Retained complex movement skills with Parkinson's

[Dastardly]

I remember seeing this video when the case study was published in 2010, there has been a lot of talk on the board lately about training for those with parkinsons/neurological movement problems, I thought this might be of interest.

Turns out most people with Parkinsons, even if severe, maintain the ability to ride a bicycle without limitations. I am not sure about the specifics of how this all works (it seems researchers are not either) but I was thinking, in regards to doing barbell training or any other activity requiring concentrated full body co-ordination. Perhaps it may occupy the same sort of neural network as where the cycling ability is 'stored'. Perhaps, an experienced gymnast would maintain the ability to elegantly leap and bound even if when they try to walk casually they are crippled by tremors. Perhaps the experienced barbell lifter, would still be able to perform the powerful articulations of the limbs that mirrors 'the lifts' whether that is the deadlift, squat or bench press?

https://www.youtube.com/watch?v=aaY3...layer_embedded
http://www.guardian.co.uk/science/20...catherine-hess

This phenomenon is called kinesia paradoxica. While the mechanisms involved are still not understood, the knowledge is invaluable. It may lead to new forms of physical therapy and exercise for people with Parkinson's disease or other neurological disorders that affect movement, co-ordination or balance.

Currently, the "bicycle sign" is being suggested as an effective and inexpensive way to differentiate between Parkinson's and the rarer atypical Parkinson's. One way in which the two diseases differ is in the ability or loss of ability to ride a bicycle. Individuals with Parkinson's who were able to ride a bicycle before the onset of symptoms retain the ability to cycle. Those with atypical Parkinson's do not.

[Mark Rippetoe]

Maybe the Sully/Feigenbaum/Morris/Bradford axis has some input into the mechanisms at work here.

[Will Morris]

Maybe the Sully/Feigenbaum/Morris/Bradford axis has some input into the mechanisms at work here.

I'd love to. I will put something down tomorrow after my test.

[Paul1]

Patients with Parkinson's, at least early on, are often able to override their tremors when they do something volitional. A common demonstration of that is that at rest, i.e. not doing anything, they have that "pill-rolling" tremor in their fingers -- but ask them to pick up a pen and write something and the tremor disappears. Similarly, some PD patients have postural instability at rest (they move their trunk all over the place), but when they stand up and start walking they look normal (or more normal).

The point of these demonstrations is that the disease is much less manifest during volitional movement than it is at rest. This at least holds true earlier on in the disease, before it gets to the point where they can barely even initiate any movement.

It should be mentioned that motor patterns reside largely in your motor cortex -- which is not the part of the brain affected by Parkinson's.

[John Petrizzo]

Patients with Parkinson's, at least early on, are often able to override their tremors when they do something volitional. A common demonstration of that is that at rest, i.e. not doing anything, they have that "pill-rolling" tremor in their fingers -- but ask them to pick up a pen and write something and the tremor disappears. Similarly, some PD patients have postural instability at rest (they move their trunk all over the place), but when they stand up and start walking they look normal (or more normal).

The point of these demonstrations is that the disease is much less manifest during volitional movement than it is at rest. This at least holds true earlier on in the disease, before it gets to the point where they can barely even initiate any movement.

It should be mentioned that motor patterns reside largely in your motor cortex -- which is not the part of the brain affected by Parkinson's.

This was exactly my experience working with this population as well. I did a clinical rotation in a Parkinson's Disease treatment center, and patient's could often times override their resting symptoms with volitional movements at least for the short term. Unfortunately, as the disease progresses this becomes more and more difficult and the amount of concentration it takes the patients to override their symptoms to do things like take a normal sized step, is not maintainable for longer than brief periods of time.

A previous thread on this forum posted by a person with Parkinson's Disease extolled the virtues of barbell training and the abatement of his symptoms with training. I would be curious to hear how he is doing now and if he kept up his training.

[Will Morris]

Parkinson's Disease is a disease of the Basal Ganglia, specifically the destruction of dopaminergic neurons within the Substantia Nigra pars compacta. The Basal Ganglia has a fairly mysterious, yet widespread function that isn't greatly understood. That said, we know through Parkinson's and other Basal Ganglia diseases, that the Basal Ganglia is very much a part of initiation of movement and suppression of some movements. Unlike the cerebellum that fine tunes movement through high fidelity feedback systems, the BG helps initiate movement in concert with the primary motor, premotor, and supplemental motor cortices in the cerebrum. It is these functions that present themselves in the Parkinson's patient as resting tremors and "akinesia" or "poverty of movement". It isn't only the tremors that become an impairment, they also have a hard time starting a movement, like walking. They typically begin with a type of shuffling or festinating gait, but once they start walking you notice their walking becomes better and gets to a more normal gait. Then, if you have them turn, they go back to a shuffling gait. Now, as Dr. Paul1 mentioned, this is further complicated with proximal trunk instability that comes with PD.

Though controversial to some extent, the idea of central pattern generators help explain why individuals with PD can retain seemingly complex motor tasks, however, things like walking, chewing gum, riding a bicycle, etc. are tasks that require very little cortical input. There are circuits within the spinal cord, brain stem, and other lower CNS structures that allow us to limit cortical input for rhythmic activities like this. So, when you are learning to ride a bicycle, it requires a lot of cortical input, but once you learn how to ride it and become proficient, the neural pathways have been refined to the point where you needn't think about riding it to be able to do so. You free up cortical capital, as it were, to think about more important things, like "why in the world am I riding a bicycle and not doing something that doesn't suck so bad?".

As much as I would love to speculate that a PD patient would retain the ability to train with barbells, I would assume the fact that squatting, deadlifting, etc are not rhythmic, cyclical activities, and that they require the BG inputs to intiate the movement, I doubt seriously a PD patient crippled with tremors would be able to do this safely. This isn't to say that in the early stages of PD, where a patient can cortically override the resting tremors, a patient wouldn't benefit from barbell training. If they can do so safely, I can think of no better training method to address their loss of proximal trunk stability.

Something else to keep in mind if you are a coach that wishes to train someone with PD is that these individuals go "on-and-off cycles" of medication. When someone is off their medication, tremors and poverty of movement are worse, but when they are on medication, they have a tendency to have more jerky, relatively useless movements. You will see them fling their arms, move their heads in weird patterns, etc.

[Jonathon Sullivan]

The relative improvement of the Parkinsonian tremor during volitional motor activity (and sleep) is a classic feature of this disease. Unfortunately, initiating motor activity becomes progressively more problematic during the evolution of the disorder. There is some evidence that resistance training and other forms of exercise help Parkinsonian patients retain the ability to initiate movement, particularly gait (see Hass et al 2012). I seem to recall there are some studies (not very good, alas) indicating that the crippling postural derangments may also be improved, although not by much. And of course training can promote strength and lean mass retention, which is a problem for these patients. So resistance training is definitely possible (as we've seen) and almost certainly palliative in this population, at least for a while.

Paul is correct that motor patterns encoded in the cortex (particularly in the parietal cortex) are not primarily affected by the disease (although I'm told by a neurology colleague that "motor planning" is affected, so there's that). The problem is the progressive loss of dopaminergic nigrostriatal neurons in the pars compact part of midbrain region of the brainstem (and probably the basal ganglia). Parkinsonism is, in the final analysis, a neurodegenerative condition, and its natural history is to get worse over time. All current therapies in mainstream use are purely symptomatic/palliative, not curative or process-arresting. Cell-based therapies hold some promise, but they are slow in coming.

It sucks.

[Xultrarunner]

I have previously posted on my struggle with this disease. My father also had Parkinson's as well. I would say there really is something to the complex movement issue and also the impact of music. My dad never exercised, but he played classical piano. I remember visiting him once when he was wheelchair bound. My mother wheeled him up to the piano and he played Chopin's waltz #7 pretty well. My mother told me that it was as if the music allowed him to switch to different brain pathways not harmed by the disease.

When I was diagnosed, I read everything I could find. There are interesting papers on the benefits of dancing. I also found some papers and videos on biking, especially at high turnover rates. This is reported to suppress tremor. I incorporated 30 sec sprints on the treadmill and sprints on the bike. I think I covered this in an earlier post, but my symptoms get worse for a half a day to a day and then disappear for a few days - sort of like over compensation. I am OK if I do this twice a week.

This spring, I started train running again each weekend. This involves dodging rocks, fallen trees and running streams (I live in the southern end of the Blue Ridge Mountains). This requires very complex movements and balance. At first it was very hard and I had a lot of falls. This all changed when I started to listen to music while I ran. My IPOD has an exercise playlist I created for this purpose. Mostly a mix of disco tunes and Chopin waltzes. Donna Summer's Hot Stuff really does the trick - the strong beat seems to flood out the Parkinson's.

By the way, last week I turned 70.

As with my earlier posts, the OHP has proved critical in fighting the postural changes characteristic of this disease. Also, since the last post, I took up Mark's suggestion to address grip problems with splitting fire wood and similar farm tasks. This has helped a lot and I recently restarted the Starting Strength on dead lift and squat with no problems controlling the bar. We will see how it goes.

Most days, I remain neurologically without symptoms in daily, but when I exercise I usually push things to the point where I confront my limits. If I do not exercise and do not get enough sleep, things go south pretty fast.

I do not agree that all drugs are palliative. Azilect was developed to slow or block progress of this disease and it certainly does that reliably in animal models. In the big randomized trial leading to FDA approval, the 1 mg dose did slow progression. This was lost at the 2 mg dose. It has been the mainstay of my treatment. I was diagnosed in October 2011, based on an exam and a DAT scan showing dramatic changes on the left side of the brain. My symptoms were clearly present at least a half a year earlier. Neurologically, I am much better than I was at diagnosis, yet have not been on L-DOPA or any dopamine agonists. Azilect and the exercise program have been quite effective.

There is some really spectacular basic science going on that I think will revolutionize treatment. My career has been in medical science and I do follow this closely.

I do not post often, but I follow everything in this forum twice a day. It has been hugely important to me in dealing with this disease.

[mlh1996]

Had to register just to participate in this discussion.

This all changed when I started to listen to music while I ran. My IPOD has an exercise playlist I created for this purpose. Mostly a mix of disco tunes and Chopin waltzes. Donna Summer's Hot Stuff really does the trick - the strong beat seems to flood out the Parkinson's.

This is (somewhat) the focus of my Master's thesis. If I may ask you a question:

Have you noticed any training effect with this? I mean, have you tried running without the music recently? And if so, did you see an improvement?

[Will Morris]

We use metronomes, music, etc. fairly extensively in the clinic when working with PD. It really does wonders for assisting in normalizing cadence of walking, and particularly, when a PD patient needs to turn around. We also use visual clues, such as tape on the floor in a clock-like fashion, to give some visual cueing as to where to place their foot.

One patient I worked with had an extremely hard time walking. She had a crippling festination in her gait, but if I turned on music and danced with her, she moved with no problems at all.