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Movement Disorders

Music and Movement....Disorders

Author(s): 
Deck: 
When one thinks of music and movement, the natural association is dance.
Teaser: 

When one thinks of music and movement, the natural association is dance. In all parts of the world and in all cultures, there is some musical expression through dance, ranging from what may appear to be relatively simple rhythmic movements to compelling drum beats to complex ballets with narratives and dozens if not more dancers doing intricate steps to full blown orchestras. Anyone that has raised children recalls how even very young children, will move and shake to rhythmic music and the massive industry in all western countries of dance lessons starting with child students attests to its natural attraction and ability to fulfill what appears to be an intrinsic human desire.

I recall as a child being taken to ballet, modern dance, musicals with dance and even the renowned Rockets at the Radio City Music Hall by my mother who herself had been a serious amateur dancer in her youth and then a lifelong ball-room and late-life folk dancer with her seniors' centre on West End Avenue in Brooklyn. There was even a period of my pre-teen years when my mother attempted to teach me ballet steps at home which very soon was transposed into my desire to learn to dance to Rock and Roll, using my sister four years my junior as my every accommodating dance partner. Even many years after, in our mature and pre-senior years, at family celebrations we often could still do a dance number to something of the order of Rock Around the Clock or the theme song for Saturday Night Fever. She has continued to engage with multi- cultural folk dancing whereas I have slowed down considerably in my abilities to participate although I enjoy watching others, dance especially my children and more recently my granddaughters.

The general assumption probably held by most individuals that with physical and especially neurological disability, the ability to engage or think about participating in dance would likely naturally diminish. For people living with conditions that impose physical challenges to free and fluid movements, the idea of dancing is more often a dream than a reality. It is likely that it would not even enter the consciousness of most people with neurological disorders, especially those like Parkinson's Disease might be able to participate in, respond to and benefit from music, especially when it is within a framework of dance.

With this in mind the recent article in October 25th issue of The Globe and Mail, by Gayle MacDonald, "Unlocking the secret of Dance" was exhilarating and inspiring. In a partnership with the world-renowned Canada's National Ballet School, with the collaboration and influence of some its most prominent members and in a cooperative effort with among others Toronto's York University and my own Baycrest Geriatric Health Care System, it is hoped that in addition to the great joy satisfaction that all the participants appear to be getting from the program, scientific research studies will demonstrate the mechanism of responsiveness and hopefully clinical improvement.

Dance appears to provide a number of benefits to those living with Parkinson's disease which affects seven million people world-wide including approximately 100,000 in Canada and a million people in the United States. It has been established that dance improves characteristics like balance, gait, posture and other physical measurements beyond the social joy and satisfaction from what is in essence a group and social undertaking. Studies are underway to try and determine what the dance does to the brain and the mechanisms by which improvements may occur and whether or not they are sustainable and may be an important adjunct to commonly used medication therapies that are not without their problems.

It has been well known for many years that those living with Parkinsonism can improve their gait by listening to rhythmic marching-type music and some have learned to use ear-phone-directed march music from iPods and other similar devices to provide the compelling rhythmic background to assist in their walking. (Neuroscience and Biobehavioral Reviews: Into the groove; Can rhythm influence Parkinson's disease? Cristina Nombela, Laura E. Hughes, Adrian M. Owen, Jessica A. Grahn, 2013. http://www.ncbi.nlm.nih.gov) In my own practice I have often taken my patients with such movement disorders and while walking with them up the corridor outside my office I hum loudly a well-known John Philip Sousa March, The Stars and Stripes Forever which most people recognize. Quite a lot of the patients and the family are amazed how all of a sudden the person who had been struggling with gait and speed would be walking alongside me to the loudly hummed musical refrain. If the result is good I instruct the person or family member to get some recordings of such marches or others if they are ones that resonate and put them on an iPod type device and place the march when the person wants to go for an enjoyable walk, for the purposes of actual exercise, or as one might in a garden or along a neighbourhood street.

If this Parkinson's ballet dance project proves successful it may result in a wide range of programs that bring dance and music to many individuals living with Parkinson's disease and provide a creative and satisfying and in many ways liberating enterprise for them.

Section: 

Identification and Management of Impulse Control Disorders Among Individuals with Parkinson’s Disease

Identification and Management of Impulse Control Disorders Among Individuals with Parkinson’s Disease

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 


Andrew M. Johnson, PhD, Associate Professor, School of Health Studies, Faculty of Health Sciences, The University of Western Ontario,
London, ON.
H. Christopher Hyson, MD, FRCPC, Assistant Professor of Neurology, Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON.
Kaitlyn P. Roland, MSc, Research Assistant, Interdisciplinary Graduate Studies, The University of British Columbia Okanagan, Kelowna, BC.

Abstract
Although Parkinson’s disease is primarily considered to be a motor disorder, it has inarguable effects on cognition and personality. The cluster of neuropsychiatric sequelae known as impulse-control disorders has been of particular interest in recent years, perhaps owing to the potentially disastrous effects that such behaviors can have on individuals and families. Research has suggested that impulse control disorders are significantly more prevalent among individuals with Parkinson’s disease, particularly with regards to pathological gambling and hypersexuality, and has further suggested that these disorders are significantly and substantively affected by the use of dopamine agonists. Treatment options for impulse control disorders tend to revolve around dopamine agonist dose reduction or cessation. The use of psychosocial strategies, or deep-brain stimulation of the subthalamic nucleus may also be considered in the management of patients with impulse control disorders.
Keywords: Impulse control disorders, Parkinson’s disease, dopamine agonists service use
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Parkinson’s Disease Dementia versus Dementia with Lewy Bodies

Parkinson’s Disease Dementia versus Dementia with Lewy Bodies

Teaser: 


Catherine Agbokou, MD, MSc, Service de Psychiatrie Adulte, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
Emmanuel Cognat, MD, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.
Florian Ferreri, MD, MSc, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.

Differentiating between Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) is a difficult issue for many clinicians. To date, these diseases share most of their clinical, neuropathological, and management features. Therefore, PDD and DLB are considered by some authors to be the two extremities of a single spectrum disease named Lewy body diseases. Nevertheless, specific diagnostic criteria now exist for each disease and specific diagnosis remains of interest in clinical practice. In this article, we summarize features and diagnostic criteria of both PDD and DLB, compare them, and examine their treatment options.
Key words: Parkinson’s disease dementia, dementia with Lewy bodies, Lewy body disease, movement disorders, dementia, treatment.

Chorea among Older Adults

Chorea among Older Adults

Teaser: 

Bhaskar Ghosh, MD, DNB, DM, MNAMS, Movement Disorders Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB.
Oksana Suchowersky, MD, FRCPC, FCCMG, Movement Disorders Program, Department of Clinical Neurosciences; Department of Medical Genetics, Faculty of Medicine, University of Calgary, Calgary, AB.

Chorea is a hyperkinetic movement disorder characterized by nonsustained, rapid, and random contractions that may affect all body parts. Chorea is hypothesized to be due to an imbalance between the direct and indirect pathways in the basal ganglia circuitry. Important causes of chorea among older adults include medications, stroke, and toxic-metabolic, infective, immune-mediated, and genetic causes. The history and clinical examination guide appropriate investigations and help determine an accurate diagnosis. In secondary causes, removal of the precipitating cause is the mainstay of treatment. If the chorea is persistent or progressive, drug therapy may be instituted. Genetic counselling is important in hereditary chorea.
Key words: movement disorders, chorea, older adults, diagnosis, treatment.

The Impact of Exercise Rehabilitation and Physical Activity on the Management of Parkinson’s Disease

The Impact of Exercise Rehabilitation and Physical Activity on the Management of Parkinson’s Disease

Teaser: 

A.M. Johnson, PhD, Assistant Professor, Faculty of Health Sciences, University of Western Ontario, London, ON.
Q.J. Almeida, PhD, Director, Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON.

Although medication therapy is generally effective in the clinical management of Parkinson’s disease (PD), additional improvement of some gross motor symptoms may be achieved through the use of nonpharmacological treatments, such as physical therapy and exercise rehabilitation. Despite the fact that PD is a neurological disorder, successful rehabilitation has been demonstrated with treatments that combine cognitive and physical approaches. While the exact mechanism through which these therapies obtain successful outcomes is still largely unknown, it is worthwhile to explore these adjunctive approaches to treating the motor output symptoms of PD.
Key words: Parkinson’s disease, movement disorders, exercise rehabilitation, physical therapy, motor control.

Canada: A Reputation for Excellence in Neurosciences

Canada: A Reputation for Excellence in Neurosciences

Teaser: 

The neurosciences seem always to have been a strong point of Canadian medicine, from both a clinical and a research perspective. Montreal, with its Neurological Institute, has long been internationally renowned. In fact, the day I wrote this editorial, there was an article in the Globe & Mail announcing that a famous American neuroscientist was moving to the MNI because he felt there were greater opportunities there than in his current position in New York City! Clearly, Montreal remains at the forefront of neuroscience research, but it is no longer the only excellent Canadian venue. Several universities across the country have made neuroscience research a priority, and most have excellent multidisciplinary research enterprises. In my University (Toronto), there are numerous outstanding investigators. Don Stuss heads a group at the Baycrest Centre for Geriatric Care that has done groundbreaking work on frontal lobe function. Peter St George-Hyslop at the Centre for Research in Neurodegenerative Diseases (CRNDs), is an international authority on the genetics and molecular biology of Alzheimer disease. There is outstanding work being done on brain tumours, dementia, stroke, epilepsy and other neurological conditions.

However, in Canada there seems to be particular strength and depth in the field of movement disorders. Although we have one article from the United Kingdom (Hallucinations in Patients with Parkinsonism, by Dr. Burn and Professor McKeith), it is a relatively easy task to find Canadian experts in all facets of the movement disorders. One Canadian, Dr. Ali Rajput from Saskatoon, has made an incredible contribution by his careful clinical-pathological correlations in Parkinson's disease (PD). He is considered one of the world's leading clinicians in the care of patients with PD. He and Dr. Alex Rajput (his son) have written an article on how to differentiate Parkinsonian Dementia from Alzheimer disease, as well as on its management. We have an article on diagnosing and managing depression in Parkinson's disease by Dr. Mandar Jog, the director of the Movement Disorders Program at the University of British Columbia. Zhigao Huang and Robert Tsui from the Pacific Parkinson's Research Centre at UBC discuss COMT inhibition in Parkinson's disease. Robert Chen and Daniel Sa, from the University of Toronto, give an update on advances in therapeutic strategies for Parkinson's disease, including pallidotomy and deep brain stimulation.

Of course, Parkinson's Disease is not the only movement disorder. D'Arcy Little, a frequent contributor to this journal, discusses the epidemiology, presenting features, diagnosis and treatment of Huntington's Disease. In other articles, Deborah Hebert from the Toronto Rehabilitation Institute and the University of Toronto discusses limb apraxia from a clinical perspective. Dr. Madhuri Reddy has written an article on the natural history of long-term care clients. Dr. Robert Teasell from the University of Western Ontario, and one of Canada's leaders in stroke rehabilitation, shares his knowledge of the area with us. As well, the Regional Geriatric Programs of Ontario have submitted an educational module on Driving & Dementia. Enjoy!

Next month, by popular demand, the issue will focus on skin disorders in the elderly. Be sure not to miss it!

Movement Disorders: A Potentially Dangerous Outcome of Specific Classes of Drugs

Movement Disorders: A Potentially Dangerous Outcome of Specific Classes of Drugs

Teaser: 

Nadège Chéry, PhD
Medical Writer/Consultant,
Snell Medical Communication Inc.
Montreal, Qc

The prescription of medications is among the most frequent and the most reliable forms of therapeutic strategy that physicians use for the treatment of patients with a variety of medical disorders.1 Unfortunately, many of these medications also produce side effects, especially in the geriatric population,1 some of which may be mild and relatively tolerable by most patients, and others, such as dyskinetic reactions, which are considered harmful.2,10 Drug-induced movement disorders represent an important iatrogenic condition that is occasionally encountered in clinical practice.2 These potentially disabling movement disorders are involuntary, they appear to be idiosyncratic extensions of the expected action of the drug and they are known to particularly affect the elderly patient.2-6 Among the devastating consequences of these disorders are involuntary movements, which may contribute to falls and fractures in the elderly, and social isolation, which can result from the limited mobility of an elderly individual.4,7

Nonetheless, movement disorders are often reversible; the withdrawal of the offending drug(s) usually leads to the alleviation of symptoms.3 Unfortunately, in some cases, discontinuing the offending drug may not be feasible.

The Fascinating Field of Movement Disorders

The Fascinating Field of Movement Disorders

Teaser: 

Dr. Barry Goldlist
Editor in Chief
Geriatrics & Aging

As I write this editorial, I am looking forward to an important event in Canadian geriatrics. For the first time since its inception, the Canadian Geriatrics Society is meeting independently of the Royal College of Physicians and Surgeons. This is not by chance, and certainly not because the Royal College has asked us to leave. This is a deliberate attempt to make the activities of the society more accessible to family physicians with an interest in geriatrics. Now, physicians will no longer have to pay a registration fee to the Royal College when they are only interested in the section on geriatrics. This year's meeting is in Edmonton, and in addition to our usual scientific sessions and symposia, we are having a CME day that is specifically targeted to primary care physicians. We would certainly welcome as members any physicians who are interested in care of the elderly. The current membership fee is minimal ($50/year) and information can be obtained from our current secretary-treasurer, Dr. Chris MacKnight (e-mail: "cmacknig@is.dal.ca" and mailing address: Camp Hill Veteran's Memorial Building, 5955 Jubilee Road, Halifax, NS, B3H 2E1). Next year's meeting is tentatively scheduled for mid-October in Toronto, in collaboration with a meeting on dementia that is being sponsored by the Tanz Centre for Research in Neurodegenerative Disease at the University of Toronto. I have seen the preliminary program and it is quite impressive.

I believe we have quite an interesting journal for you this month. Extensive research has clearly documented that impaired mobility is the most common cause of functional disability in the elderly. The causes of impaired mobility are numerous. Perhaps the most common is "simple" osteoarthritis but stroke, and fractures secondary to osteoporosis, are also important causes. This issue focuses on the fascinating field of movement disorders. Although it might seem relatively easy to recognize full-blown Parkinson's disease, diagnosis at an early stage can be quite challenging. Dr. Janis Miyasaki discusses the diagnosis of Parkinson's disease and how to differentiate it from other causes of tremor and the other Parkinsonian syndromes. As in other chronic conditions, the long-term management of patients suffering from Parkinson's disease can be extremely challenging. In her article, Sharon Yardley discusses some of the non-pharmacological treatments that are available. Dr. Robert Chen explores the burgeoning field of surgical treatment for Parkinson's disease. The pharmacological armament for treatment of Parkinson's disease has expanded dramatically in the past few years. While this is good news for the patient, as treatment can now be better tailored for the individual, it means physicians need to be provided with more information. In their article on the pharmacological treatment of Parkinson's disease, Doctors Sanjiv and Tsui address this potential information gap. Dr. Nadege Chery's article addresses drug induced Parkinsonism, which can represent a therapeutic challenge if the offending drug is considered essential for the patient. Parkinsonism is not always caused by a primary neurodegenerative disorder, and in his article Dr. D'Arcy Little describes the secondary causes of Parkinsonism, such as trauma or stroke.

As well as the focus on movement disorders, we also have our usual pot-pourri of articles on geriatric topics. Our column on ethics examines the ethical issues involved in transplanting foetal brain tissue in patients with Parkinson's disease. Another article discusses the utility of memory clinics for the diagnosis and management of Alzheimer's disease and other dementias. In the cardiology column, we look at the rational diagnosis of leg swelling and also review the application of the results of the HOPE study to clinical practice. There are also articles on the clinical aspects of Lou Gehrig's disease and the benefits of pancreatic transplants, an area in which Canadians are among the world leaders. I hope you enjoy this edition.