We all need to do the things that make life meaningful and keep us independent, whether in our work, hobbies, social life or in simply taking care of ourselves. But maintaining these activities can be especially challenging for people who live with Parkinson’s disease (PD). One of the best resources for people in this situation is occupational therapy (OT), which is designed to improve your ability to take on the activities you value and to be the person you want to be. Here is an overview of how OT can help.

What Is Occupational Therapy?

In life with PD, you may have encountered speech or physical therapists. Where does occupational therapy fit in and how is it different? First, note that the word “occupation” in OT means “activity.” Our job in OT is to identify strategies that will allow you to continue doing activities that are important to you. Each person with PD will have different goals based on his or her symptoms and disease progression, as well as individual lifestyles, interests and priorities. Whether you have been living with PD for one month, five years or 20 years, and whether your goal is playing tennis or spending time with family, our approach is the same: to find ways to match your personal strengths with activities and an environment that will help you reach your goal.

Be Your Own Therapist

Which activities are most important to you? Once you answer, try the strategies below to see which ones work for you for each activity.

Use your personal strengths.

How can you build on your strengths and minimize your limitations? For example, if you have the strength of helping children enjoy reading, you could exercise that strength by reading to your grandchildren, by listening to them as they read, or by playing a reading game that stimulates both your imagination and theirs.

One of your strengths may be thinking skills. One thinking skill is imagining doing the activity before doing it. For example, imagining writing big can actually help you write big. Another thinking skill is speaking the steps out loud. When combing your hair, try saying “hold and comb,” to avoid dropping the comb.

Make sure you are exercising. Improving strength, balance and endurance through exercise supports your participation in all sorts of activities. Whether it is dancing or walking to a neighbor’s house, find an enjoyable way to exercise.

Lastly, be positive. Think, “I will do…” rather than “I’ll try to…” and you may be more successful.

Change the environment.

How can you adapt your surroundings to support your chosen activity? For example, will it help to choose a different physical or social setting for the activity, or to use different objects and tools? Take a look at your environment. Create a quiet space with conveniently arranged furniture to make activities easier. Look into adaptive devices such as a tub seat to make showering safer or a swivel seat cushion in the car to make getting in and out easier. Additionally, think about the social environment and choose places where people will understand your needs.

Adapt the activity.

Which activities do you enjoy and how can you adapt that activity to make sure you can still do it? For example, if you love baking, perhaps substitute complex recipes with simpler ones.

To get started, write down your goals or say them aloud to yourself or to someone else. Then ask, are there ways to simplify or modify the activity? For example, if you love golfing with friends, but now find it challenging, ask yourself if it is just the golf you enjoy or if it is the socializing that goes with it? Based on your answer, can you meet your friends for coffee or a drink after they finish their round? Can you play nine holes instead of 18? Can you use the golf cart instead of walking the course?

Lastly, focus on one activity at a time. Parkinson’s can make it difficult to multitask. If someone is talking to you while you are eating, tell him or her that you will continue the conversation as soon as you finish your meal.

Find an Occupational Therapist

Are you looking for a more personalized plan? If so, request a referral for occupational therapy from your neurologist or movement disorder specialist. Ask them if they can recommend an occupational therapist with knowledge of PD. You can also contact your state OT association, or local rehabilitation facility or home care agency, to find an OT. You can find more information on the American Occupational Therapy Association website at www.aota.org.

Conclusion: Stay Engaged

People with PD can and should keep doing the activities they love to do. If PD symptoms get in the way, an occupational therapist can help. Together, you will set realistic goals, identify challenges and strategize solutions. Identify what is important to you and figure out a way to continue doing it. Find the “sweet spot” where your strengths, the activity and environment work together and then go for it.

Tip: Enhancing Hand Coordination

We use our hands throughout the day in all activities. People with PD may notice changes in the ease in which they perform hand and finger motions. An occupational therapist can help evaluate and make recommendations to improve hand coordination:

• Exercise hands and fingers regularly
• Engage in enjoyable and stimulating hand exercises, such as gardening or knitting
• Use toothbrushes, hairbrushes, silverware and writing tools with larger handles
• Use both hands in tasks - don’t favor one hand over the other
• Schedule tasks that require greater hand control for times when you are well rested and medications are working well

A balanced diet is a foundation of good health. For people with Parkinson’s disease (PD), a balanced diet is even more important. In PD, there are some foods that may help to ease symptoms and help brain health, while others can affect the way medications work. While there are many things about PD that cannot be changed, the informed choice of diet can help people to live better with the disease.

Foods That Promote Brain Health

In the science of brain health, we often use the word neuroprotection: the process by which we can support the health of brain cells and their ability to communicate with one another. Over the years, various food groups have been studied in animals and in large epidemiological studies of human populations for their potential to promote brain health. Initial research has provided some evidence about possible benefits of certain foods. Although there isn’t yet evidence about the specific benefits for Parkinson’s disease, what we do know is that these foods are part of a healthy diet.

Neuroprotection

Of all the foods that have been studied for their potential to promote brain health, research into nuts and herbs has shown promise. Here is what we know.

• Walnuts. Walnuts contain an essential fatty acid called omega 3 and a variety of minerals, which early studies associate with a decreased risk for dementia. Try eating five to 10 each day.
• Pistachios. Emerging evidence shows these nuts (the vitamin K and antioxidants in them) may have potential for helping to reestablish lost connections between neurons. They also contain a small amount of lithium, which may help to improve mood. You can eat a few of them two or three times a week.
• Macadamia nuts. Oils in these nuts may increase the production of neurotransmitters that help brain cells communicate with each other. They are high in calories, but a few a day is good for you.
• Cashews. Iron, zinc and magnesium in cashews may boost serotonin — a neurotransmitter linked to good mood — and may reduce memory loss.
• Almonds. Although they have little effect on brain health, almonds contain fiber, which helps relieve constipation (a common symptom in PD).
• Brazil nuts. These nuts contain selenium, a mineral that may have the potential to counteract environmental toxins like pesticides and herbicides. Eat no more than one or two a day.
• Turmeric. This spice turns Indian food orange, and its active ingredient is curcumin. Add tumeric to food, but don’t take it as a supplement.
• Ceylon cinnamon. In animal studies, this spice has shown potential for normalizing neurotransmitter levels and other PD brain changes. Look for Ceylon cinnamon, which is grown in Sri Lanka and labeled as such. Organic cinnamon is also preferable.

Anti-Inflammatory Foods

Fighting inflammation can be another important strategy for keeping the brain healthy. The types of fats you consume may play a role in reducing inflammation in the body, and those known as “medium-chain triglycerides” may be particularly helpful. Coconut oil contains this fat. You can cook with it just as you would with olive oil. Other anti-inflammatory foods include rosemary, oily fish, like salmon, tuna and mackerel, dark leafy green vegetables, like kale, collard greens and spinach and soy products.

Benefits of Purple and Red

Foods that contain antioxidants may also protect brain health. Antioxidants counteract molecules known as “free radicals,” which can damage healthy cells including neurons. Fruits that are purple and red, like blueberries and raspberries, contain pigments called anthocyanins, which are well-known antioxidants. Some studies suggest that drinking green tea (three cups a day) is neuroprotective, because EGCG, found in green tea, is both an anti-inflammatory agent and an antioxidant.

Foods for PD Symptoms

Nutrition adjustments can help ease some of PD’s most common symptoms, both of a motor and a non-motor nature. If you experience digestive difficulties, especially constipation (which is very common in PD), try to drink more fluids, and increase your fiber intake with fruits and vegetables such as kiwi, apples, prunes, dates, figs, radishes, berries, nuts and beans. Probiotic supplements like Bifidobacterium (B. breve, B. adolentis and B. infantis), that add healthy bacteria to the gut, may also be helpful.

If drinking more water leads to urinary incontinence or urgency, increase your fluid intake by eating foods with a high water content such as tomato, cucumber, radish, celery, broccoli and grapefruit. If you struggle with weight loss or loss of appetite, try increasing your calorie intake by eating nuts and foods that contain healthy fats, like coconut and avocado. To stimulate your appetite, try bitter greens like collard and beet greens, or spicy foods. Exercise can increase muscle mass and hunger.

Fatigue and sleep difficulties are also common symptoms of PD. The culprit of these problems may be sugar. When eaten during the day, sweets briefly boost energy, but make you sleepy later. When eaten in the evening, they may keep you awake.

Another reason to limit sugar is that it causes a spike in blood glucose, which contributes to inflammation. When reaching for a snack, try foods that offer a balance of protein and fat, like nuts or avocado, or whole-grain complex carbohydrates, like brown rice and quinoa.

How Foods Affect PD Medication

Another benefit of dietary changes can be improvement in the effectiveness of PD medications. Taking medications at mealtime can affect how quickly they are absorbed into your system, and the rate at which your body uses, or metabolizes them. If you take carbidopa/levodopa (Sinemet) for PD symptoms, you may find that protein-rich foods such as meat, fish, eggs or dairy products, or high-fat foods, lengthen the time it takes for the medicine to kick in, or make the medication less effective.

The solution? Talk to your doctor about taking levodopa 30-60 minutes before a meal or 1-2 hours after finishing a meal. Be aware that high-protein and high-fat snacks can also interfere with levodopa. Your doctor or a nutritionist can give advice on how to schedule the protein you eat, to avoid having it interfere with levodopa.

Conclusion

People with PD need to eat a balanced diet in order to feel their best and maintain energy. Eating more nuts and berries, cutting back on fried food and sweets, and cooking with herbs are all elements of sound nutrition and they may also help you manage your PD.

Sponsored by Kyowa Kirin.

Este video es de la lista de reproducción de la conferencia, “Hacia adelante: Navegando el mar del Parkinson.” 

Presentadora

Betsaida Cruz-Coble, PT, DPT, NCS, MemorialCare Long Beach Medical Center

Este video es de la lista de reproducción de la conferencia, “Hacia adelante: Navegando el mar del Parkinson.” 

Presentadora

This audiobook contains descriptions and explanations of specific exercises that can help to maintain flexibility, strength, and aerobic conditioning.

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Intensidad: baja, moderada, y alta

La bradicinesia de la enfermedad de Parkinson (EP) se derrota con terapias especializadas que involucran amplitud y velocidad máxima, actividades de la vida diaria, práctica intensa, con esfuerzo máximo de 8-10/10, usando todo el cuerpo. ¡Acompáñenos para practicar actividades para derrotar la bradicinesia!

¿En busca de algo más? Podrá encontrar todos nuestros videos de Viernes de Ejercicio en YouTube.

Le pedimos que consulte con su equipo médico sobre cualquier inquietud o recomendación antes de intentar nuevos ejercicios. La Parkinson’s Foundation no se hará responsable de ninguna lesión resultante de realizar las clases en línea

It is not uncommon for the stresses of daily life — feeling overwhelmed, under prepared and over stimulated — to cause anxiety and unrest. These psychological issues can impact your health and even exacerbate the symptoms of Parkinson’s disease (PD). That is why it is important to assess what may be causing stress and learn how to deal with the situations that give rise to anxiety. Meditation, yoga or Tai Chi and deep breathing can help restore a sense of calm. Whether you are living with Parkinson’s or caring for someone with PD, finding balance can help you cope with the daily stresses of life. This may mean limiting your exposure to environmental stressors or using complementary therapies. Such approaches are wonderful ways to lower anxiety, lower blood pressure and improve your all-around health.

Managing Stress

Identify stress triggers along with ways to help control your emotions and release anger in a safe way. Try writing in a journal or going for a walk when tension reaches a breaking point. Physical outlets, such as hitting a pillow, can help you vent frustration. If stress triggers are unavoidable, you need reliable ways to reduce and manage them. No method is too silly if it works.

Yoga or Tai Chi

Tai Chi is a moving meditation based on the circulation of “chi,” life’s energy force, believed by the ancient Chinese to be blocked in the presence of disease. It is comprised of continuous, flowing movements. Yoga, which originated in ancient India, can include holding stationary poses or moving into a flowing series of poses and aims to integrate the mind, body and spirit. Both can help with relaxation, which can help with PD symptoms. Additional benefits include:

• Increased awareness of movement and actions
• Better awareness of proper body alignment/ posture and enhanced flexibility
• Improved balance and core strength, which help to reduce fall risk
• Improved breath support and control

Breathing Exercises

Breathing exercises offer a simple and effective way to relax in moments of stress or anxiety. When you are stressed your body goes into a high state of physical arousal. You may notice muscle tension, a faster heart beat or shallow breathing.

3-minute Relaxation Routine

• Select a key word such as relax, calm or peace
• Concentrate on relaxing using your key word. Pay attention to your breathing. Take in one deep breath and hold it.
• While holding your breath, tense up a group of muscles, such as the muscles in your face, arms or legs.
• As you breathe out, relax the tense muscles and let go. Continue using your key word as you drop your shoulders.
• Repeat, alternating to different muscle groups, for 3 minutes.

Consider Massage Therapy

Many people with PD recognize the benefits of massage. Massages are available in a variety of settings, including many local malls. Specific benefits may include:

• reduction in rigidity and tremor
• improvement in sleep
• increase in daily stamina
• reduction in anxiety
• increased feeling of relaxation

In finding a massage therapist, it is important to find someone trained by an accredited school of massage therapy. Tell your medical team, family or friends that you are considering getting a massage. They may be able to provide you with a referral. You can also find a massage therapist by calling toll free 1-888-843-2682 or visiting the American Massage Therapy Association website: www.amtamassage.org/findamassage/.

Distinguishing Between Stress and Anxiety or Depression

Feeling stressed or worried is understandable when managing a chronic illness. It is important to remember that depression and anxiety play a key role in PD and its effect on quality of life. If constant worry or nervousness go beyond what is manageable, a person may be experiencing anxiety, which is more serious.

Remember, anxiety and depression often go together.

Symptoms of anxiety can include:

• feelings of panic
• fear and restlessness
• sleep disturbance
• poor concentration
• palpitations
• shortness of breath
• irritability
• dizziness.

Symptoms of depression can include:

• excessive worrying
• persistent sadness
• crying
• loss of interest in usual activities and hobbies
• increased fatigue and lack of energy
• feelings of guilt
• loss of motivation
• complaints of aches and pains
• feelings of being a burden to loved ones

If you think your stress may be a symptom of depression or anxiety, do not feel embarrassed to seek professional help or counseling. A social worker, psychologist or psychiatrist can help you pinpoint the causes of your distress and provide constructive ways to cope with the situation.

You may find Cognitive Behavioral Therapy (CBT), a non-drug approach to developing the skills and actions that change patterns of thought and behavior related to depression, to be a helpful tool.

Your mood is a critical aspect of living with PD that you can control. Talk to your friends, family and doctor about your feelings of stress, anxiety or depression.

For more resources on managing stress, anxiety or depression, call the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (473-4636).

​Aventurarse por el laberinto informativo sobre la nutrición y los consejos que hay a disposición del público es un reto, aun para los consumidores sanos. Si se le añade a la mezcla la enfermedad de Parkinson (EP, o PD, por sus siglas en inglés) dicho reto se complica aún más. Los problemas nutricionales que afrontan las personas con EP son complejos y diversos, y muchos de ellos no tienen una respuesta clara.

A continuación contestamos la pregunta ¿qué es lo que más importa? cuando se refiere a nutrición.

Coma una dieta balanceada

Es difícil para una persona sentirse bien y mantener su energía cuando no se está alimentando adecuadamente. Alimentarse adecuadamente implica comer regularmente (sin saltearse ninguna comida), consumir una variedad de alimentos de todos los grupos alimenticios (granos, vegetales, frutas, leche y productos lácteos, carnes y frijoles) y comer prudentemente para mantener un peso saludable. Aunque parezca un consejo sencillo, implementarlo puede ser un reto, particularmente si usted tiene un ajetreado estilo de vida o si los síntomas del Parkinson están afectando su capacidad de comprar, preparar y comer los alimentos.

Si usted no se está alimentando tan bien como debiera, sería conveniente que consultara a un dietista profesional que pueda ayudarle a evaluar sus necesidades en cuanto al consumo de alimentos y discutir con usted estrategias para mejorar su dieta. También podría ser conveniente buscar la ayuda de otras personas, tanto para comprar y preparar los alimentos, como para mantener a mano alimentos nutritivos y fáciles de comer. Si usted tiene problemas de depresión, esto podría interferir con su apetito; asegúrese de discutir el problema con su médico.

Mantenga sus huesos sanos

Las personas con Parkinson son propensas a la osteoporosis, una enfermedad causada por una baja densidad en los minerales de los huesos. Los factores de riesgo para la osteoporosis incluyen la edad madura, el bajo peso corporal, fumar, el consumo excesivo de alcohol, la falta de exposición a la luz solar, el consumo inadecuado de vitamina D y calcio, y la falta de ejercicios de resistencia o levantamiento de pesas.

La osteoporosis puede ser especialmente preocupante para una persona con Parkinson, quien afronta un mayor riesgo de caerse. El resultado inevitable es una mayor probabilidad de fracturas, las cuales son peligrosas y dolorosas, además de estar en detrimento de la calidad de vida de la persona. Pregúntele a su médico acerca de hacerse una prueba de la densidad de los minerales en sus huesos, llamada densitometría. Si resulta que es baja, existen tratamientos médicos a su disposición.

Para mantener la salud de sus huesos, asegúrese de que su dieta incluya abundante calcio y vitamina D. Las personas mayores de 50 años deberían consumir diariamente 1500 mg de calcio y 800 UI de vitamina D. La leche y los productos lácteos son las fuentes dietéticas más ricas en calcio. Se recomiendan tres porciones al día (una porción es una taza de leche o yogur, y una y media onzas de queso sólido). Aunque existen otros alimentos que contienen calcio (tales como el tofu, las bebidas a base de soya fortificadas, el jugo de naranja y las verduras de hojas oscuras), el calcio que no proviene de los productos lácteos puede ser difícil de absorber.

Usted también puede obtener vitamina D saliendo regularmente al aire libre y consumiendo alimentos ricos en vitamina D (tales como la leche fortificada con vitamina D, el yogur o los cereales de desayuno, y la grasa de pescado). Si usted vive en una zona donde la luz solar es limitada y/o no consume muchos alimentos ricos en vitamina D, se recomienda el uso de un suplemento nutricional.

Los suplementos vienen en varias formas. Unos son más fáciles de tolerar que otros. Su farmacéutico está en capacidad de aconsejarle sobre las diferentes clases disponibles.

Mantenga regular su digestión

El estreñimiento es común en la enfermedad de Parkinson. Aunque esto puede ser un asunto incómodo de discutir con su proveedor de atención médica, la prevención y el tratamiento del estreñimiento es de suma importancia, ya que un estreñimiento grave puede llevar a una obstrucción del intestino, lo que potencialmente puede poner la vida en peligro.

Aunque el estreñimiento observado en el Parkinson es debido en gran parte a la enfermedad misma, pueden implementarse ciertas medidas en el estilo de vida que podrían ayudar a manejarlo. Estas incluyen consumir alimentos ricos en fibra (panes de grano integral, cereales o molletes (muffins) de salvado, frutas y vegetales, frijoles [habichuelas] y legumbres, y ciruelas) además de beber abundante líquido. Luego, está el ejercicio, el cual ayuda a mantener la densidad de los huesos y aliviar el estreñimiento.

Si usted no es capaz de lograr la regularidad en su digestión por medio de su estilo de vida únicamente, podría requerirse el uso de laxantes y otras intervenciones para la evacuación de los intestinos.

Equilibre los medicamentos y los alimentos

Los medicamentos utilizados para tratar el Parkinson pueden causar efectos secundarios relacionados con la nutrición, tales cómo náuseas y falta de apetito. Típicamente estos efectos secundarios son más molestos al inicio del tratamiento. Normalmente, el cuerpo se va adaptando poco a poco y estos desaparecen. Sin embargo, algunos individuos continúan teniendo problemas con ellos. Tomar un pequeño bocado (como una ginger ale y unas pocas galletas saladas) junto con los medicamentos podría ayudar a controlar estos efectos secundarios. Si persisten las náuseas o la falta de apetito consulte a su médico, ya que estos síntomas pueden llevar a una indeseada pérdida de peso.

Los aminoácidos (de la proteína dietética) pueden interferir con la absorción de la levodopa en el cerebro. Si usted descubre (no todo el mundo experimenta esto) que comer alimentos ricos en proteína (tales como carne, pescado, aves y productos lácteos) disminuye la eficacia de la levodopa, mantenga su porción de carne aproximadamente del tamaño de una baraja de naipes y tome su Sinemet® media hora antes de una comida que contenga proteína.

No restrinja la proteína en su dieta; el problema, si descubre que lo tiene, tiene que ver más con el momento en que se consume la proteína que con la cantidad que se consume a lo largo del día.

¿Existe algún alimento “maravilla” o suplemento que retrase el avance del Parkinson?

Los suplementos (tanto nutricionales como herbales) y las terapias dietéticas están en los primeros lugares de la lista de terapias complementarias utilizadas por las personas con Parkinson. A pesar de las persuasivas teorías acerca de la eficacia de varios suplementos o factores dietéticos en el retraso del avance de la enfermedad, no existen respuestas definitivas basadas en la evidencia. Algunas terapias han sido estudiadas solamente en tubos de ensayo o en animales de laboratorio. Se han hecho pocos ensayos en humanos (por ejemplo los que examinan los suplementos de vitaminas antioxidantes), y la mayoría han producido resultados decepcionantes. La Coenzima Q10 es un suplemento nutricional que es considerado de interés en la comunidad científica y está bajo estudio para determinar si tiene algún beneficio potencial en la enfermedad de Parkinson.

Algunos alimentos que están en la categoría de los que “no hacen daño y podrían ayudar” (al menos en teoría) incluyen el café (varios estudios en la población sugieren que el café podría proteger contra el Parkinson, particularmente a los hombres), el té verde, una variedad de frutas y vegetales, los alimentos ricos en vitamina E tales como el germen de trigo, las nueces y semillas, y el aceite de origen vegetal. Si los antioxidantes citados no ayudan con los síntomas del Parkinson, pueden ayudar con otros aspectos de la salud, de manera que no hay ningún motivo por qué no usarlos.

Al pensar acerca del valor potencial de utilizar este o aquel suplemento, considere los factores de costo, seguridad y eficacia, y asegúrese de que no sean simplemente el producto de exageraciones publicitarias. Por ejemplo, un titular reciente decía: “La vitamina B6 puede reducir el riesgo de enfermedad de Parkinson.” Lo que el titular no mencionaba era que los hallazgos de este estudio, aunque interesantes, habían sido observados solo entre fumadores, y de lo que se hablaba era del inicio de la enfermedad de Parkinson y no de su avance.

Sin embargo, tan tentadores como suenan los alimentos “maravilla” y los suplementos, en este momento no existen evidencias que sugieran que desempeñan un rol de importancia.

Ajuste sus prioridades nutricionales a su situación y etapa de la enfermedad

Los síntomas del Parkinson varían de persona a persona y según la etapa de la enfermedad. Cada persona debe establecer cuáles son sus prioridades nutricionales basadas en los problemas que afronta. En los comienzos del Parkinson, debemos hacer énfasis en alimentarnos bien y mantener un peso saludable. A medida que la enfermedad avanza, debemos ajustar nuestras dietas para manejar nuevos síntomas específicos conforme estos vayan surgiendo (tales como dificultades para tragar, efectos secundarios de los medicamentos, problemas digestivos y retos alimentarios).