Tag Archives: Reviews

Music, Parkinson's, Research, Reviews , , , , Leave a comment

Keep on moving to (and making) music

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The evidence that rhythm, movement, and making music continues to accumulate as a therapeutic approach to address the symptoms and Quality of Life issues related to Parkinson’s Disease (PD).

Today we look at an article just out in Frontiers of Human Neuroscience, titled

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives  

Over the last quarter of a century, increasing research results point to rhythm and music as effective and useful tools for treatment and rehabilitation of people with neurological disorders. This article reviews the evidence for four different approaches, what the consensus is at the present time, and, of course, suggests future directions.

The authors look at four different approaches:

  1. Rhythmic Auditory Stimulation (RAS)
  2. Music-Supported Therapy (MST)
  3. Therapeutic Instrumental Music Performance therapy (TIMP) and
  4. Patterned Sensory Enhancement (PSE)

The consensus of recent meta-analyses and systematic reviews is that, for Parkinson’s Disease (PD), is that RAS is an effective tool for improving gait, stride, and speed – folks walk faster and with longer steps with RAS. Additionally, evidence is showing that it also reduces freezing of gait (FOG), improves balance and reduces the occurrence of falls.

Neither MST nor TIMP have been studied much beyond the rehabilitation of stroke patients. They involve practicing on a keyboard or drums, beginning with the patient’s comfort level and increasing in difficulty. Some studies have begun to be used to investigate effectiveness as treatments for PD.  Some have shown improvements in motor dexterity. More research is needed, but in the meantime, learning to play drums or keyboards can’t hurt, and may enrich one’s quality of life (QOL).

Growing evidence in neurological and brain imaging have shown increased activity in the auditory and motor areas of the brain, indicating that brain plasticity might be achieved through music and rhythmic interventions. The authors note that RAS has been well studied with stroke and PD populations, but not with other movement disorders and Alzheimer’s populations. In addition MST and TIMP have only begun to be investigated as a means of restoring fine motor coordination.

The authors also call for neuroimaging use in studies, to better understand the physiological basis of the rehabilitation process. They point out the gaps in research and hope to provide a framework for future research – not so much a roadmap, I would think, but a laying out of what we know and what we don’t know, and what kinds of studies are needed to answer the questions about what we don’t know..  They state that “musical rhythm is a powerful tool” for therapy, and our understanding and exploration of how it modulates brain networks is in the initial stages.

 In other words, “We’ve only just begun.”

Meanwhile: Don’t stop moving to the music.

 

Citation:
Braun Janzen T, Koshimori Y, Richard NM and Thaut MH (2022) Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives. Front. Hum. Neurosci. 15:789467. doi: 10.3389/fnhum.2021.78946

 

Reviews , , Leave a comment

Darwin’s notebooks and Parkinson’s Disease?

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What connection could there be between Charles Darwin’s notebooks and PD?

According to Roger Barker, writing in the Advanced Clinical Neuroscience Rehabilitation journal on Parkinson’s disease over the last 20 years – new concepts and developments, it took Cambridge University that much time to realize that it had lost two priceless original notebooks belonging to Charles Darwin, and during that time, in the field of PD much new knowledge has been gained, partly due to

  • Stem cell creation discoveries, (how to create induced pluripotent stem cells {iPSCs)),
  • Gene cell editing with CRISPR/Cas9,
  • and the ability to do single cell RNA analyses.

Much has been gained directly from observational and clinical studies, however.

First, alpha synuclein proteins were observed in tissues which had been transplanted, which led to hypotheses that

  • Alpha synuclein fibrils  can spread seed pathology in the adult Central Nervous System (CNS), which led to the hypothesis that
  • PD begins in the gut/olfactory system and then spreads along the connecting nerves to the brain, seeding the pathology as it goes until it finally reaches the STN (subthalamic nigra) dopaminergic cells.

This in turn led to

  • The concept of a prodromal stage of PD before the cardinal symptoms of tremor, bradykinesia and rigidity are evident in the motor control brain cells, and
  • The possibility of targeting pathological alpha synuclein proteins to slow down or stop the progression of PD.

In addition, PD has been hypothesized to have two different origin points

  • H1: The disease starts in the PNS and spreads centrally or
  • H2: The disease tarts within the CNS itself and then out to more peripheral sites. 
  • Recent imaging studies support this concept of PD falling into these two subtypes
  • Not either/or, but both could be true (Blog author’s note: which could be a reason why the course of PD is different for each person?)

Many different methods have been used to study the course of PD

  • The most powerful are those using community based epidemiological studies following patients over time
    • avoids possible bias in selection
    • Results:
      • younger patients tend to do better than older patients and
      • that those with more PD related symptoms and signs at diagnosis do less well

Another area of interest has been the relation between PD and the gut biome and inflammation

  • Alpha synuclein pathology starts in the gut and travels to the brain and CNS
  • People on anti-inflammatory medication seem to have lower rates for PD
  • Result is:
    • Repurposing of anti-inflammatory medications to treat PD and
    • Use of drugs specifically targeting the gut biome or alpha synuclein
  • Further advances include
    • stem cell transplants (now in clinical trials)
    • autologous cell transplants
    • As to whether these therapies will prove effective not yet known

Twenty years of research on PD has produced a great deal more knowledge than the previous 200 years since Dr. James Parkinson wrote his essay on the “Shaking Palsy.” The concept of prodromal stages and symptoms (to me) seems to be one of the most important ways to diagnose probable PD before the cardinal symptoms appear – resting tremors, bradykinesia, and rigidity – and thus provide the possibility of delaying the onset of the disease through lifestyle or nutritional changes, or both.

Dr Barker’s review can be read at:  Barker R. Adv Clin Neurosci Rehabil 2021;20(2):13-15

And that’s my slide presentation of Dr. Barker’s article. Hope I hit all the major points and didn’t miss anything.

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Exercise, Maimonides, Parkinson's, Research, Reviews , , , Leave a comment

Discrete choice experiment

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Published in the Australian Journal of Physiotherapy as an open access article, we have an experiment in which several factors were used to determine participants’ preferences in a hypothetical exercise program.

People with Parkinson’s disease are more willing to do additional exercise if the exercise program has specific attributes

Conclusions were:

People with Parkinson’s disease were more willing to participate in exercise programs that cost less, involve less travel, provide physical or psychological benefits and are supervised by qualified professionals. To enable more people with Parkinson’s disease to exercise, health services should provide programs addressing these factors and account for sex differences. [emphasis added. Men were more likely to favor strength training, women were averse to aerobic exercise, and folks already exercising 300 minutes per week were less likely to favor adding more exercises.]

The group to which I subscribe on their YouTube channel, and support in various ways, is Power For Parkinson’s® (PFP). I also am a member of the Georgetown Area Parkinson’s Support group (GAPS) and the Capital Area Parkinson’s Society (CAPS) Both PFP and GAPS sponsor several exercise groups aimed directly at people with Parkinson’s Disease (PD) and their needs, so I am usually working out at least one hour daily. So I might fall into the last group of folks not willing to add more exercises.

On a different tangent, A couple of articles showed up that deal with the idea of Multiple Intelligences. Actually, one is a book excerpt with selected portions available on Google Books, and the other is the cover, Table of Contents, Bibliography, and Index of a different book. Granted, the Index does list Parkinson’s Disease on at least 2 pages. Why bother? Because, as those who have read the earlier blog post(s) on Moses Maimonides and Me, I don’t particularly subscribe to Maimonides’ categories of four ways in which humans strive to achieve perfection.

These books are:

Eastern European Perspectives on Emotional Intelligence

in which some of the available pages include charts of Howard Gardner’s Multiple Intelligences, and some of the results which seem to show a clustering of several factors (using factor analysis). Since that is outside of my area of expertise, I won’t comment on it. (This is all copyrighted material, provided only for personal education, etc.

The other is Mind Ecologies: Body, Brain and World which has the extensive bibliography and index. Probably well worth looking into the bibliography, if one has a mind to do so (but not today). The TOC reads:

1. Life, Experimentalism, and Valuation 16
2. Pragmatism and Embodied Cognitive Science 51
3. Social Cohesion, Experience, and Aesthetics 94
4. Pragmatism and Affective Cognition 124
5. Perception, Affect, World 156
6. Broadening Ecologies 184 

and the whole thing is copyright The Columbia University Press.

My pulmonologist prescribed a nap in the morning and afternoon, and since I missed the morning nap, will head off to do one this afternoon.

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Dance, Dance for Parkinson's, Exercise, Parkinson's, Research, Reviews , , , , , , , , , , , Leave a comment

A review on dance and PD

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Dance classes for Parkinson’s patients was one of the things that got me involved in Power for Parkinson’s© and the Georgetown Area Parkinson’s Support group to begin with. For me, it has helped to improve symptoms and quality of life tremendously.

In this desk review of many studies, the authors came to the following conclusions:

Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.

 Carapellotti AM, Stevenson R, Doumas M (2020) The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis. PLoS ONE 15(8): e0236820. https://doi.org/10.1371/journal.pone.0236820

I have come to the conclusion that every study or review has to include the phrase “more research is needed.” And it is true.

You can read the article in its entirety at the URL in the citation, or download it directly from this link:

The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis

 

Exercise, Parkinson's, Research, Reviews , , Leave a comment

Lifestyle effects on PD

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In a nutshell: Exercise helps to keep your mitochondria working, and that helps to slow down the loss of your dopaminergic neurons. Here we have an application of the old rat race to a rat model of PD – in which treadmill exercise helped to keep mitochondria functioning properly, while sedentary rats lost dopaminergic cells.

Physical exercise protects against mitochondria alterations in the 6-hidroxydopamine rat model of Parkinson’s disease

These “results suggest a neuroprotective and progressive effect of intermittent treadmill exercise, which could be related to its benefits on mitochondrial biogenesis signaling and respiratory chain modulation of the dopaminergic system in PD.”

But other studies and reviews have shown other factors that affect the progression of PD, so don’t put all of your metaphorical eggs in one basket – a review that covers some of those various factors:

Narrative Review of Lifestyle Factors Associated with Parkinson’s Disease Risk and Progression

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