The Community and Professional Liaison committee of the Parkinson's Association of Western Australia, has the task of raising the level of PD knowledge and awareness in our state. It's members address: -the staff at hospitals/nursing homes, -service clubs, -any interested community group. A working party has recently produced a guide for the use of its members. It was felt that the guide, which covers the subject of PD in point form, may be of some use to similar groups elsewhere. I am therefore, on behalf of the committee, sending the list this copy of the text of the guide (see below). Should anyone want a copy of the formated version of the guide (Word6 for Windows) I can send it to them as an attachement. Dennis. ************************************************** Dennis Greene 48/11 [log in to unmask] http://members.networx.net.au/~dennisg/ ************************************************** +++++++++++++++++++++++++++++++++++++++++++++++ The Parkinson's Association of Western Australia Community and Professional Liaison - Guide for Speakers "Medical content reviewed and approved by: Dr Peter Panegyres (Neurologist) Dr Keith Grainger (Neurologist)" Preface Please use these outlines as a guide for what to cover. -Modify the outlines to suit your particular audience and your own style. -What we bring is our own experience as a person with PD or as a carer. Give personal anecdotes. -We do not pretend to be neurological experts. -If you or people close to you have had funny experiences with PD include these stories, if appropriate. Humour goes over well. -If you have analogies that help you understand things, share these. Dennis, eg, likens the mind/body message breakdown to an unreliable overseas phone connection, with distortions and delays. -Work out whether you are more comfortable with questions as you go along, or a question time at the end. Remember that audiences differ. Some ask lots of questions, others don't. -There are videos you can take along to show if time allows. -Take handouts that are free, also offer fact sheets and brochures and books for sale. -Remember to talk about PAWA. Can use this as a positive note to end on. Outline 1 - Suitable for Professional Audiences In Brief WHAT IS PD? 1. CNS disease affecting movement and speech. 2. Reason why dopamine producing cells die is not known. 3. The 3 major symptoms...... 4. Symptoms show in many ways and the pattern differs for each person with PD. TREATMENT FOR PD 1. Stay as active and involved as possible. 2. Make full use of the help different therapies can give in working towards remaining active and involved. 3. Drug therapy 4. Surgery PD- EFFECTS ON EVERYDAY LIVING 1. Tremor 2. Rigidity 3. Slowness 4. Combination of rigidity and slowness:- 5. Depression HANDLING FREEZING EPISODES The following are some little tricks you can try:- POSSIBLE COMPLICATIONS FROM LONG TERM MEDICATION 1. "On-Off" effect or sudden fluctuations in performance. 2. Dyskinesias 3. Dystonias 4. Sleep problems 5. Hallucination and delusions 6. Dryness of mouth and eyes PARKINSON'S ASSOCIATION OF W.A. Services provided by our Association Outline 1 - Suitable for Professional Audiences WHAT IS PD? 1. CNS disease affecting movement and speech. Lack of dopamine caused by progressive death of dopamine producing cells in an area at the base of the brain. Messages being generated, body still capable of carrying out functions, but lack of dopamine means that messages from the brain can't get through properly. So, the person with PD has difficulty initiating or carrying out normal movements. 2. Reason why dopamine producing cells die is not known. Speculation has centred on the possibility of a combination of factors, including some genetic predisposition to react negatively to things in the environment. Not contagious; Not a straight out hereditary pattern. 3. The 3 major symptoms are Shakiness (tremor) Stiffness (rigidity) Slowness (bradykinesia) 4. Symptoms show in many ways and the pattern differs for each person with PD. No one person has every symptom. Sometimes a person's symptoms may be very obvious and disabling, at other times hardly noticeable. This may vary from day to day, and at different times of any one day. TREATMENT FOR PD 1. Stay as active and involved as possible. 2. Make full use of the help different therapies can give in working towards remaining active and involved. -physio, -OT, -speech -dietician 3. Drug therapy (through your neurologist and GP) Dopamine replacement drugs (sinemet & madopar) Drugs that help the dopamine in the brain to work more effectively (dopamine agonists eg parlodel, permax, apomorphine) Drugs that make more dopamine available, by working against enzymes that destroy dopamine. (MAO-B inhibitors eg selegiline.) ( COMT inhibitors eg tolcapone.) Drugs that block that action of the neurotransmitter, acetycholine. (thus reducing the chemical imbalance between dopamine and acetycholine.) (eg artane, cogentin, disipal) Others amantadine (believed to release dopamine from nerve endings in the brain) and motilium (used to reduce the nausea often associated with drugs used for PD). NOTE No two people will have exactly the same symptoms and therefore medication needs vary. The timing or spacing of medications also varies between different PWP. Listen to the PWP and carers. They usually have a very clear knowledge of their medication and when it is needed. Some PWP suffer adverse reactions if they do not take their medication within a few minutes of the due time. They are not being obsessive or deliberately awkward, only seeking to keep on functioning. 4. Surgery Not everyone is suitable for surgical intervention. Patient selection is a matter for a neurologist. Surgery is not a cure, nor does it stop the progression of the disease. There are risks of complications and patients will still require drug treatment, although perhaps at an adjusted dose. [The current procedures, done while the patient is conscious and using a stereotactic frame on the head, are:- -pallidotomy and thalamotomy - where a tiny lesion is created in a specific area of the brain and -deep brain stimulation - a reversible procedure in which a minute part of the brain is subject to chronic stimulation from an implanted electrode.] PD- EFFECTS ON EVERYDAY LIVING 1. Tremor -more apparent at rest, -reduced in active movements or when asleep -worse in stress situations -Can be very embarrassing, especially when handling liquid food or drink, and can cause people to withdraw socially. -Can also cause problems in some work situations. 2. Rigidity -reduced facial expression. ("mask-like" face. Muscles used in laughing or smiling do not work as well. (Others may dismiss the PWP as not interested, unresponsive, depressed, or even a bit "slow") -posture problems. (Tend to stoop forward, shoulders hunched) -pain. (because of muscles tightening and holding parts of the body in abnormal positions) -disturbed sleep. (body rigidity leading to stiffness and pain) -freezing. (getting stuck on the spot while walking) Please refer to separate sheet on handling freezing. 3. Slowness -movements slower -difficulty in initiating movement. -Reduced arm swing -Walking may develop into a shuffle, with small, forward pitched running steps -Writing typically small and cramped, may be slow, hard to start the writing action. 4. Combination of rigidity and slowness:- -Posture problems and poor balance lead to increased risk of falls. -Constipation and urinary problems (eg frequency) -Difficulty turning over in bed or rising from a low seat. -Fine motor movements difficult eg brushing teeth, doing up buttons or shoe laces. -Swallowing-difficulty with the several different actions involved in swallowing; dribbling. -Speech and communication difficulties. -Voice may be weak and strained -Speech tends to fade out -Words may tumble over one another. 5. Depression A common problem amongst PWP. However, it is also possible for lack of responsiveness due to facial masking to be mistaken for depression. HANDLING FREEZING EPISODES -Give the person time, if possible. Try to relax the person and break the tension with a joke or other pleasant distraction. -Do not let yourself get frustrated and, above all, do not push or try to forcibly move the person. -The following are some little tricks you can try:- -Place your foot, an up-turned walking stick, or perhaps a handkerchief in front of the person as something to consciously step over; -Use cue cards e.g. "large step" placed at a place where repeated freezing episodes occur; -Use a small electric metronome that can be switched on for stepping in time to the beat; -Say "GO" loudly, or "left, right, left,......" -Sing / whistle / clap hands; -Gently rock the person from side to side. POSSIBLE COMPLICATIONS FROM LONG TERM MEDICATION 1. "On-Off" effect or sudden fluctuations in performance. -The "off" times are when the drug somehow becomes ineffective for the patient; characterised by extreme slowness and difficulty moving. -When the "on" state returns, the medication becomes effective once more and the patient regains mobility. 2. Dyskinesias Involuntary movements caused by high levels of levodopa. (Superficial similarity to tremor. However dyskinesia: -involves more writhing or twisting movements, -occurs only during the "on " periods, and -is made worse by an increase in dopamine replacement medications 3. Dystonias -Uncontrollable, sometimes painful, cramping of a muscle group eg foot or calf muscles. Often indicative of low levodopa levels. 4. Sleep problems insomnia, vivid dreams and nightmares possible as side-effects of medications. 5. Hallucination and delusions Although not common, can be a very worrying side-effect and difficult to treat. (Some drugs eg anti-cholinergics, are normally avoided with elderly patients because confusion is a likely side-effect.) 6. Dryness of mouth and eyes May increase risk of infection. PARKINSON'S ASSOCIATION of W.A. Phone: 9381-8699 (city) 1800-644-189 (country) Make the point that when a person is ready, the Parkinson's Association is there as a point of contact with others in the Parkinson's community. Each person is welcome to become involved to the level they choose and in the ways they prefer. Explain the positive actions of PAWA. Services provided by our Association include: -Support and information by phone and in person, and referral to other resources, such as respite care, where appropriate. -Written & taped information on PD for loan or sale -Regular newsletters -Educational seminars with expert speakers, including special seminars for the newly diagnosed -Network of support groups for people with Parkinson's and their partners / carers -Support for local researchers -New members are also welcome to help with the activities of the fund-raising committee. Outline 2- Suitable for Service Groups Briefly cover the following areas -What is PD -Treatment for PD -Effects on everyday living -Possible complications from long term medication -Shift emphases to PAWA activities. -In addition to the items listed on page 11, discuss the following: -The need for funding. -current long term projects -(eg at time of writing 1. Centre of Excellence Project 2. Nurse Specialist Project, 3. Nursing Home PD Cluster Project 4. Proposed PD unit as part of Nursing course at Curtin) Current short term requirements (equipment etc.) Speakers will need to liaise with Bob Grahamfor latest requirements. Outline 3 - Suitable for non-professionals, home visitors etc. Concentrate on the following areas -Be as positive as possible -The 3 major symptoms -The need for the PWP to remain as active as possible -The positive aspects of drug therapy -Describe the On -Off effect without getting too involved with causes. -Explain the body language and communication problems associated with mask-like face, stillness and loss of spontaneity ++++++++++++++++++++++++++++++++++++++++++++++++++++