Non-Drug Treatments

Introduction

Although the most common treatments for Parkinson's disease are drug-based, new research has come up with many new ideas for treating the disease. For instance, there is evidence supporting the use of virtual reality to help the dyskinesia of Parkinson's patients, that exercise can affect the degeneration positively, and that behavioral treatments may improve motor skills in Parkinson's patients.

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Virtual Reality

The idea behind treating Parkinson's disease with virtual reality is actually very clever. It turns out that Parkinson's patients who are almost unable to walk normally, seem to walk almost normally when there are a series of objects placed in their pathway in front of them. It is as if the patients use the objects as cues for walking -- and it allows them to initiate coordinated movements that they are apparently unable to initiate without the cues. This strange phenomenon is called "kinesia paradoxa" for good reason.

What scientists have discovered is that by using a simple virtual reality computer game, they can cue Parkinson's patients to walk on their own, despite their degenerating motor control. The patients can place a pair of virtual reality goggles on their head that create visible "bars" that appear to be in front of the patient's foot as they walk along. These bars are the cues that allow Parkinson's patients to walk with much less difficulty than usual. It is hopeful that soon affordable goggles will be made that can be used by anyone to improve motor skills in Parkinson's patients.

How it Works:

For some reason, cueing a patient's walking is able to abate many of the symptoms of dyskinesia, whether it is due to the disease itself, or due to L-Dopa. One theory that has been discussed is that "kinesia paradoxa" works by providing extra feedback about self-motion, or in other words, by providing the brain with extra information about how it is moving -- in a straight line, fast, slow, etc. The reason why the cueing probably helps is because the brain's normal system for monitoring the visual and motor feedback is faulty, and external cues help to compensate for the loss of normal functioning. The mechaninsms are still being researched, and little is known about these effects.

Problems:

There are a few glitches in this treatment. First of all, it appears that the longer the patient has suffered from Parkinson's, the less this method of treatment works: the more severe the dyskinesia, the more realistic the cues need to be in order to get the same reaction of motor control.

Also, the technology is there, but expensive. It would be highly unrealistic for all of the current Parkinson's patients to receive this treatment, since it would cost much more than any other treatment. Hopefully, there will be future advancements that allow this treatment to become feasible (Weghorst, 1997)

Exercise

Another example of the new trend towards non-drug treatments was the discovery of the use of exercise to minimize the problems associated with spinal rigidity in Parkinson's patients. Evidently, the physical problems of flexibility and function of the spine that arise in early and middle-stage Parkinson's patients can be helped through a ten week exercise program that works on axial mobility, spinal mobility, and physical performance. In a controlled trial done by Margaret Schenkman and others, these exercises improved physical performance in the axial rotation of the spine, in the time it takes for a patient to rise up from a sitting position, and the functional mobility of the spine (reduced rigidity). There appears to be no side-effects, other than a little muscular pain due to exercise, and the patients tend to end the program in better shape than they began it. If something as simple as exercise helps, hopefully this treatment is easily available to everyone.

Problems:

Although simple and easy, the exercise treatment seems to help especially those in the first years of Parkinson's more than those with a more advanced form of the disease. This is probably due to the ineffectiveness of exercise in a patient well beyond coordinated physical movements. Also, the effects of exercise are obviously limited; only some may gain measureable flexibility, and for most, this treatment is only going to help when performed on a very regular basis. However, if it may help, what's the harm in trying?

Behavioral Treatments

One of the most interesting non-drug treatments that has been researched is the use of behavioral treatments to reduce tremors and improve motor skills. Some of the behavior treatments studied included relaxation training, specific motor training based on each individual's problem areas, and social interaction training. Groups that received this training over a period of 10 weeks and within 20 training sessions improved significantly in both motor and social skills after training.

How it Works:

First of all, each treatment listed above has a purpose. The relaxation techniques taught are supposed to help the Parkinsonian patient voluntarily reduce tremor through their own means. Throughout many studies, it has been shown that relaxation techniques appear to reduce tremor, probably because the mind is able to exert some amount of control over the excess movements induced by Parkinson's disease.

The specific motor training included such things as practicing handwriting, walking, standing up form a chair, and other activities.The ways patients are trained involves creating situations that require a patient to perform functions they no longer are adequately able to do. The theory behind why this training may improve symptoms of Parkinson's is that perhaps disuse of these functions normally leads to reduced motor functions, and that by simply creating situations where these skills are used more often is enough to prevent more cell loss in these motor areas.

The social interaction training involved role-playing that was guided by trained therapists. The role-playing attempted to simulate problematic social situations that caused stress in Parkinsonian patients, and helped them develop strategies to reduce stress through rehearsal of how to react in those situations, and through the application of the relaxation techniques in simulated situations. This also probably had an effect on the reduction of tremor due to extensive use of motor systems and also through the relaxation effects.

Problems:

The problems with this type of treatment are difficult to pinpoint, but seem to revolve around the uncertainty of how long the training remains effective in helping the patient to cope with their symptoms. It is also unknown as to whether or not the training must be done periodically, or if a few sessions once and a while are adequate. Again, like the exercise treatment, it may be possible that the treatment time outweighs the actual benefit of the treatment, and without knowing the lifespan of the training it is difficult to make the decision to initiate training. The treatment is a little less feasible than the exercise, due to the requirement of trained professionals teaching each patient these techniques (Mohr et al, 1996).