William and MaryKinesiology and Health

Science

Walking with Parkinson’s with the aid of Music 2010

John Yonushonis

MY NAME IS JOHN YONUSHONIS AND I HAVE

PARKINSON’S

Parkinson’s

MY ENTIRE RIGHT SIDE IS SLOWER THAN

LEFT I CANNOT SEQUENCE MY RT THUMB TO MY

RT FINGER MY NIGHTTIME TREMORS ARE SUCH THAT

I CAN NOT DRINK A CUP OF COFFEE I CAN NOT FLIP MY WRIST I HAVE COMPLETELY LOST MY ABILITY TO

WRITE AND CAN NO LONGER READ BOOKS BUT I CAN PLAY THE NATIVE

AMERICAN FLUTE

TODAY

RAISE THE AWARENES OF PARKINSONS AND UNDERSTAND WHAT IT DOES TO THE HUMAN BODY

TALK ABOUT MUSIC THERAPY AND NATIVE AMERICAN FLUTE AS ALTERNATIVE THERAPY

SPEAK PERSONALLY ABOUT MY WALK WITH THE DISEASE

OPEN THE DISCUSSION TO ANY QUESTION

PARKINSON’S IS A CHRONIC, PROGRESSIVE, NEURODEGENERATIVE DISORDER WHOSE SYMPTOMS INCREASE OVER TIME AND HAS NO CURE

Who Gets PD?

1 in 100 over 60 years of age Average age of onset 60 years of age 15% diagnosed before 50 years of age Slightly more men than women

What is Parkinson’s Disease?

Chronic progressive neurological disorder Certain brain cells or neurons in the

substantia nigra (SN) die or are impaired Those neurons produce dopamine Responsible for coordinated movement

and balance

Our Brain

Circuits formed by living cells called neurons

100 billion neurons A transmitter called an axon Receptors called dendrites

Our Brain

Neurons not directly connected to one another

Tiny gap between the transmitter end of one cell and the receptor end of another cell

Gap is called a synapse

Our Brain - Messages

Neurons act as a communication network Neurotransmitters carry the message

across synapses from one neuron to another

This allows the nervous system to communicate with muscles and translate thought into motion

PD Messages

There is a defect in dopamine producing neurons They do not properly produce and transmit

dopamine The Messages about balance, coordination and

movement are impaired Decreased stimulation of the motor cortex

also occurs Planning, control and execution of voluntary

motor functions are impacted Due to insufficient formation and action of

dopamine

Circuits

PD is all about brain circuits When one part is disrupted then the

circuit malfunctions causing too much or too little movement.

Movement

Normally we don’t think about how it is possible for our bodies to move

It just happens when we want it to!

Dopamine

Travels from the SN to the striatum Initiates movement Controls movement and balance Makes sure:

Muscles work smoothly, Under control and Without extra or unwanted movements

How does it Work?

Transmitter end of SN neurons release dopamine into the synapse

Fits into special receptors on receiving neuron Message is passed along After receiving cell is stimulated , excess

dopamine is released back into synapse To fine tune movement the excess dopamine us

broken down in the synapse by an enzyme MAO-B Important step in precise control of movement as too

much or too little disrupts balance between dopamine and another neurotransmitter system - acetylcholine

Loss of Dopamine

SN degenerates decreased dopamine production Causes lack of regulation of the movement in

the control centers in the brain loss of control of movements

Cardinal signs become apparent at 70-80% dopamine loss

LETS LOOK AT THE SIGNS

Tremor

Present in 70% of people Involuntary movement “Pill-rolling” movement Most obvious at rest or when under stress Lessens with intentional movement Disappears with sleep

Bradykinesia

Slowness of movement Incomplete movement, difficulty

initiating movements and sudden stopping of ongoing movement.

Loss of spontaneous or automatic movement

Slowness may interfere with daily routines; getting dressed, shaving or showering may take much of the day.

“Freezing”, small steps or shuffling gait Significant problem and the most

disabling symptom. 

Rigidity

Stiffness or inflexibility of the limbs and/or trunk

Muscle tone is always stiff and does not relax – leads to decreased range of motion

Felt as “tightness” in limbs Can cause pain and cramping

Postural Instability

Abnormal postural reflexes make balance and coordination difficult

Seen as a forward lean Fall backwards – trouble keeping upright Leads to falls Stooped posture Walk with series of quick small steps

Other Signs of PD Small handwriting Changes in posture – stooped and lack of arm swing Decreased facial expression Speech changes Difficulty swallowing and drooling Depression/anxiety Pain Sleep disturbances Constipation Loss of sense of smell Urinary frequency Sexual dysfunction Low blood pressure Fatigue/loss of energy Changes in mental function over time

How is PD Diagnosed?

No definitive blood test or x-ray Medical history Neurological exam Rule out other conditions Should see a Movement Disorder

Specialist neurologist who specializes in PD

Positive response to PD medication

Why Does This Happen?

Cause unknown - lots of theories Environmental factors

rural living, well water, herbicide use and exposure to pesticides

Genetic factors 15-20% have close relative with PD symptoms

Aging wearing away of dopamine accelerated

Probably result of genetic predisposition coupled with a yet unknown environmental factor

Goal of Treatment

Quality of life Best way to live with PD

Know about PD Know about drugs and how they work Willing to make life style changes

Good working relationship between person with PD, their doctor and their family

MY STORY/ INPUT FROM MY WIFE ANN AT TAOS PUEBLO

LETS TALK ABOUT WHAT IT IS LIKE TO HAVE PARKINSON’S

PERSONAL STORY PART OF A SPEECH I GAVE TO BARROWS NEUROLOGICAL LUNCHEON

When I was in elementary school, I will never forget a story I read, and for the life of me, I hope someday to remember its title. It was about a dog and it’s VISION OF A ROOM with one door and what it felt like when the door closed and it was alone. It could not open the door, could not see through the door, could not see around the door and, most of all, could not do anything to change its destiny until the door opened again. All the little dog could do was hope. All it could do was work to overcome the fear that no one would ever open the door again. All the little dog could do was wait.

PERSONAL STORY

I have now talked to hundreds of people with NEUROLOGICAL DISORDERS and their story is the same: We all became the little dog in the room with no way to open the door. We only had fear to begin with, but with the help of our friends, our fear turned to hope. FOR ME IT, AND MY WIFE ANN that taught me that the room I was in was no longer small. The room I was in became a room with a window and then it became ROOM WITH AN OPEN DOOR. The flute brought me back into society.

ADVANTAGE OF NATIVE FLUTE

RELAXATION COORDINATION BREATHING EXERCISE SOCIAL STIMULATION FUN FOCUS ON NOW, TODAY

TONY IN CAMERONTHE FLUTE AND HIS GRANDFATHER

THE BLESSING SONG

REMEMBER

A BRAIN THAT ENGAGES IN MUSIC IS CHANGED BY ENGAGING IN MUSIC

Dr Michael Thaut

MUSIC AS THERAPY Began after World War I and World War II

when community musicians of all types, both amateur and professional, went to Veterans Hospitals around the country to play for the thousands of veterans suffering both physical and emotional trauma from the wars. The patients' notable physical and emotional responses to music led the doctors and nurses to request the hiring of musicians by the hospitals.

How Does Music Therapy Help

The Biochemical Theory Music stimulates the cerebral cortex and

Autonomic Nervous System, which sends vibrations and impulses through the body

The Entrainment Theory Sounds are received through the human

energy field and entrain the body’s rhythms

The Metaphysical Theory Music is a gift from God and connects

people together (For example…)

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THE ENTRAINMENT THEORY

ADJUSTS THE INTERNAL RHYTHM OF AN ORGANISM TO EXTERNAL FREQUENCIES TO CREATE HARMONY

OUR BRAIN ENTRAINS THE FREQUENCY AND RHYTHM OF SOUND TO ENHANCE OUR NATURAL RHYTHM

IN PARKINSON’S THE ENTRAINMENT ALLOWS PEOPLE TO DANCE WHO CAN NOT WALK

Music Therapy Metaphysical Theory

the “ability to experience an altered state of

physical arousal and subsequent mood

by processing a progression of musical notes of varying tone, rhythm, and instrumentation for a pleasing effect.”

PYTHOGOREAN HARMONY THEORY

In the Mysteries the lyre was regarded as the secret symbol of the human constitution, the body of the instrument representing the physical form, the strings the nerves, and the musician the spirit. Playing upon the nerves, the spirit thus created the harmonies of normal functioning

PYTHAGORAS set HARMONY to a mathematical scale Pythagoras cured many ailments of the spirit, soul, and body by having certain specially prepared musical compositions played in the presence of the sufferer

WHY IS MUSIC USEFUL

PROMOTES WELLNESS ALEVIATES PAIN MANAGE STRESS OUTLET TO EXPRESS FEELINGS IMPROVE COMMUNICATION IMPROVE PHYSICAL COORDINATION FORCES FOCUS ON TODAY

Parkinson’s and Music

INCREASES THE ABILITY TO OVERCOME THE DIFFICULTY GENERATING SEQUENCE

GIVES BACK RHYTHM GIVES BACK TEMPO GIVES BACK TIMING

John Phillips Sousa Parkinson’s patients that cannot walk but can

dance The loss of dopamine creates a lack of

synchronization of movement that music may be able to somehow reorganize

FOCUS ON RHYTHM

My personal opinion: there is a rhythm in the soul of mankind and is manifested internally, universally similar but distinctively different in everyone and can be touched by the Native American Flute (remember Tony and his Grandfather)

Next: a healthy mind creating a healthier brain

Music helps depression you can help those with Parkinson’s

CAN YOUR MIND HELP THE COURSE OF THE DISEASE

Dr Anthony Santiago Muhammad Ali Parkinson’s

“It is the stagnation of our personal story, maintaining a rigid definition of our own meaningfulness and worth, coupled with a loss of imagination, a lack of courage to face our imperfections that defines depression, not just a particular chemical change.

Left unattended (in Parkinson’s) this molecular backdrop transmogrifies into a self fulfilling paradigm

Those actively engaged…….have a slower progression of the disease (Parkinson’s)”

MY WALK WITH PARKINSON’S

MY PROMISE: I WOULD NOT BE EMBARASSED BY THE

DISEASEI WOULD TELL EVERY ONE ABOUT IT TO

INCREASE AWARENESSI WOULD HELP MY BROTHERS AND SISTERS

WITH PARKINSON’S FFPNR

LUNCH WITH MUHAMMAD ALI BECAUSE OF MUSIC THERAPY

A

ALI

A

ALI

PLAY ANYTIME I GET A CHANCE AND TELL MY STORY TO EVERYONE

EXPERIENCESBLESSING SONG

KLAGETOH

EXPERIENCES BECAUSE OF MUSIC THERAPY

KLAGETOH HOGAN

WWW.FFPNR.ORG

FOUNDATION FOR PARKINSON’S AND NEUROLOGICAL RESEARCH MISSION

A WORLD WITHOUT PARKINSON’S