• Symptoms of Parkinson's disease

• Treatment Options

  • Treating Parkinson's disease with medication
  • Medication options for Parkinson's disease
  • Surgery for Parkinson's disease
  • Complementary / alternative treatments for PD
  • PD Treatment Team
  • Tips for managing Parkinson's disease medications

• PD: What you need to know

Complementary/alternative treatments for PD

In addition to surgery and treatment with medications, there are other therapies that can be used to improve the well-being of a person with Parkinson’s disease (PD). A complementary treatment is one that is used alongside a more traditional therapy such as medication, and many people with PD find these therapies very helpful – physically and/or emotionally. Delivery of the complementary therapy is usually performed by a member of the multidisciplinary team, e.g., physiotherapist. In contrast, an alternative therapy is one that is given in place of a traditional medication e.g., herbal medicine, coenzyme Q10.

Before starting or discontinuing any therapies, it is important to discuss all safety aspects with a doctor.

Healthy sleep

Sleep may not sound like a therapy, but it is an essential part of maintaining a healthy body and mind. Parkinson’s disease (PD) can be an exhausting disorder and, therefore, getting enough sleep is very important. In addition, some PD symptoms are improved by sleep, and many people find that their body movements are better in the morning after a good night’s rest. Conversely, symptoms may become (temporarily) worse after a late night.

Unfortunately, PD and the medications used to treat the condition can sometimes cause problems such as insomnia and vivid dreams, as well as pain and stiffness, which prevent restful sleep. Therefore, it can be helpful to establish a routine to promote sleep. This could include going to bed and getting up at regular times, avoiding oversleeping or daytime napping (or limiting it to a fixed period of time), and making the bedroom a dark, uncluttered, and restful place. It may also help to avoid caffeine drinks (e.g., coffee, cola) before bedtime, and not to read, eat or watch TV in bed.
            
Relaxation methods such as breathing techniques, yoga, massage, acupuncture or aromatherapy can reduce stress and prepare the body for sleep. However, if all these techniques fail, then it might be possible for the doctor to prescribe some sleep-promoting medications, or to alter the doses of any medications that could be causing sleep problems. As always, no changes in medication should be made without first consulting a doctor.

Diet

Diet is a very important aspect of living with Parkinson’s disease (PD). Maintaining a healthy and balanced diet is essential for the body to cope with PD symptoms.

In addition, the type of food and the time that it is eaten could change how some PD medications work. For example, protein may slow the action of levodopa. In addition, drinking plenty of water (8–10 glasses per day) is very important, and it is a good idea to keep any alcohol consumption in moderation.

Further details about diet and PD are presented in the ‘Healthy eating and PD’ section of this website. (link to section)

Exercise

Parkinson’s disease (PD) has many movement-related symptoms and exercise can help to ease some of these movement difficulties. Exercise is also necessary to maintain fitness and, no matter how fit a person is, it is important to ask for advice on exercise regimes from the moment of diagnosis.

Exercise can have a very positive effect on people with PD, switching the focus onto healthy body functioning. It also provides a sense of achievement and fun, alongside improving:

• muscle strength
• joint flexibility
• balance
• walking
• energy levels

and by helping to prevent:

• constipation
• sleep difficulties
• bone wasting (osteoporosis – exercise reduces the risk)

Exercise should not be strenuous or uncomfortable, but rather gentle, enjoyable and beneficial to the person with PD. For example, something as simple as a daily walk is a useful form of exercise, as it gets the heart, lungs and muscles pumping, improves flexibility and relieves stiffness. Tai Chi and certain types of yoga can be done by many people with PD, providing relaxation techniques and a gentle exercise routine, leading to a feeling of well-being. In some people, dancing can also be very beneficial as music, especially music that emphasises rhythm, e.g., tango or marching, not only improves general mobility but may also improve balance and help overcome freezing episodes. Taking exercise as part of a group can be a social activity, or a short routine of stretches and strengthening exercises can be done at home.

A doctor or physiotherapist should be able to suggest a safe exercise routine to use, as well as specific exercises for the most affected parts of the body. There are many exercises that can be recommended according to the needs of each individual.

Cueing and cognitive movement strategies

People with Parkinson’s disease (PD) sometimes find that their medication is not as effective as expected and this can cause problems such as ‘freezing’. Freezing is when a person with PD feels frozen/fixed to the floor when trying to start to walk or when walking through a narrow space such as a doorway. The use of visual cues, such as a line on the floor or doorframe, or auditory cues such as following the sound of a metronome or listening to marching music, are useful strategies to diminish freezing.

People with PD may also have difficulty performing long sequences of movements, such as transferring from sitting to standing. The good news is that breaking the long sequence of movements into small sections using cognitive movement strategies (i.e., performing one section after the other and concentrating on each step), can be a successful approach. For example, to rise from a sitting position, move to the left, to the right, to the left, to the right, ‘1… 2… 3…’, and stand up.

A physiotherapist will be able to identify the most suitable cueing and cognitive movement strategies for each specific situation.

Emotional support

Emotional support is a key part of managing Parkinson’s disease (PD), and can bring many benefits to people with PD, their caregivers and families.

It is common for people with PD to experience depression at some point during their illness. The depression may occur as a reaction to being diagnosed with PD and, in such cases, the depression can be treated by reducing stress levels, effectively treating movement symptoms, and taking part in exercise. These straightforward measures aim to improve quality of life for the person with PD and thereby improve mood.

Cognitive behavioural therapy is another complementary method that can be used to treat the psychological symptoms of depression. This type of therapy examines a person’s thoughts and behaviour and helps to change a counterproductive negative outlook into a more positive and realistic attitude.

However, it is possible that some cases of depression are caused by PD itself lowering the levels of chemicals in the brain that control mood. If this is the case, then the depression can be treated with antidepressants, although this should always be discussed fully with a doctor as some antidepressants can be harmful for people with PD, possibly reacting badly with PD medications already taken.

Whether or not a person experiences depression, it is important that their emotional needs are looked after, as well as their physical requirements. Thankfully, there are many organizations that offer all kinds of emotional support ranging from a simple chat over the phone, to group meetings and practical help. Even if there are family and friends to offer care and support, there may be times when either the person with PD or their caregiver/family needs someone else to turn to – this is the purpose of these groups.

Aside from depression, people experiencing life with PD may feel that they need emotional help in other ways including stress management, and/or psychological support. Again, assistance is readily available from support groups and counselors. Members of the multidisciplinary team will be able to provide advice on what help is available/appropriate for each individual.

Other therapies

There are many other non-pharmacological/non-surgical therapies available to improve the physical well-being and quality of daily life of a person with Parkinson’s disease. These include expert techniques such as physiotherapy (to improve muscle strength and movement), speech therapy, occupational therapy (practical advice on the home, workplace, or general living environment), sex therapy (see section on ‘Intimacy’), breathing techniques, acupuncture, Alexander technique, spinal manipulation, massage, yoga and aromatherapy.

Appropriate practical tips for living with PD can also have a big impact on daily life (tips related to taking medication are discussed in the ‘Tips for managing medications’ section). Simple changes to the home such as making sure that walkways are clear and well lit, securing or removing loose rugs or slippery flooring, adding handrails, and tidying away trailing electrical cables, can make it easier to move around the house. Arranging storage places and commonly used items so that they are easily accessible can also help with everyday living. As listed above, occupational therapists are available to offer specialist guidance on all these topics, and physiotherapists will also be able to advise on the selection of appropriate walking aids.

People with PD often report that these therapies have a positive impact on their quality of life. Anyone who is interested in finding out more should speak to a member of their multidisciplinary team, who will either be able to provide the therapy themselves, or recommend the best source of information.

Positive attitude

Parkinson’s disease (PD) can be managed and treated in many ways, with medications, surgery, exercise, diet, complementary therapies, emotional support and strong relationships all playing important roles.

However, the quality of life of a person with PD is not just related to treating PD and its symptoms. Finding out more about PD, relating to the new situation in life, and learning to accept new goals and challenges, is just as important as practical management. In addition, a focus on what can be achieved, rather than what cannot, is a helpful and positive attitude.

The following quote is taken from a book entitled ‘Health is between your ears. Living with a chronic disease’ by Svend Andersen, a psychologist who has PD.

‘I believe that the most important decision you can make when life deals you a hard blow is: “No matter what happens, I will manage, and get something good out of it.” Such a decision implies that you are prepared to be knocked out by life, but you have the will to bounce back up again.

Will you become a victim of the illness and let it decide your life, or will you use the situation to learn something new and to find new meaning on a new basis, where illness gets the space it needs, and no more?’ An example of this determined spirit is contained in the book, ‘Shake well before use’, by Tom Isaacs. Tom was diagnosed with young-onset PD, and the book describes his experiences on a 4,500 mile walk round Britain’s coastline.