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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.


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10/16/2019

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Parkinson’s-Related

Dementia


Parkinson’s Disease:

- Affects the nerve cells in the brain that

produce dopamine

- With decreased dopamine, the brain

cannot function properly

- Causes muscle rigidity, tremors, and

changes in speech and gait

- Progressive disease with no cure


Parkinson’s-Related

Dementia:

- Related to the deposit of proteins in the brain known as Lewy bodies

- Those living with Parkinson’s-related dementia often have brain plaques and tangles such as those found in Alzheimers disease

- Dementia typically develops later in the disease

- It has been found that people living with Parkinson’s disease that experience hallucinations are at higher risk for dementia

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How Can We Help Those

With Parkinson’s-Related

Dementia Live Better?


Planned Movements versus

Automatic Action:

- Different brain activity in these two areas

- Different pathways are used for repeated cyclic actions

- Motor memories for familiar tasks have four elements:

- Initiation

- Sequencing

- Terminate

- Transition

- May need guidance for one or more elements

- Modeling can be more helpful than words


Breathing:

- Soft, only use top third of lungs used, less oxygen

- Suck in, then forced exhalation – repeat three times

- Sing out: Ahhhhhhh

- Aaaaa, Eeeee, Iiiiii, Oooooo, Uuuuuuu

- Blow out and move a tissue

- Blow out a candle

- Suck with a straw

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Talking and Singing:

- Vocal cords tighten, chest wall tightens, facial muscles

tighten

- Speech production and volume production requires

forceful movement of air

- Echo: repeat a word over and over

- Play with volume control: singing John Jacob Jingle

Heimer Schmitt

- Follow familiar tunes: Show Tunes, Hymns, Kid Songs

- Use what you gain for a short period afterward

- Singing two times a day: favorite songs


Activities of Daily Living:

- Self-Care routines

- Consider doing exercise actions with music

with the actions, then do the activity

- Consider what body actions are challenging,

then build a pattern that builds it in

- Mirrored work helps

- Songs that may help:

-Row, Row, Row your Boat

-Head, Shoulders, Knees and Toes

-PawPaw Patch


Upper Body Rhythms:- Bilateral: same movements

- Bilateral: coordinated action

- Bilateral: alternating actions

- Whole Arms: figure eights, Hokey Pokey, moving to the

music, partnered

- Whole Hands: drumming, clapping, clapping games

- Wrist Actions: waving, turning door knobs, Baby

Bumblebee, Yahtzee, pouring rice/beans/water

- Hand Actions: cans, ball drops, targeted throws, tool

use, object use, sandbags or bean bag tosses

- Finger Actions: chips, manipulatives, flipping cards,

undoing nuts/bolts, snapping while listening to

music

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Upper Body Movements:

- Weighted

- Wrist weights

- Pushing through hands

- Body weight

- Resisted

- Pushing: repetitive versus sustained versus on and off

- Pulling: moving in toward, pulling ropes, towel pull, pulleys, rope pull/tug of war

-Moving forward against resistance: heavy cart, moving furniture, sanding


Lower Body Rhythms:

- Single leg movements: swinging leg with or without

resistance, in water, with resistance bands, against weight

- Single leg movements while weight bearing: to side, to front, to

back, up and down, knee to chest and down, ankle on knee,

slide up and down the shin of the extended leg

- Bilateral leg actions: hopping, jumping, trampoline work

- Alternating leg actions: weight shifts, side stepping, stair

climbing (more challenging to go down stairs than up),

marching, partnered walking such as Follow the Yellow Brick

Road, The Ants Go Marching

- Cross Midline with Legs actions: Figure Eights, Grapevining,

Alphabet Hunt

- Going Backwards: marching backwards, counting to move,

partnered backward, circle songs such as Hava Nigila


Walking With a Rhythm:

3-Week Program- Using a metronome with music increased pace

by 25%

- Using self-paced rhythm when walking increased by 7%

- Not using a rhythm pattern when walking decreased pace by 7%

- Options:

-Walking with poles

-Walking with a partner

-Walking in water

-Walking with weights

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Dancing Lessons with a

Partner: 8-Week Program- Decreased depression and apathy

- Improved spontaneous weight shifts,

balance, and coordination

- Increased social contacts

- Maintained dancing activity following the

program

- Informally used dance group as a support

group

- Positive partnering with spouses, tango


Which Dances Work Best?

- All benefit!

- Partnered dancing is better

- 20 lessons in 13 weeks

- Tango is most beneficial

- Foxtrot or Waltzing is well worth the effort

- Not dancing resulted in mobility losses over

the same period

- Use it or start to lose it!


Let’s Try it Out:

- Swing

- Square Dancing

- Waltzing

- Foxtrot/Ballroom

- Congo Line

- Bunny Hop

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More on Dancing:

- Contradancing or square dancing is effective

- Line dancing is less effective

- 1 hr to 90 minutes in duration at most

- Better overall movement for a period

afterward


Tai Chi:

- Tai Chi was found to be more effective than

just stretching or resistance training in:

-Reducing fall risk

- Improving functional movements

-Speed of movements

-Ability to change direction

- Program lasted 2 times a week for 24 weeks

- Gains were sustained 3 months out


Therapy Compared to Regular

Exercise or Movement

Activities

- Gains happen with therapeutic intervention

- Regression tends to happen when therapy

stops

- Gains happen with movement programs

that are embedded into routines

- Gains are sustained longer and better in

the embedded programs

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Singing to Address Voice

and Speech Changes:

- Small group singing improves vocal

abilities and sustained speech skills

and swallow control

- Social interaction doubled during singing

activities

- Group singing was effective


Bicycling:

- Traditional bike: challenging but important

in early stages

- Tandem biking may have greater value

- Theracycle: automatic supportive when

balance and outside biking is

problematic or not possible

- Supported versus independent biking

- Upper extremity cycling


Rowing:

- Bilateral total body work out

- Aggressive and resistive

- ERG: uses the actions and does not

require the balance in water

- Scull: solo versus partnered work –

coxswain using rhythm call

- Grade the intensity, frequency, duration

for a good work out

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Boxing:

- Heavy work

- Alternating actions

- Total body forceful movements

- Balls of feet and clenched fists

- Seated boxing

- Punch balls


So, What is Dementia?

- It is not part of normal aging! It is a disease!

- It is more than just forgetfulness, which is part of normal aging

- It makes independent life impossible, eventually

- It changes everything over time

- It is not something the person can control

- It is not always the same for every person

- It is not a mental illness

- It is real

- It is hard at times


What is Dementia?

It is both

a chemical change in the brain

and

a structural change in the brain

So…

Sometimes they can and sometimes they can’t

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The person’s brain is dying


Normal Brain Alzheimers Brain

Used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama


Positron Emission Tomography (PET)

Alzheimers Disease Progression vs. Normal

Brains

G. Small, UCLA School of Medicine.

NormalEarly

Alzheimers

Late Alzheimers Child

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Four Truths About Dementia:

1. At least 2 parts of the brain are dying:

one related to memory and another part

2. It is chronic – can’t be fixed

3. It is progressive – it gets worse

4. It is terminal – it will kill, eventually



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How You Look At Dementia

Matters!

- It is not all about loss

- It is not ‘untreatable’

- It is not unpredictable

- Behaviors don’t come out of nowhere

- Dementia doesn’t just affect the person

with the disease – it impacts all of us


Beliefs:

People living with dementia are doing the

best they can

We must learn to dance with our partner

What we choose to do matters

We are a key to making life worth living

We must be willing to change ourselves


Positive Physical Approach™

for Those Without Vision Loss:

-Pause at edge of public space (6 feet)

-Gesture and greet by name

-Offer your hand and make eye contact

-Approach slowly within visual range

-Shake hands and then maintain Hand-under-Hand®

-Move to the side

-Get to eye level and respect intimate space

-Wait for acknowledgement

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Hand-under-Hand®:Protects aging, thin, fragile, forearm skin


How Do We Modify Positive

Physical Approach™ for

Those with Vision Loss?


For Those With Vision Loss:-Pause at edge of public space (6 feet), knock

on a table or door if possible, to help them localize the sound and your location

-Greet by name and approach slowly while talking

-Pause at the edge of their personal space and get down their level if they are sitting

-Place your hand palm-side up on their knee (or use the flat part of your hand, not fingertips)

- If they lean towards you and reach out their hand, shake hands and move into Hand-under-Hand®

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Remember:

- Move slowly so they can localize your

position based on your sounds

- If they are sitting, only touch their

peripheral body parts (knee) until you

are well-connected

- Use the flat part of your hand or the back

of your hand, not fingertips


How to Use Cueing When

There is Vision Loss:- If they seem to be struggling to understand

your verbal cues:

- Deepen your voice

- Use less words

- Use more pauses

- Do not slow your words, will distort them

- Use Hand-under-Hand® to demonstrate

gestures:

- Example: While in Hand-under-Hand® mimic

the motion of drinking from a cup to reinforce

the verbal question of “Are you thirsty?”


How to Use Cueing When

There is Vision Loss:

- They will be able to feel many of your body

language motions (i.e. shrugging

shoulders) through your Hand-under-

Hand® if you make them stronger and more

exaggerated

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How Can We Become Better

Care Partners?

- Let go of the past to be in the moment

- Go with their flow

- Be willing to try something new

- Be willing to learn something different

- Be willing to see it through another’s eyes

- Be willing to fail and try again


Do:

- Go with the flow

- Use supportive communication techniques:

empathy and validation

-Give examples

-Acknowledge and accept emotions

-Use familiar phrases or known interests

-Respect values and beliefs and avoid the

negative

-Offer info if asked, monitoring the emotional

state


Don’t:

- Try to control the flow

-Use reality orientation and big lies

-Correct errors

- Try to stop the flow

-Reject topics

-Try to distract until you are well-connected

-Use negative visual cues

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© Teepa Snow, Positiv e Approach, LLC – to be reused only with permission.

The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts or ideas

contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright holder

shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other consequential

damages arising directly or indirectly from any use of this material, which is provided as is, and without warranties.

Any links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose.

This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other

applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or changed in any

format, sold, or used in any way other than what is outlined within this under any circumstances without express permission f rom

Positive Approach to Care.

Copyright 2017, All Rights Reserved

Teepa Snow and Positive Approach to Care

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