deep breathing and relaxation exercises. These may help maintain proper speech control, control tremor, and reduce anxiety.
• Both the patient and any caregivers should consider psychologic therapy and support for depression and loss of motivation. If psychological therapy is too costly, inexpensive support programs and groups are widely available and can be invaluable for the patient and the family.

Speech Therapy. Speech therapy may help those who develop a monotone voice and lose volume, particularly in combination with medications. There are no well-conducted studies comparing specific speech therapies, but the Lee Silverman Voice Treatment (LSVT) appears to be an example of an effective technique. It has five major components:

• Focus on the voice ("think loud/think shout").
• High effort (pushes patients to overcome limitations).
• Intensive treatment (16 sessions in one month).
• Calibration (learning to know and accept the amount of effort needed to produce normal sound so it becomes automatic).
• Quantification (continuous feedback to objectively document success).

LSVT may not only help speech but may even improve swallowing.

Equipment and Devices. A number of devices can be helpful for maintaining stability and preventing falls. The following are some examples:

• Rails installed where the patient needs support in getting up or down, such as along the bed and in the bathroom.
• Walkers with locking wheels. (Walkers do not appear to be helpful for freezing.)
• Chairs with straight backs, firm seats, and arm rests.
• Firm mattresses and satin sheets or less expensive sheets with high thread counts. (These are useful for helping patients slide out of bed.)

Review Date: 05/22/2006
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).