Therapy Achievements is dedicated to helping people with physical, cognitive and visual limits re-gain function and reach their potential. By providing out-patient physical, occupational and speech therapy services, we help people maximize their independence and reach their potential. Our multi-disciplinary team approach to rehabilitation enables us to tailor your plan of care to your specific and unique needs.
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My uncle, Don Anderson, underwent placement of a deep brain stimulation for Parkinson’s Disease in 2012. It immediately stopped his shaking. He had the procedure done at Providence Saint Joseph Medical Center in Burbank by Dr. Michael Marvi.
My Uncle was able to participate in a series of commercial about deep brain stimulation for treatment of Parkinson’s Disease. In one commercial, they demonstrate what happens when they turn the stimulator off.
The National Parkinson’s Disease Foundation has published a fact sheet about deep brain stimulation for Parkinson’s Disease:
What are the facts about Deep Brain Stimulation for Parkinson’s Disease?
- Deep brain stimulation (DBS) is a surgical procedure used to treat the debilitating symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems.
- The procedure is also used to treat essential tremor, a common neurological movement disorder.
- DBS does not damage healthy brain tissue by destroying nerve cells. Instead the procedure blocks electrical signals from targeted areas in the brain.
- At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications. DBS uses a surgically implanted, battery-operated medical device called a neurostimulator—similar to a heart pacemaker and approximately the size of a stopwatch—to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms. Before the procedure, a neurosurgeon uses magnetic resonance imaging (MRI) or computed tomography (CT) scanning to identify and locate the exact target within the brain where electrical nerve signals generate the PD symptoms.
- Some surgeons may use microelectrode recording—which involves a small wire that monitors the activity of nerve cells in the target area—to more specifically identify the precise brain target that will be stimulated.
- Generally, these targets are the thalamus, subthalamic nucleus, and a portion of the globus pallidus.
- Once the system is in place, electrical impulses are sent from the neurostimulator up along the extension wire and the lead and into the brain. These impulses interfere with and block the electrical signals that cause PD symptoms.
The Deep Brain Stimulation system consists of three components:
- The lead- (also called an electrode)—a thin, insulated wire—is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is positioned within the targeted brain area.
- The extension- is an insulated wire that is passed under the skin of the head, neck, and shoulder, connecting the lead to the neurostimulator.
- The neurostimulator- (the “battery pack”) is the third component and is usually implanted under the skin near the collarbone. In some cases it may be implanted lower in the chest or under the skin over the abdomen.There are three brain targets that have been FDA approved for use in Parkinson’s disease.
Which Brain Target should you choose for Deep Brain Stimulation for Parkinson’s Disease?
There are three brain targets that have been FDA approved for use in Parkinson’s disease. The most commonly utilized brain targets include the subthalamic nucleus (STN) and also the globus pallidus interna (GPi). Target choice should be tailored to a patient’s individual needs. There are many ongoing studies that will help to refine target choice for individual patients. Although the picture is not yet clear on the issue of target choice, the STN does seem to provide more medication reduction, while GPi may be slightly safer for language and cognition.
How do I know if I am a good candidate for DBS?
- You have had PD symptoms for at least five years.
- You have “on/off fluctuations, with or without dyskinesia.
- You continue to have a good response to PD medications, especially carbidopa/levodopa, although the duration of response may be insufficient.
- You have tried different combinations of levodopa/carbidopa and dopamine agonists under the supervision of a movement disorders neurologist.
- You have tried other PD medications, such as entacapone, tolcapone, selegiline or amantadine without beneficial results.
- You have PD symptoms that interfere with daily activities.
What is the prognosis for Deep Brain Stimulation for Parkinson’s Disease?
- Although most patients still need to take medication after undergoing DBS, many patients experience considerable reduction of their PD symptoms and are able to greatly reduce their medications. The amount of reduction varies from patient to patient but can be considerably reduced in most patients. The reduction in dose of medication leads to a significant improvement in side effects such as dyskinesias (involuntary movements caused by long-term use of levodopa). There is a 1-3% chance of infection, stroke, cranial bleeding, or other complications associated with anesthesia, per side that is done. It is best to discuss the risks associated with your neurologist because there are many risk factors, including underlying medical conditions.
- The most commonly utilized include the subthalamic nucleus (STN) and also the globus pallidus interna (GPi). Target choice should be tailored to a patient’s individual needs. There are many ongoing studies that will help to refine target choice for individual patients. Although the picture is not yet clear on the issue of target choice, the STN does seem to provide more medication reduction, while GPi may be slightly safer for language and cognition.
Julie Roberts is a country music singer living with multiple sclerosis. She worried about how people would react if they knew she had MS. Then she decided ‘I do not have to give up on my dreams’
Huntsville Multiple Sclerosis support group was privileged to have Julia speak at the September 2014 meeting.
She shared: “Accepting my diagnosis of multiple sclerosis was probably the most difficult part of my MS journey. However, it also helped me retake control of my life.”
Roberts was diagnosed with Multiple Sclerosis while recording her second album, 2006’s ‘Men and Mascara,’ but she knew there was something wrong well before that. Remembering her time on the road in support of her first record, she says, “I’d be in the middle of a show and couldn’t hold my microphone anymore. I would get these electric shocks that would start at the back of my head and felt like it would spread all over my head.”
She adds, “I would be signing in my autograph line after a show and while writing the name my fan would give me, I couldn’t even see what I was writing. My vision was very blurry most nights. If I was in the gym, I couldn’t even hold weights.”
This all led to her going to the doctor, and when they took an MRI of her brain, they found 11 lesions that signaled her diagnosis.
Multiple Sclerosis is a disease that can be slowed down with medicine, but Roberts chose not to take medication; she instead decided to eat well and work out daily in an attempt to keep healthy, but a scan showed that the lesions in her brain had increased to 12. “For years, I was in denial that I had MS. I thought if I didn’t focus on my MS, then maybe it would just go away. It took the Nashville flood in May 2010 for me to “wake up” and decide it was time to take responsibility for what is, and what will be, my life with MS. My Mom, my sister and I lost our home and almost everything we owned in the flood. When we were rescued by boat, we were given another chance at life. I realized then that things can be replaced, but life and good health are invaluable.
The stress from the flood brought on a relapse of my MS, which I could no longer ignore. At that point, I decided to accept that MS is part of who I am, and that I needed to learn how to manage it in order to continue living my dreams.
I believe it was God who gave me another chance at life with the flood rescue and I wasn’t going to waste it. I was determined to show this disease who was boss and that I would not let MS define my life’s journey! I wanted to show the world that MS looks different for everyone and that MS does not mean you have to give up on your dreams.
I’ve learned to manage my MS by keeping all my options open. I have a neurologist who helps me control my MS with a disease-modifying therapy and address any symptoms that may appear. I am also much more than my MS and I manage my life through diet, exercise and my faith. I have learned that I do not have to give up on my dreams.
Occupational Therapy at Therapy Achievements
Ultrasound is a great way to rehab hand pain and can speed up the healing process. Karen Allen Hislop, one of the occupational therapist at Therapy Achievements is using it to treat De Quervain’s Tendonitis with great results.
Therapy Achievements is a Rehabilitation Center that provides out-patient Physical Therapy, Occupational Therapy and Speech Therapy. We have programs for Balance and Movement, Speech and Swallowing, Swelling from Lymphedema and Edema, Driving Rehabilitation and Functional Living Skills for visual and cognitive re-training. We help people with Brain Injury, Stroke, Multiple Sclerosis, Parkinson’s Disease, Lymphedema, Head and Neck Cancer, and other disorders that interfere with mobility and function. We offer VitalStim Technology, Saebo Technology, LSVT LOUD Treatment, LSVT BIG Treatment, and Neurodevelopmental Treatment.
Spinal Cord Injury Facts: The Numbers
- More than 240,000 Americans currently suffer from a spinal cord injury
- Spinal cord injury disrupts function of muscles & nerves
- Spinal cord injury can result in paraplegia or quadriplegia
- Car accidents, crash, falls, and sport injuries are the most common causes of spinal cord injury
Spinal Cord Injury Facts: Well Known People with Spinal Cord Injury
- Stephen Hawking, scientist
- Christopher Reeve, actor
- Ted Pendegrass, musician
- Curtis Mayfield, singer
- Darren Drozdov, wrestler
- Darryl Stingly, NFL player
- Sam Schmidt, Indy racer
Do you have a spinal cord injury? Therapy Achievements Can Help!
Physical Therapy to Improve Balance, Flexibility and Strength
Reduce Pain and Improve Mobility
Occupational Therapy to Improve functional ability
Recommend assistive devices
Speech Therapy to Improve Voice Volume and Control
Parkinson’s Disease Facts: The Numbers
- 10 million people worldwide are living with Parkinson’s disease.
- 60,000 Americans are diagnosed with Parkinson’s disease each year
- 4% of people with PD are diagnosed before the age of 50.
- Men are 1 ½ times more likely to have Parkinson’s than women
- $2,500 a year is the average annual medication costs for an individual person with PD
- Therapeutic surgery can cost up to $100,000 dollars per patient
Parkinson’s Disease Facts: Well known people with Parkinson’s Disease
- Michael J. Fox (b. 1961), Canadian actor
- Billy Graham (b. 1918), American evangelist
- Janet Reno (b. 1938), Former Attorney General of the United States
- Muhammad Ali (b. 1942), boxer (pugilistic Parkinson’s syndrome)
- Eugene McCarthy (1916-2005) American politician
- Francisco Franco Spanish dictator (1892-1975)
- George Wallace, former governor of Alabama (1919-1998)
- John Lindsay, New York City mayor (1921-2000)
- Mao Zedong, Chinese Dictator (1893-1976)
- Pope John Paul II (1920-2005), Polish cleric
- Salvador Dalí, Spanish artist (1904-1989)
- Sir Michael Redgrave (1908-1985), British actor
Parkinson’s Disease treatment with Deep Brain Stimulation (DBS) has been used for over a decade to help stop uncontrollable shaking. It is typically offered when medications no longer help. Similar to all of the presently available Parkinson’s drugs, surgical options offer symptomatic benefit. It can ease symptoms but has not been proven to change the underlying course of disease. It is usually done in people who have had Parkinson’s for at least four years and still get a benefit from medication but have motor complications, such as significant “off” time (periods when medication isn’t working well and symptoms return) and/or dyskinesia (uncontrolled, involuntary movements).
DBS typically works best to lessen motor symptoms like stiffness, slowness and tremor. It doesn’t work as well for imbalance, freezing when walking or non-motor symptoms. DBS may even exacerbate thinking or memory problems so it’s not recommended for people with dementia.
Deep Brain Stimulation: How It Works
A surgeon implants a small battery operated device similar to a pacemaker under the skin near the collar bone. The doctor then positions wires from the device with electrodes on their ends in areas of the brain that control motor function. Usually a person remains awake during surgery so that he or she can answer questions and perform certain tasks to make sure that the electrodes are positioned correctly. The device works by electrically stimulating these areas and blocking the abnormal nerve signals that cause the tremor in Parkinson’s disease patients.
Most people with Parkinson’s disease will require the surgery be done on both sides of the brain.The procedure is performed with the patient awake to ensure optimal placement of the electrodes and maximize the potential for benefit. A few weeks after surgery, a movement disorder specialist uses a handheld programmer to set parameters, tailored to each individual’s unique symptoms, into the neurostimulator. The DBS settings are gradually tweaked over time and medications are simultaneously adjusted. Most people are able to decrease (but not completely discontinue) Parkinson’s drugs after DBS. Determining the optimal combination of drugs and DBS settings — that which gives the most benefit and the least side effects — can take several months and even up to a year.
Parkinson’s Disease Rehab: Dr. David Greer
Parkinson’s Disease rehab is something Dr. David Greer is very familiar with. He has been treating patients with Parkinson’s Disease for over 10 years. And he knows first hand treating people who have Parkinson’s Disease can be very challenging.
At present, there is no cure for Parkinson’s disease, but there are a number of medications that can provide dramatic relief of the symptoms. The challenge comes in finding the most effective medication treatment for each patient. Factors to consider include:
- the correct drug or drug combinations
- the dosage
- the method of taking medication
Parkinson’s Disease Rehab: Dr. David Greer’s Challenge
The risk of side effects of drugs vary from person to person and finding the right treatment is like solving a puzzle. A “one size fits all” treatment approach will not work. And the puzzle often turns into a moving target. Because the effectiveness of treatment changes over time, what used to work well will gradually fade in effectiveness. Medications will need to be adjusted and new combinations may be necessary to optimize function. And that’s what Dr. David Greer likes the most about his work. In his words, “No two days are the same. Every day I have the opportunity to help people.”
Parkinson’s Disease Rehab in Huntsville, AL
Dr. Greer grew up in Durum, North Carolina. He went to the University of North Carolina at Greensboro and medical school at Irvine Medical School. He completed a residency at Vanderbilt. He specialized in neurology because “Neurology is who we are – the way we act, the way we think, the way we move. Conditions that affect the brain and nervous system are so meaningful and a neurologist has such an opportunity to make an impact. Even minor adjustments to treatment can have a significant impact on the quality of a patient’s life.”
Dr. Greer chose to practice in Huntsville, AL because “It’s the right sized city. It has a mix of interesting people and it is in close proximity to Vanderbilt and UAB” – two medical centers where much of the research in treatment of Parkinson’s disease is happening. Dr. Greer remembers being impressed with Dr. Ray Watts, Dr. Harrison Walker and Dr. Erwin Montgomery at the UAB Neurology Clinic during his residency tours and was delighted when he was invited to tour the deep brain stimulation program and observe a deep brain stimulation placement surgery. He now works in close collaboration with UAB and patients who undergo the surgery, monitoring their progress and making adjustment to the units as necessary. “There are so many research things just around the corner for Parkinson’s Disease – extended release medications, duodenal infusions, drug drips – that’s what makes this work so much fun. We have such an opportunity to help people. It makes working not so much work.”
Parkinson’s Disease Awareness Month:
Each year, April is designated as Parkinson’s Disease Awareness Month.
What Is Parkinson’s Disease?
Parkinson’s Disease is a progressive disorder that results in the loss of nerve cells in the brain that produce dopamine. Dopamine is a chemical messenger that transmits signals between two regions of the brain to coordinate activity. If there is deficiency of dopamine, nerve cells “fire” out of control. This leaves the individual unable to direct or control movements. Although descriptions of people with Parkinsonism date back to ancient Egypt, it wasn’t until 1817 that paralysis agitans (shaking palsy)was first described in an essay by English surgeon James Parkinson. The condition was renamed Parkinson’s disease sixty years later.
Who Gets Parkinson’s Disease?
Parkinson’s disease usually affects people over the age of 50 although the illness does occur in people between the ages of 30 and 50, or in rare cases at a younger age.
What Are The Symptoms of Parkinson’s Disease?
Diagnosis of Parkinson’s disease is important so that appropriate treatment can begin. There are four primary symptoms of Parkinson ’s disease: tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks.
How Is Parkinson’s Disease Diagnosed?
At present, there are no laboratory tests that can confirm the diagnosis of Parkinson’s disease and a physician determines a diagnosis by taking a family and health history, performing a physical and neurological exam, observing the person’s movements and muscle function, and ruling out other disorders that can cause similar symptoms.
What Are The Causes of Parkinson’s Disease?
Although the exact cause for the loss of cells is unknown, most cases of Parkinson disease probably result from a complex interaction of environmental and genetic factors:
- Most cases of Parkinson’s disease occur in people with no apparent family history of the disorder.
- Approximately 15 percent of people with Parkinson’s disease have a family history of this disorder.
- Researchers have identified specific genetic mutations that can cause Parkinson’s disease, but these are uncommon. They have also identified alterations in certain genes that do not cause Parkinson disease but appear to modify the risk of developing the condition in some families.
- Some gene mutations appear to disturb the cell machinery that degrades or breaks down unwanted proteins in dopamine-producing neurons. In patients with Parkinson’s disease, the protein alpha-synuclein fails to break down and forms into clumps called Lewy bodies. Lewy bodies accumulate in dopamine-producing neurons and lead to the impairment or death of these cells.
- Other mutations may affect the function of mitochondria, the energy-producing structures within cells. As a byproduct of energy production, mitochondria make unstable molecules called free radicals that can damage cells. Cells normally counteract the effects of free radicals before they cause damage, but mutations can disrupt this process. As a result, free radicals may accumulate and impair or kill dopamine-producing neurons.
- Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is relatively small.
Treatment of Parkinson’s Disease:
In addition to the many new advances in medication therapy, treatment for Parkinson’s Disease may include:
- Rehabilitative therapy—Physical, occupational and speech therapists can assess the person’s abilities and needs, and provide exercises to help maintain the highest possible range of motion, muscle tone, balance and flexibility, and communication ability.
- Lifestyle alterations—Exercise helps maintain muscle tone and strength. Diet is important for nutrition, for maintaining an appropriate weight, and because protein level may be a factor in the person’s condition. Rest and stress reduction are also important.
- Support groups – Huntsville enjoys a very active Parkinson’s support group that offers aid, support, education, discussion and raises research funds for treatment of Parkinson’s disease. Information about Huntsville’s support group can be found at http://parkinsons-huntsville.webs.com or calling 256-859-6523.
April is Parkinson’s Disease Awareness Month!
Join the Parkinson’s disease community this April in raising Parkinson’s Disease awareness all over the US and around the world. Here are a few strategies to help you get started:
- Read All About It: Put PD in the Local Papers
- Paint the Town … with Tulips!
- Involve Public Officials
- Dare to Go Digital by Sharing Awareness Online
For now, there is no cure for Parkinson’s disease but with early diagnosis and an effective plan of treatment, the symptoms of the disease can often be controlled or lessened. For those with Parkinson’s disease, Huntsville offers many services and supports which enable people to remain active and have the quality of life that is important to them.
Physical, Occupational & Speech Therapy for
- Balance and Mobility
- Speech and Swallowing
- Lymphedema Therapy
- Driving Rehab
- Functional Living Skills