Complementary and Alternative Medicine Therapies for Parkinson’s Disease

CAM Therapies

Complementary and alternative medicine or CAM is a name given to a range of therapies that are more often practiced in eastern than in western countries, such as acupuncture. Acupuncture has been practiced for centuries in China. In the past few decades, several scientific investigations have established that certain forms of needle acupuncture can trigger release of the body's natural opioids and other chemicals that may help with healing. Studies on meditation and relaxation, massage therapy, yoga and Tai Chi have also shown that they can have positive impact if delivered by well-trained practitioners.
In 1998, the National Institute of Health (NIH) established the National Center for Complementary and Alternative Medicines (NCCAM) in order to boost research into these therapies to see if they can work -- because lots of people were spending money on these therapies, even though it was unclear if they worked. The good news is that several CAM therapies appear to have significant (better than placebo) and positive effects on health.
Choosing a CAM Therapy and a Practitioner
• To help you choose a CAM therapy that is right for you, talk with your neurologist and make sure that the therapy in question poses no undue risks to you.
• NEVER listen to any CAM therapist who tells you that levodopa is toxic or that Parkinson’s disease can be cured via their therapy.
• Make sure that the therapist is a licensed, certified practitioner and that the license is obtained from a reputable source.
• Ask the therapist if your health insurance will help cover the costs. Many therapists have to present educational and training credentials to insurance companies before the insurance companies will cover their clients. Always prefer therapies that are covered by insurance, it both keeps your costs down and it helps establish the legitimacy of the therapist.
• Ask the therapist about the risks associated with the treatment and how those risks will be minimized in your case.
• Ask the therapist how many treatment sessions are necessary before you can expect to feel positive results.
If you do not receive satisfactory answers to these questions, or if the therapist can present no credentials then it may be wise to seek an alternative therapist.

Acupuncture

During acupuncture, sterile needles (about the size of a human hair) are inserted into various regions of the body, like the earlobe, the back, the buttocks and the legs in order to re-balance "energy flows" in the body. Usually several treatment sessions are required lasting anywhere from a half hour to an hour. After the needles are put into place the therapist turns on some relaxing music and leaves the room. You then relax and allow the needles to do their work. After a few minutes the needles are removed and that’s it.
To date, only a single study has evaluated effects of acupuncture on Parkinson's disease and that study found no improvement of motor or mood symptoms in the 20 patients who had the treatments. These same patients, however, reported that they felt a bit better and slept a bit better.

Massage Therapies

Common sense suggests that if you feel stiffness, pain and rigidity in your muscles, massage will help. It is no wonder then that many people with PD utilize various forms of massage therapy to relieve some of their symptoms. Most often this use of massage therapy is supported by PD specialists as long as the massage therapist is a trained and certified therapist.
There are many forms of massage therapy including Swedish massage, neuromuscular therapy, Shiatsu, acupressure, craniosacral therapy and many others besides. To date only neuromuscular therapy (NMT) has been assessed with adequately controlled experimental designs. NMT focuses on manipulating "trigger points" in the body -- places in muscle tissue that have become "knots" and painful discomfort. These trigger points are gently massaged until they dissolve away. The good news is that the available evidence suggests that NMT appears to have significant beneficial effects on both motor and non-motor symptoms of PD. All of the other forms of massage therapy have been assessed in less rigorous ways but they too generally show significant positive impact on PD symptoms.
How does massage work? It very likely makes you feel good to start with. This "feel good" effect alone may boost your mood and relieve muscle tension. Massage can also increase blood supply to your muscles and increase your range of motion in those muscles thus decreasing rigidity in those muscle groups.
Don’t be deterred by the expense involved in massage therapy if it helps you. More and more therapeutic massage is being covered by insurance –- especially if your doctor prescribes it as medically necessary.

Relaxation and Meditation Techniques

Living with PD can be stressful and with time, it can become more difficult to find ways to relax. Studies show that one way to relax is to actively attempt to do so by setting aside 20 minutes per day to just sit, watch your breath and then just let your mind wander. When you find your attention wandering just smile and bring it back to your breath…and that’s all you need to do each day.
You can add more intense relaxation exercises to these meditation sittings by simply turning your attention away from your breath and onto one body region at a time. Many persons with PD find it valuable to listen to "guided relaxation" tapes or CDs. Here the guide walks you through relaxation of one muscle group after another until your whole body has received attention and is relaxed.
Here are some other tips that may be helpful to you in your relaxation and meditation exercises:
• Make relaxation and meditation a daily practice. 20 minutes each day without worrying about getting it "right"…just put in the time each day and your body will soon respond
• Select a form of meditation that fits your fundamental beliefs. A Christian might visualize sitting in the presence of Jesus while an atheist might visualize sitting on a quiet sunlit beach…find an image that works for you, that gives you a sense of peace and well-being and then just bask in it.
• Use a "mantra," or a short phrase, that has some spiritual content that you repeat over and over again, while you sit and breathe. Again choose a mantra that fits with your fundamental beliefs and that gives you comfort. A religious person might just repeat “Lord” over and over again, while an atheist might repeat “calm” over and over again.

Chinese Martial Arts

One of the major problems for people with PD is postural instability. If you have difficulty maintaining your balance you might fall and hurt yourself. Strengthening your muscles through exercise can offset some of the postural problems associated with PD. Adding some training in Chinese martial arts techniques, in addition to your regular exercise regimen, may help you to better compensate for these postural problems AND strengthen your muscles more generally.
Always check with your doctor before you attempt any of these martial arts training programs.

T’ai Chi Chuan (TCC)

TCC combines aspects of aerobic exercise and measured breathing with slow, dance-like movements derived from self-defense moves. The best way to learn TCC and related arts (like QiGong) is to learn it from a trained professional. There are now many Chinese martial arts centers in the major cities. Just make sure that your trainer has some certifications in the practice before signing on with him. To date studies have not shown significant motor benefits in Western PD patients as the techniques take so long to learn. But non-westerners and Chinese patients, who have been exposed to these martial arts programs for many years may derive more benefit. The jury is still out on these programs with respect to benefits for people with PD.

Yoga

Yoga exercise classes are now available in every major city in the West and probably in the East as well. To date no controlled studies of yoga for PD have been published. But it is possible that low-impact forms of Yoga may be helpful for PD. Yoga as taught in the West typically involves learning a series of body postures that allow for stretching and relaxing muscle groups. Yoga also involves spiritual and meditative exercises as well as attention to breath.
As will all the other CAM therapies, find a practitioner who is certified in the yoga therapy he or she is offering. Ask him or her to modify the traditional yoga postures to accommodate your limitations.

Simple Steps to Improve Tight Muscle and Poor Posture in Parkinson's Disease

These general exercises and suggestions are designed to assist a patient suffering from Parkinson's disease. They are ancillary to medical treatment and should be carried out in consultation with one's physician or neurologist. In certain conditions where other diseases are associated with parkinsonism, the physician may set to limit the intensity of the physical activity. However, more intensive physical therapy may be indicated and in some instances should be done under the direction of a physical therapist should the need arises.

STANDING

1. Stand ln front of a wall, facing it about 8" away. Raise arms and reach as high as possible toward the top of the wall. Lean toward the wall and stretch.
2. With your back to the wall, alternate raising legs as high as possible by bending the knee as if marching in place.
3. Holding on to something secure, squat down as far as possible, bending knees; then come up.

SITTING

1. Sitting in straight-back chair, place your arms behind the chair and bring your shoulders back as far as possible; raise your head up and look at the ceiling.
2. Sitting In the same chair, grip the ends of a broom or mop stick with both hands, try to raise it over your head until you get it behind your head. Keep head and shoulders as erect as possible.
3. Sitting in same chair, place one leg at a time on another chair and press the knee straight. Keep it there 15 minutes. Try both legs together.
4. Sitting in a chair, raise legs up from the knee alternately, as if stamping your feet.

LYING ON A FIRM BED OR FLOOR

1. Lie on the floor or bed, flat on your back; try to press your body to the floor as flat as possible. Move your head from right to left as far as possible. Make sure your head, shoulders, back, and knees touch the surface.
2. Lie on the floor or bed on your abdomen. Do the following one by one:
a. Put your hands behind back and look up to ceiling, trying to raise your chest off the floor.
b. Kick your legs alternately, as if swimming.
c. Turn your head from right to left.

FOR BETTER BALANCE

1. Stand with hands on hips, feet spread apart:
a. Practice marching in place
b. Practice raising leg straight out to the rear.
c. Practice raising leg out to the side.
d. Practice drawing a circle with the leg.
2. Standing with hands at side, feet spread apart:
a. Lean forward and back
b. Lean to both sides
c. Lean in a circular motion and reverse the motion

FOR WALKING

1. When walking, REMEMBER:
a. Take as large a step as possible
b. Raise your toes as you step forward, hitting ground with your heels
c. Keep legs apart and posture straight
d. Swing arms and look straight ahead - your feet know where the floor is located.
2. Collect a dozen magazines; lay them out in a straight line. Space them so that you can take as long a step as possible. Practice walking over these magazines without stepping on them.
3. For a better swing to arms, walk holding a rolled magazine in each hand; keep elbows straight.
4. Practice walking sideways, backwards, and take big steps.

FOR TURNING

1. When practicing turning:
a. Keep feet spread-apart and head high
b. Use small steps; rock front side to side
c. Raise legs from the knees
2. If you feel glued to the floor:
a. Raise your head, relax back on your heels and raise your toes
b. Rock from side to side, bend knees slightly and straighten up and lift your toes
c. It sometimes helps if the arms are raised in a sudden short motion

FOR GETTING IN AND OUT OF A CHAIR

1. If you become glued a few steps before you reach the chair, try this: Don't aim for the chair but some object past it. Pass the chair as closely as possible and as you go by it sit down.
2. To sit down, bend forward as far as possible and sit down slowly. Get close to the chair. Do not fall into the chair.
3. To get up, move to the edge of the chair, bend forward and push up vigorously using your arms; try to count 1 2 3 GO! If you have a favorite armchair, raise the back legs with 4" blocks. This will help you to get up easily. Don't let people drag you up by your arms, but help you by pulling you under your arms, or with a slight push on your back.

FOR GETTING OUT OF BED

1. Place blocks under the legs of the head of the bed. This will elevate the head of the bed, & make it easier for you to sit up and swing the legs off the bed.
2. A knotted rope tied to the foot of the bed can help you to pull yourself up.
3. To get to a sitting position, shift the body down and rock yourself by vigorously, throwing your arms and legs toward the side of the bed.

FOR USING YOUR ARMS AND HANDS

1. Practice buttoning and unbuttoning your clothes; practice cutting food and writing. Squeeze a ball or work with "Silly Putty." Keep your fingers busy many times a day. Tear paper; take coins out of the pocket; play the piano.
2. Always try to dress yourself completely. Use shoehorns, elastic laces, or extra-long shoelaces to get a better grip. Dress in the most relaxed and comfortable position, sitting or standing, but make sure you are in a safe position.
3. To keep elbows straight and shoulders loose, install a pulley in doorway, place a chair under it or slightly in front. Stretch your arms and shoulders in all directions. By working the pulley when seated, you can get a more vigorous pull.

FOR GREATER SAFETY IN BATHTUB AND TOILET

If it is difficult to sit down in a bathtub, try the following:
1. Place a bench, stool or chair inside the tub; have the legs sawed off to tub height. Sit on the chair and soap yourself. Use shower to rinse, or rubber shower extension.
2. Bathtub grab bars are available. Purchase only those that attach securely.
3. Raised toilet seats are commercially available.
4. Toilet armrest for getting on and off the toilet are available.

FOR SPEECH, FACE AND CHEWING DIFFICULTIES

1. Practice singing and reading aloud with forceful lip movements. Talk into a tape recorder, if one is available.
2. Practice making faces in front of a mirror. Recite the alphabet and count numbers with exaggerated facial motions. Massage your face with vigor when washing and bathing.
3. When chewing food, chew hard and move the food around; avoid swallowing large lumps.

Ten Basic Exercises for Patients with Parkinson's Disease

The maintenance of normal muscle tone and function is an important aspect of the treatment of parkinsonism. In part, medication administered for the illness achieves this goal. However, to realize the full benefit of the medication, daily exercise and activity are essential. Here is an outline of some of the exercises capable of maintaining muscle power and tone and preventing deformities of the limbs and spine. Their daily performance has proved most beneficial to patients with this illness.

TEN BASIC EXERCISES FOR THE PARKINSON PATIENT

1. Bring the toes up with every step you take. In Parkinson's disease, "you never make a move", without lifting the toes.
2. Spread the legs (10 inches) when walking or turning, to provide a wide base, a better stance, and to prevent falling. It may not look "beautiful," but neither does falling.
3. For greater safety in turning, use small steps, with feet widely separated. Never cross one leg over the other when turning. Practice walking a few yards and turn. Walk in the opposite direction and turn. Do so fifteen minutes a day.
4. Practice walking into tight corners of a room, to overcome fear of close places.
5. To insure good body balance, practice rapid excursions of the body. Backward, forward and to the right and left, five minutes, several times a day. Don't look for a wall when you think you are falling. It may not be there. Your body will always be there to protect you, if you will practice balance daily.
6. When the legs feel frozen or "glued" to the floor, a lift of the toes eliminates muscle spasm and the fear of falling. You are free to walk again.
7. Swing the arms freely when walking. It helps to take body weight off the legs, lessens fatigue, and loosens the arms and shoulders.
8. If getting out of a chair is difficult, rise with "lightning speed," to overcome the "pull of gravity." Sitting down should be done slow, with body bent sharply forward, until one touches the seat. Practice this at least a dozen times a day.
9. If the body lists to one side, carry a shopping bag loaded with books or other weights in the opposite hand to decrease the bend.
10. Any task that is difficult, such as buttoning a shirt. or getting out of bed, if practiced 20 times it day, becomes easier the 21st time.