Using electrical activity in the brain to overcome freezing

Assistant Professor Caroline Paquette
Assistant Professor Caroline Paquette

Although most of us take it for granted, turning while we walk is a complicated job. Our brains must calculate where to place our feet, and how to adjust and maintain our balance when we shift direction – all in a split second.

For some people with Parkinson’s disease, turning often results in freezing. Without warning, they find themselves rooted in place. They cannot simply will themselves to move forward.

At McGill University, Caroline Paquette, an assistant professor in the Department of Kinesiology and Physical Education, is trying to determine what regions of the brain are affected in people with Parkinson’s disease who experience freezing. She’s using Positron Emission Tomography (PET) to scan the brains of people with Parkinson’s after they have walked through a series of obstacles that require turns. Her research is being funded by a two-year, $90,000 New Investigator Award from the Parkinson Canada Research Program.

“We know that turning is complex walking, and it’s a huge trigger for freezing,” Paquette says. “It’s quite a big problem in people with Parkinson’s disease, because if your mobility is affected, it affects your quality of life and independence.”

To discover how to overcome freezing, Paquette must first understand what mechanisms in the brain are involved. Before the people in her study begin walking, Paquette and her team inject them with a small radioactive tracer. After they have completed their walking and turning task, technicians scan their brains to see what areas the tracer has lit up, indicating increased activity.

By studying those brain scans of people with Parkinson’s who freeze while walking, as well as the scans of people with Parkinson’s who are not affected by freezing, and comparing those images to scans from people without Parkinson’s disease, Paquette hopes to identify the specific areas of the brain that turning activates.

Paquette will then use another non-invasive technology, called Transcranial Magnetic Stimulation, to stimulate those areas of the brain that seem under-utilized in people who are experiencing freezing.

Coupling TMS, which involves using magnets to create electrical activity in the brain, with current rehabilitation regimes might reduce or eliminate freezing, Paquette believes.

Rehabilitation is already somewhat effective in reducing incidents of freezing, Paquette noted.

“With training, we know that you can get people to have fewer debilitating freezing events, to use other cues on their own and to rely less on the environment. If you are able to use Transcranial Magnetic Stimulation on top of that you could get results faster and maybe have longer-lasting effects,” Paquette says.

If Paquette can prove her theory, her research would open up new areas of treatment and reduce the isolation, anxiety and fear of falling that plague those people with Parkinson’s disease who never know when they will find themselves stuck and unable to move.

For Paquette, this Parkinson Canada grant comes at a critical time because the study will help launch her reputation and her research.

“This is the key for me to build the basis for my lab and my research program so we can get funding to make better treatment interventions available for people with Parkinson’s disease, to improve their mobility.” Paquette says.

Read about other researchers recently funded by the Parkinson Canada Research Program by visiting the research section of www.parkinson.ca.

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You should be dancing

Dancing for Parkinson'sTake a cue from the Bee Gees’ hit song and consider taking a dance class especially designed for people living with Parkinson’s disease (PD). No need to mimic John Travolta in Saturday Night Fever, these dance classes are modified to be safe and effective for their participants with PD, as well as their spouses or care partners, while offering the joy of dance and all the benefits of moving to music.

AB (Alice Betty) Rustin has been taking a Sharing Dance for People with Parkinson’s class at Canada’s National Ballet School for three years now and a Dancing with Parkinson’s class in the city as well. “It’s always great to spend time with others with Parkinson’s,” says AB. “And I feel better after a class. The movements are not as strenuous as in an exercise class. They are much more fluid. And, you’ve got the wonderful music.” (Watch CBC TV segment on dancing and Parkinson’s here.)

Research indicates that dance is an effective, complementary therapy, for those living with Parkinson’s disease, according to Rachel Bar, Manager, Health and Research Initiatives, at Canada’s National Ballet School, in Toronto. “More than 40 research studies have established its benefits,” she says.

Indeed, several Parkinson’s researchers funded by the Parkinson Canada Research Program, have studied the benefits of dancing for people with Parkinson’s, from symptom relief to improved mood and quality of life. One of these researchers Joseph DeSouza conducts studies with participants at the Sharing Dance for People with Parkinson’s class and Dancing with Parkinson’s classes.

Research on dancing and Parkinson’s shows that improvements in balance and gait last long after dance classes end. DeSouza also wants people to know that dancing has other positive benefits. “All the other dance classes that take place all over the world show that people feel better – they’re happier,” DeSouza says. “It’s almost like a supplemental therapy that helps them cope with whatever they’re dealing with.”

Across the country, dance classes for people with Parkinson’s are gaining in popularity and several Parkinson Canada local offices and support groups are coordinating such offerings with local dance education instructors and partners.

In Saskatchewan, the Parkinson Canada Regina support group now offers a Creative Dance Movement for Parkinson’s class with dance instructor Fran Gilboy, who completed initial specialty training with Sarah Robichaud of Dancing with Parkinson’s in Toronto this past May. The support group first approached Gilboy last spring to offer a 30-minute dance class and then had her return for another session.

“After the first class, I was inspired by this group. After the second class, I was on my phone in the parking lot, trying to find a way to get funding to offer classes in an ongoing way,” she says. The Regina support group applied for a grant from the Saskatchewan Arts Board and was awarded a $9,400 grant to offer a program about twice a month from September through to April 2018.

“My heart strings were really pulled by this group,” says Gilboy, who has long taught creative dance to both children and adults. “There is a whole different level of pleasure in teaching this Parkinson’s group. There is the simple essence of joy in dance and other things just fall away. It’s now my favourite class,” she says.

Another outcome of the Saskatchewan grant is the production of a short documentary video to use to fundraise for further grants and support and future marketing of the program. The video will be shown at a Parkinson Canada gathering of support group facilitators in Saskatchewan and accompany a lecture and demonstration at a Parkinson Canada education conference in Saskatoon in April.

No experience is necessary and participants are encouraged to do what is possible for them on any given day.  Offered this first year free of charge, the classes take place at the Sunrise branch of the Regina Public Library at 3130 Woodhams Drive. The class is open to people with Parkinson’s, care partners, family members and friends. For more information, contact Rosemary Oddie at 306-585-0087 or email parkinsonsregina@gmail.com or John Dawes at 306-584-3267 or email john.dawes@sasktel.net.

In the Greater Toronto Area, Dancing with Parkinson’s classes are offered in more than a dozen locations, including each Monday from noon to 1 p.m. in the conference centre at the Parkinson Canada Toronto office at 4211 Yonge St. north of York Mills.  Contact Naseem Jamal at 416-227-3377 or Naseem.jamal@parkinson.ca to register.

Across the country, check with your local Parkinson Canada office for similar offerings or visit your local area’s Parkinson Canada event calendar, accessed here.

Canada’s National Ballet School offers Sharing Dance for People with Parkinson’s classes on Tuesdays and Fridays. You can find information about their program and other organizations offering dancing classes for people with Parkinson’s at www.dancepdnetwork.ca.

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You’ve been heard – thank you!

ApomorphineEarlier this summer, we put a call out to the Parkinson’s community across Canada to have your say about apomorphine (brand name Movapo®) and treatment options for people with Parkinson’s.

Thanks to your timely and meaningful input, we were able to prepare a patient evidence submission to CADTH, the Canadian Agency for Drugs and Technologies in Health.

We will keep you informed as any major milestones are reached. If you wish to follow the progress of this review now that together we completed the first important step, visit the CADTH website page that outlines the next steps in this review process: https://www.cadth.ca/apomorphine

The final recommendation is expected early in January 2018. If there is a positive recommendation, further processes will need to get underway before public coverage is made available. We will be sure to keep you informed.

We are grateful for your input and we are here if you have any follow-up questions. Contact Jacquie.Micallef@parkinson.ca.

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Help, I need somebody

Sandie and Robert
Sandie and Robert

You just found out your Dad has Parkinson’s and the whole family is in a panic. Who do you turn to? Your doctor just wrote you a prescription for a new Parkinson’s drug. You can’t remember the side effects to watch out for. Who can fill you in? Or, you just read about a miracle cure for Parkinson’s on the Internet? How can you find out if this information is for real?

For these, and so many other questions and concerns related to living with Parkinson’s, Parkinson Canada offers Information and Referral as one of many core services available across the country. Individuals can call 1-800 – 565-3000 or contact us by email at info@parkinson.ca. In 2016, the organization received more than 9000 contacts for help. Sandie Jones and Robert TerSteege are two members of a Canada-wide team that includes information and referral associates and community development coordinators, who provides confidential, one-on-one service to thousands of families. And these professionals have heard it all, retaining their kind and caring interest, along with a great depth of expertise, honed over time.  “We just want to help,” says Sandie.

Helping others seems to be part of their DNA. Both Sandie and Robert have always worked in the helping professions; Sandie started her career as a mental health nurse, and Robert working with people with disabilities. Long-term employees with Parkinson Canada, they have seen demand for their services grow, new treatments emerge, and an increasingly complex health and social services system grow around Parkinson’s care.

Sandie has been helping people living with Parkinson’s and their care partners for almost 20 years now. “I remember in my early nursing years when there was no treatment for Parkinson’s at all. I had an aunt that took part in the first clinical trials for Levodopa.” Her aunt had been basically immobile, and finally was able to sit up and speak, when taking Levodopa. “It reminds me of how far we have come and that there is hope for the future and I share those thoughts with clients.”

People living with Parkinson’s and their families most often need information and support when they are first diagnosed and when, or if, living at home is no longer an option. “Some people remember when Parkinson’s was such a cruel, painful and difficult disease, with no available treatment. Maybe they knew someone with the disease back then, and are terrified,” says Sandie.

You may remember what it’s like to leave the neurologist’s office after hearing the words, “You have Parkinson’s.”  You likely didn’t hear anything beyond those words.  After the shock subsides, you’ll want to know so much more: about symptoms and medications, other treatments, how your life will be affected; the feelings can be overwhelming. Friends and family want to know how best to support you. Whether you speak to Ryan in Atlantic Canada, Danielle in Quebec, Donna or Jennifer out west, like Robert and Sandie, they are all trained and qualified to explain things in a way that is relatable to you and your situation.

“It’s not always easy to understand or absorb information about Parkinson’s,” says Robert, whether from your doctor or in written materials. After all, we are talking about brain chemistry. It is a complex disease!”

Often callers simply feel less alone, when they can speak to someone who is empathetic, and outside of the family. “They feel validated when they learn that others are experiencing the same symptoms and feelings,” says Robert.

For instance one gentleman called because his wife insisted he do so, explains Robert. He had been experiencing depression and anxiety. When Robert spoke to him about how this is a very common symptom of the disease, and not a character flaw, he was much more receptive to talking to his doctor about getting treatment for these symptoms.  Both he and his wife were much relieved.

Many people also deal with issues of employment, caregiving, insurance, taxes, or assistive devices.  They may not know what sources of support are out there, as well as what programs they may be entitled to access.  “By getting a clear picture of what a person needs,” says Robert, “we can often direct a person to the available services in the community, including Parkinson Canada support groups and programs.”

With the amount of information sharing available through the Internet, many people also contact Parkinson Canada about claims on complementary therapies, breakthroughs reported in the news, and other things they have discovered online.  Parkinson Canada will not endorse any specific product, service or enterprise.  “We take pride in sharing credible information,” says Robert. “If we do not have an answer, we will do our best to source reputable information, so that people can make informed decisions for themselves.”

Probably the toughest conversations occur when the disease has progressed. During later stages, there are fewer benefits from medications. This is the time when families may consider other treatment options, and plan for outside help or a move from home. “Care partners and the person with Parkinson’s may feel like a failure, when they can no longer cope,” say Robert and Sandie. Parkinson Canada staff can help these individuals explore their options so they can make informed decisions and suitable plans.

Tips to getting the most out of your contact with our services

No matter why you contact Parkinson Canada, there are things you can do to help us help you.

  1. Be honest. It can be difficult for some people to discuss what they have been taught are taboo subjects such as bodily functions or sex. But, the more honest and specific you can be about your concern or questions, the more likely you are to get a satisfactory answer.
  2. If you call and get a voicemail recording, do leave a message. You will get called back; often we are helping someone just like you.
  3. When you speak to an associate, or leave a message, try to do so from a quiet place – without background noises like other conversations, the radio or TV. Speak as slowly and clearly as you can. Do not call from a cell phone while driving in your car.
  4. Have paper and a pen on hand to write things down.
  5. If you have questions about your medications, know the name of the medication, the dosage and the times you take it.
  6. Be prepared to have a meaningful conversation.

You may find these other resources helpful too

  1. Find out more about support groups and programs in your community here.
  2. Check out our Knowledge Network of webinars and podcasts here.

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Exercise to change the brain

Dr. Marc Roig
Dr. Marc Roig

For someone with Parkinson’s disease, the simple desire to grasp a glass of water can become an insurmountable task, made impossible by the tremors in their hand or arm. Finding strategies to improve these movement impairments is one of the major goals of rehabilitating people with Parkinson’s disease.

At McGill University, Marc Roig, an assistant professor in the School of Physical and Occupational Therapy, is studying the effects of using high-intensity exercise to stimulate the brain’s ability to learn and change with repeated experiences. His research is being funded with a $44,907 Pilot Project Grant from the Parkinson Canada Research Program.

Roig and his team are working with people who have Parkinson’s disease, to see if they can improve their ability to move and to complete tasks like grabbing an object. The team is using high-intensity cardiovascular exercise to provoke changes in the brain that make it easier to train itself to relearn motor tasks.

“One of the main problems with people with Parkinson’s is they lose their ability to do very simple motor tasks,” says Roig, a neuroscientist. “We want to understand why this happens and try to find interventions to improve that.”

Roig believes exercise may be the key to triggering the brain’s ability to change and to open a window to improve motor learning. He will use Transcranial Magnetic Stimulation (TMS), a form of non-invasive brain imaging that moves a magnetic coil over the skull, to map the areas of the brain he wants to measure. By attaching electrodes to the muscles of the hand and then moving the magnetic coil until the fingers move, his team will be able to map the changes in the brain that occur before and after intense exercise, and to record changes in the brain activity of people with Parkinson’s who are on medication and those who are not on medication.

After they exercise, the people enrolled in Roig’s study will also have to complete a task involving the application of force in a computer game, to measure whether the exercise and the burst of brain chemicals it stimulates also improves their motor ability.

Most people with Parkinson’s disease eventually take a synthetic form of dopamine, called levodopa, to replace the levels of this brain signalling chemical that Parkinson’s depletes. Roig is also testing his theory that the people with Parkinson’s will need their medication to take advantage of the improvements exercise can produce.

“With the new information, we can better understand how exercise interacts with dopamine and with motor learning,” Roig says.

His goal is to use that information to create new interventions during rehabilitation, and to explore the response of different areas of the brain.

“The final goal is to try to improve the quality of life of these people, but to do that you need to understand the mechanisms of the disease,” Roig says.

Eventually, his work may lead to new techniques and new rehabilitative interventions that can help people with Parkinson’s use exercise to train their brains to complete the simple tasks of everyday life that come so easily to others without this disease.

Read about other researchers recently funded by the Parkinson Canada Research Program by visiting the research section of www.parkinson.ca.

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