SPRING 2021 | VOLUME 13, ISSUE 1
Parkinson Voice Drooling in parkinson’s disease
By Rajesh Pahwa, MD, University of Kansas Medical Center Sialorrhea or drooling is a major unmet need that may affect People with Parkinson’s (PwP) over the course of their disease. The average person swallows about 1,000 times a day and for most of us we don’t even know we are doing this. Drooling in PwP occurs when there is excessive saliva in the mouth which leaks out because people with Parkinson’s may subconsciously not be swallowing frequently enough. This is important to recognize because not only is drooling uncomfortable and embarrassing but excessive saliva can also occur in the throat and lead to aspiration. There are three major salivary glands: in front of the ear lobe (parotid); under the jaw (submandibular); and under the tongue (sublingual). These are the glands that create the saliva which plays an important role for the body including but not limited to: -wetting and softening; -cleaning and lubricating inside the mouth; - stimulating taste buds which is particularly important for people with Parkinson’s who may have lost their sense of smell; and -aiding in swallowing.
WHY DOES DROOLING OCCUR? Drooling in Parkinson’s is not because of excessive saliva production but instead because of swallowing issues or decreased swallowing due to a weakening of muscles in the throat. In addition to the decreased swallowing or weakening of muscles, PwP may have poor posture or experience excessive daytime sleepiness. Because of these issues PwP may sit with their neck in a forward position, with their mouth open, without even realizing it which leads to gravity causing saliva to pool in the mouth and overflow. Over the course of the disease, drooling occurs in 30-70% of PwP and can be severe in up to 10%. Drooling can also cause impairment in speech which may negatively impact social interactions. Because of this, it’s recommended that PwP start working with a speech language therapists/pathologists(SALT/SLPs) who specialize in Parkinson’s early in their diagnosis. Even if the person has no symptoms of speech impairment or swallowing challenges initially, if they work with a SALT/SLP from the start, this expert can help them work on swallowing technique and strengthen throat muscles, possibly helping to delay, minimize, or stop drooling from ever becoming an issue. Because of the postural challenges, it’s recommended that PwP also start working with a trained physical or occupational therapist who can work with the person to improve posture. Proper posture can aide in swallowing, by just giving cues to keep the head from tilting forward. The idea is that it’s best to train the body ahead of time to prevent challenges, rather than to just treat once they become an issue.
From: https://www.researchgate.net/ publication/308207907
Excessive saliva in the mouth can also lead to other issues that should be addressed such as dental issues, pneumonia due to aspiration, and psychosocial-
challenges. It’s recommended that you speak to your dentist about Parkinson’s and discuss a dental care plan that works for you. You may also wish to use an electric toothbrush to aid in dental care since limited fine motor skills may not allow for a thorough cleaning. If drooling keeps a PwP or Care Partner from wanting to socialize this could increase depression and anxiety. If this is something you are experiencing, it’s recommended that you ask your doctor for a recommendation to speak to a social worker/ therapists who can help navigate some of these issues as individuals and as a couple. CONTINUED ON PAGE 2
A LOOK INSIDE 3
April Is Parkinson’s Awareness Month
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Honors & Memorials
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Upcoming Events
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“A Spring In Your Step”
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PAR Is Turning Forty and Fabulous!
10/11 Support Group & Exercise Class Schedules This Newsletter is sponsored by:
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ARE CERTAIN PwP AT HIGHER RISK FOR EXPERIENCING DROOLING? Risk factors for drooling include older age, male gender, longer disease duration, more severe disease, occurrence of hallucinations and dementia, swallowing and speech difficulty, low blood pressure on standing leading to dizziness, and certain medications. While the majority of these factors cannot be changed to reduce drooling, there are things health professionals and PwPs can do to address this symptom.
HOW CAN DROOLING BE MANAGED? The first step in managing drooling is to speak to your movement disorder doctor. Certain medications used for memory issues like rivastigmine and medications for hallucinations like quetiapine and clozapine can cause drooling. In some cases, these medications can be changed to ones that do not cause drooling. Your doctor is the best one to work with you on evaluating your medications to see if an adjustment in your treatment plan makes sense. Your doctor will then look at medical management of the motor symptoms of PD including bradykinesia, rigidity and OFF time. He/She may have you evaluated and managed by a SALT/SLP to improve mouth muscle coordination and swallowing if you are not already seeing someone. If the PwP isn’t already seeing a physical therapist, the doctor may have the PwP undergo evaluation and training for improved head and body posture, including the use of neck support collars, education regarding keeping the mouth closed, reminders for frequent swallowing such as chewing gum or sucking on hard candy might also be helpful. With more severe drooling, the use of suction machines may be considered. The most common medications used for drooling are anticholinergics. Since one of the most common side effects of these medications is memory impairment, they should be used cautiously in PwP who may already experience these issues. It’s important to note that none of these treatments are FDA approved, but they are things PwP can discuss with their doctors and should not be done without medical supervision. Glycopyrrolate tablets can also be helpful for drooling. Some doctors may use atropine eye drops or ipratropium bromide nasal spray used under the tongue which might be helpful but should only be administered with medical supervision.
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Botulinum toxin injections in the parotid and submandibular salivary glands are increasingly being used to treat drooling. Rimabotulinumtoxin B (Myobloc) and incobotuliumtoxin A (Xeomin) are approved by the FDA and EMA for the treatment of drooling in the US and Europe. Incobotuliumtoxin A (Xeomin) is the only approved botox treatment in Europe. Rimabotulinumtoxin B is the most commonly used toxin for drooling. Patients usually receive 2-6 injections with small needles in front of the ear and below the jaw. These injections are performed through the skin and not through the mouth. These injections reduce the production of saliva for 8-12 weeks and consequently reduce drooling. The injections are repeated approximately every 3 months. The most common side effects include pain at the site of the injection, dry mouth and rarely swallowing difficulty. Due to reduced saliva production, there may be increased risk of dental decay or cavities.
TAKE AWAY TIPS FOR ADDRESSING DROOLING IN PARKINSON’S
In rare cases, radiation to the salivary glands and surgical intervention such as tying the salivary duct or removal of the salivary glands has been attempted but is not usually recommended.
It’s important to remember that if you are experiencing drooling that you speak to your doctor. You are not alone and there are options for treating this symptom.
In summary, drooling in PwP occurs due to swallowing difficulties. Drooling can lead to social isolation and reduced quality of life for both the person with Parkinson’s and the Care Partner. It occurs with advancing disease and can be a challenge to manage but it’s important to know that health professionals can help and that different members of the health care team can play a role, including the physical and/or occupational therapist and speech language pathologist. Ideal management of the motor symptoms of PD would include consultation with a movement disorder doctor to ensure the medication dosage is optimal and to explore best treatment options if experiencing drooling. In addition to this, working on improved posture with a physical therapist can help train the PwP on proper sitting techniques and the team can also help educate on cues to remind the PwP to swallow and tilt his/her head back. Consultation with a SLP/SALT who specializes in Parkinson’s is recommended for training on swallowing and exercises to strengthen throat muscles. Oral medications are often limited in the management of drooling due to side effects. Botulinum toxin injections into the parotid and submandibular glands may also be considered.
1. Consult with your movement disorder doctor about your concerns, challenges, and discuss treatment options, and possible medication adjustment 2. Ask for a recommendation to see a qualified physical or occupational therapist who has experience with Parkinson’s 3. Ask for a recommendation to see a qualified SLP/ SALT who has experience with Parkinson’s 4. Keep hard candies on hand to suck on, as this will help remind you to swallow. Best to make them sugar free candies to decrease risk of cavities. 5. Drink more fluids, ideally water, to help “wash” down the saliva. This is also recommended since water can help lessen the chance of constipation.
RESOURCES: Blog post by Frank Church, PhD, WPC 2019 Program Committee member https://journeywithparkinsons.com/2019/01/22/parkinsons-andsialorrhea-drooling-or-excessive-salivation/ Blog post by Maria de Leon, MD, WPC 2022 Parkinson Advocates Committee member https://defeatparkinsons.com/2014/07/31/10-tips-for-managingdrooling-in-parkinsons-by-dr-de-leon/ Parkinson’s Foundation’s Fitness Friday video on posture: https:// youtu.be/WRyPQO_u_qE ________________________________________ Rajesh Pahwa, MD is a member of the World Parkinson Coalition Board of Directors. He has spoken at past World Parkinson Congresses and Chaired the WPC Fundraising Committee for WPC 2016 and WPC 2019. He is currently the Laverne & Joyce Rider Professor of Neurology, Chief of the Parkinson and Movement Disorder Division and Director of the Parkinson’s Foundation Center of Excellence at University of Kansas Medical Center in Kansas, USA Ideas and opinions expressed in this post reflect that of the authors solely. They do not reflect the opinions or positions of the World Parkinson Coalition®, Supernus® or the Parkinson Association of the Rockies. This article and newsletter are sponsored by:
APRIL IS PARKINSON’S AWARENESS MONTH As winter melts away, the sun warms and flowers begin to bud here in Colorado, a growing excitement takes root in the Parkinson’s community as we gear up for April and another Parkinson’s Awareness Month.
For us at the Parkinson Association of the Rockies (PAR), however, April is just one of many Parkinson’s Awareness months. Day after day, month after month, we work to improve the lives of those impacted by Parkinson’s disease (PD) through programs that not only provide insight and information but also foster social connection and community. Today, whatever day it is that you’re reading this, PAR is helping people in local communities through support groups, educational programs and exercise and movement classes. PAR also hosts a variety of signature events like our Empowerment Ball, Play Fore PAR Golf Tournament and Vitality Walk that raise crucial funds for the PD Community. Regardless of the date, PAR is always here for you to help you live your best life with Parkinson’s. However, we still love April! Any effort to raise awareness for PD is important, and we wholeheartedly celebrate the opportunities Parkinson’s Awareness Month presents. April is a chance to take advantage of an extra focus on the disease and an opportunity to educate a broader audience about PD and the support PAR can provide. As we ramp up efforts to raise awareness about PD, we hope you’ll help us spread the word. As fields of tulips bloom this April, they seem to be a fitting symbol of Parkinson’s Awareness Month and the larger community. In 1980, J.W.S. Van der Wereld, a Dutch horticulturalist who had Parkinson’s disease, developed a red and white tulip. Van der Wereld named his prized flower, the ‘Dr. James Parkinson’ tulip, to honor the English apothecary surgeon who originally described Parkinson’s in 1812. Today, you will see many variations of the Parkinson’s Tulip, but PD organizations around the world use the tulip as a symbol of hope and optimism. The tulip unifies independent regional organizations like PAR, national organizations and their individual chapters, People with Parkinson’s and their family and friends, neurologists, research scientists, and more.
PARKINSON’S 101 FOR THE NEWLY DIAGNOSED The Parkinson Association of the Rockies is offering a free, three-part educational module for the recently diagnosed Parkinson’s community. This curriculum will help newly diagnosed people with Parkinson’s and their Care Partners navigate their journey with Parkinson’s while introducing the resources available in Colorado.
Part One
Part Two
Part Three
Let’s start with the Parkinson’s Basics. In our first session, participants will learn about the signs and symptoms, stages, and possible causes of Parkinson’s. Fellow People with Parkinson’s will share their stories and tips on how to thrive with Parkinson’s.
Understanding treatments options can be overwhelming! In our second session, Dr. Luisa Solis-Cohen, Colorado Neurodiagnosics, will delve deep into the different types of medications used to treat Parkinson’s and how they interact with the brain and work within the body.
Many People with Parkinson’s are prescribed exercise along with their medications but why is that? In our final session in the series, Lyndsey O’Keefe, DPT, Pace West Physical Therapy will discuss the research supporting exercise as a form of medicine for Parkinson’s disease.
WEDNESDAY, MAY 19 4:00 - 6:00pm
TUESDAY, JUNE 15 4:00 - 6:00pm
WEDNESDAY, APRIL 14 4:00 - 6:00pm
All sessions will be held virtually. For more information or to register, please visit: ParkinsonRockies.org/PD101
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DONATIONS | HONORS Your thoughtfulness helps the Parkinson Association continue to provide services & support in the Rocky Mountain Region. The following gifts in honor were received between October 2, 2020 - February 10, 2021 James Berryman Teresa Berryman Marge Boehner Richard Osborne Victor Bovine Jeanne Bovine Dale Brown David Walker Lynda Cavanaugh Lynda Cavanaugh Elida Christian Joseph Christian Margery Coates Jonathan Coates Adele Cornelius Katherine Cornelius Graham Coveyduck Steve Sargent Cathryn Culver Thomas Giddings Thomas Margie Dahlin Nancy Konvalinka Erica DeMarch Brian Hyde Mary Reilly Amy Dressel-Martin Brenda Abdilla Robert Enders Todd H. Enders Bonnie Ewen Mark McCreary
Kristine Falde Megan Adams Sigrid Olson John Farrell Mary Farrell Lane Feingold Michelle Weinraub Larry Feirmeier Robert Enders Norman Prince Jack Feuer Stephanie Feuer Ely Fishkin Ely Fishkin Paul French Susan French Burrell Gerhardt Patricia Gerhardt-Bollig Anne Green Kelsey Green Jacqueline Millan Kirk Hall Linda Hall Howard Henry Marnie Stief Karen Hensley Will Hensley Wendy Hutchison Wendy Speckman Jill Johnson Jill Johnson
Paul Judson Deborah Mueske
James Mullens Dave Mullens
Charles Schumacher Margaret Birkemeier Tim Volin
Rita Kahn Vien Le Katherine Kline Edward Kline Rich Lathrop Jana Mendez Janice Lehman Daniel Lehman Richard Lurie Mari Lurie Patrick Maley Susan Bauer Arthur Mastera Gary Deboer Betsy Mathies Dorcas Avery Orlando Mestas Barbara Gardner Daniel Michaud Maureen Covert Laurel Klusman Georganne Mitchell Douglas Mitchell Nina Montaldo Virginia Murphy
Margie Munighor Phillip Stahl Karen Neil Barbara Downing Pace Elaine Nusz Cheryl Colby Tom Nusz Charles Sugent Larry Osborn Elizabeth Ross Dina Pace Patricia Martinez Anthony Palizzi Ann Butcher Sherry Pater Jeff Pater Dudley Rice John Freitas Gregory Ritscher Katherine Hauff June Roberts Tom Ging Mary Roling Robert Roney Kay Rubel Chuck Black Dan Krueckeberg Steve Savig Jane Breed
Rick Schwartz Anonymous Mary Korch Sandy Selzer Janet Burns JoAnne Showalter Joe Showalter Janice Snowberg David Snowberg Tom Speer Brenda Speer Marilyn Stengel Lanney Marshall Layton Stewart Helen Stewart Shanker Thylur Shanker Thylur William Weiskopf Alfonso Lopez Kelli Weiskopf Joyce Mansen Richard Wolf Adam Wolf Wendy Wolf Louis Yob Barbara Yob Janna Zelinger Ray Meissner
Bill Moorehead Eugenie Snow
Weekly Inclusive Support Group
Join Cari Friedman, LCSW, Patient and Family Services Director, every Wednesday evening at 7pm for a virtual support group held over Zoom. This support group is open to anyone in the PD Community. On certain weeks, speakers are invited to discuss their area of expertise (Nutrition, Balance, Medications, Therapies, etc.) as it relates to Parkinson’s. For more information and to receive the Zoom link to access the support group, please email Cari at CFriedman@ParkinsonRockies.org or call (303) 830-1839.
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DONATIONS | MEMORIALS Your thoughtfulness helps the Parkinson Association continue to provide services & support in the Rocky Mountain Region. The following gifts in memoriam were received between October 2, 2020 - February 10, 2021 Susan Abbott Kelley Howes David Addison Martine Addison Erlene Ashley Barry Reiling Esther Baird Bruce Baird Tammy Bolin Dick Beckman Mary Cropp Anthony Cutillo Carolyn Greeb Robert Haferman Cathleen Lopez Raleigh Voas Paul Browne Linda Mealman Martin Burdick Dorothy Burdick Maurice Chevalier Deborah Wagner Randi Clark Robert Clark Robert Clifton Heather Clifton Larry Dietz Lindsey Moyes Arthur Ecoff Louise Ecoff Joe Ercolani Anne Ercolani
Sue Feingold Barbara Zimmerman Russell Fillman Judy Fillman Gordon Friednash Ken Friednash Zelda Friednash Joe Pells David Goldberg Carole Milligan Chris Goodwin Anonymous Kenny Greenberg Esther Glickman Abell Gregg Marion Cody Paul Hoskins Patricia Gregory Judith Mason Joe Jaudon Tamara Jaudon Tyler Jenner Mary Scott Brian Johnson Steve Sargent Hilton Johnson Diane Pinkard Kate Kelsall Darrell Miller Gregory Kloser Particia Germann
Alan Leimbach Kelly O’Connor Karen Susman Hans Liebe Roswita Liebe Paul McKibben Shawn McKibben Lee Mendel Barbara Mendel Pamela Wilsford Hudson James Oeser Anonymous Steve Parkhouse Patricia Parkhouse David Parks Neville Kempkes Norman Peacock Alma Peacock Jerry Pederson Steve Miller Mark Pederson JoAnn Pettinger Timothy Lanier Roger Phillips Steven Hauck Robert Rector Janet Grohs Lorraine Rothchild Mike Wolfe
Mike Ruether Elsa Bradley
Tom Toops James Rasco
Clifford Rullman Laurel Rullman Virginia Russell Fran Berry Merle Rust Sonia Rust William Sandifer Marilyn Sandifer Cece Schwartz Janice Dinner John Shotton Spotswood Shotton Peter Skeffington Wayne Littlefield Earl Sethre Rita Smith Carol Johnson Richard Swanson Julia Banks Becky Blome Robert Caruso Derek Johnson John Repp Dorothy Swanson Karin Swanson Ruth Timberlake Ted Sweeney Dan Sweeney Turek Mary
Gayle Weinstein Gloria Davis Bruce Dinner Debbie Feiner William Fishman Edwin Hyman Sandee Jaastad Fred Karp Betty Karsh Bryce Kopperud Hal Levy Nicole Lewandowski Eileen Naiman Hal Naiman Jay Newman Steve Reflow Ira Sherman Leslie Sidell Philip Stahl David Tanenbaum David Weinstein Rosemarie Welchert Eileen Bedell Donald Wolf Anonymous Quinn Coldiron Don Freeman Stacey Wolf
Devera Thorn Bernard Thorn
Monthly Care Partner Support Group Join Cari Friedman, LCSW, Patient and Family Services Director, for a monthly virtual Care Partner support group held over Zoom. The group meets on the first Tuesday of each month at 2pm. Share, learn and bond with fellow Care Partners. For more information and to recieve the Zoom link to access the support group, please email Cari at CFriedman@ParkinsonRockies.org or call (303) 830-1839.
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Four sites, 2,000 steps and one unforgettable experience! Whether you walk or run the Vitality 5K, join us and hundreds of Coloradans in celebrating our 40th Anniversary! At any of our four locations or through Virtual Vitality, you can help make a difference by increasing awareness and raising critical funds to support the free programs and services provided by the Parkinson Association of the Rockies. People of all ages (and their pups!) are welcome as individual runners, walkers or as part of a team. Out of town? Have to work? Staying safer at home? You can make it count with Virtual Vitality! This option allows you to register and raise pledges online, and to host your own walk or party at home. Event Details: Sunday, June 6, 2021 8:00am Registration Begins | 9:15am Walk Start | 10:00am Resource Fair (Denver) Wash Park in Denver | Walk Start inside park near Franklin and Mississippi Sandstone Ranch in Longmont | 3001 E. Ken Pratt Blvd., E2 Shelter Memorial Park in Colorado Springs | 1605 E. Pikes Peak Ave. City Park in Pueblo | 810 Goodnight Ave., Outdoor Pavilion 5K Run (DENVER ONLY): 8:00am Registration Begins | 9:00am 5K Starts Registration Fees: 5K Run - $45 Walk - $40/adult | $15/child (age 5-14) | FREE/child (age 0-4) For more information please visit ParkinsonRockies.org/Walk or call (303) 830-1839 Thank you to our Sponsors: Gold Sponsors
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Silver Sponsors
SAVE THE DATE
Saturday, April 24, 2021 8:30am - 12:30pm
The Parkinson Association of the Rockies’ Colorado Community Conference is Colorado’s premier conference focused on Parkinson’s research and treatments. This conference brings together individuals with Parkinson’s, their Care Partners and family members, as well as professionals who work with the Parkinson’s community to provide them with updates on the latest research in Parkinson’s, medications and medical devices. At this year’s conference, attendees will learn about the research being done in Parkinson’s, sleep and the gut and have the opportunity to speak with researchers in Colorado.
Presenting Sponsor
Conference Sponsor
Due to the pandemic, we will be holding our biennial Colorado Community Conference virtually this year on the Accelevents platform. Conference Details: For More Information: Saturday, April 24, 2021 | 8:30am - 12:30pm www.ParkinsonRockies.org/CCC Accelevents Platform (303) 830-1839 | ECussler@ParkinsonRockies.org Join us for the 22nd Annual Golf Classic to benefit the Parkinson Association of the Rockies (PAR) and the Colorado Parkinson’s community. PAR provides an abundance of services to the community including over 60 weekly exercise classes, educational seminars and 53 monthly support groups throughout Colorado. Event Details: Date: July 12, 2021 Location: Valley Country Club, Aurora 9:00am | Registration & Breakfast 10:00pm | Shotgun Start 2:30pm | Happy Hour Reception & Awards For more information or to register, please contact the Parkinson Association at (303) 830-1839 or email Michael at MBarber@ParkinsonRockies.org 7 7
A SPRING IN YOUR STEP: EXERCISE FOR PARKINSON’S By Lyndsey O’Keefe, PT, DPT, NCS, Pace West Physical Therapy We’ve all heard about the importance of exercise and regular physical activity for physical and mental health, but what happens when moving isn’t as easy as it used to be? You may also be wondering if exercise is even safe after you’ve been diagnosed with Parkinson’s disease. I am a Board Certified Neurologic Clinical Specialist physical therapist and have worked with patients with Parkinson’s disease for years recommending safe and effective exercises to improve movement, function, and quality of life. A common credence in the rehabilitation world is “Exercise is Medicine”. This is especially true for people living with a neurologic disease such as Parkinson’s. Exercise has been shown to increase production and use of the brain chemical dopamine, the decrease of which is an underlying cause of Parkinson’s disease.
HOW SHOULD I EXERCISE? A question I get from nearly all of my patients is, “What is the best exercise I can do?” My response is always, “What kind of exercise do you like to do?” One of the most important parts of an exercise program is actually doing it, which means you have to find an activity that you enjoy so you’re more likely to stick to it. The great news about aerobic exercise is that your body reaps the same benefit no matter the mode, as long as you’re working at an appropriate level (more on that later). That means you can walk, hike, bike, swim, or even dance around your kitchen and your body and brain will thank you! It is also important to work on muscle strength and flexibility to support healthy joints and posture. Balance disturbance is a frequent symptom and concern among people living with Parkinson’s disease, and so dedicating time to work on specific balance exercises is crucial. Balance is like any other skill— if you don’t use it, you lose it.
HOW MUCH SHOULD I DO? If we come back to thinking of exercise as medicine then we should talk about dosage. Just like taking any medication, doing the correct amount of exercise is critical from both a safety and an effectiveness perspective.
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The World Health Organization created guidelines for the general public about the recommended amount of exercise: 150 minutes per week of moderate intensity aerobic exercise, at least 2 days per week of strength training, and at least 3 days per week of balance activities for adults over age 65. Now what about how hard you’re supposed to be working? Aerobic exercise intensity is often measured by either your heart rate or your own interpretation of how hard you’re working, or your “rate of perceived exertion” (RPE). RPE can be a helpful tool when you aren’t sure how to measure your heart rate, or if you’re taking a medication that may alter your heart rate such as a beta-blocker. Exercise specialists typically use an RPE scale of 0-10, where 0 is “I feel like I’m sitting on the couch,” 5 is “I’m not necessarily comfortable and I’m a little breathless, but I can still talk,” and 10 is “I couldn’t possibly work any harder than this.” When the goal of aerobic exercise in Parkinson’s disease is to delay the progression of symptoms, studies have shown that working at an RPE intensity of 7, or “I can still talk but I don’t really want to, and I’m definitely sweating!” is most effective. Recommendations for the intensity of strengthening and balancing exercises often come down to the individual’s current ability. My patients have often heard me say, “It should be difficult, but doable.” If the exercise is too easy and you do not feel a struggle to perform it then your body will not be stimulated to improve — either in strength or in balance. On the other hand, if the exercise is too difficult and you lose good form or are nearly falling over then you risk hurting yourself.
GETTING STARTED Here are a few of my favorite strengthening and balance exercises that don’t require any special equipment to get started with a home exercise program. See pictures on next page for examples. Keep in mind that these are general recommendations and if you have any specific questions or concerns about your ability to perform an exercise, please contact a physical therapist or your doctor for guidance. 1. Posture: Start sitting towards the front of a firm chair with your feet wide apart and your hands on your knees. Slowly bend forward from your waist, tipping your upper body down towards the floor.
I often tell patients to pretend they’re looking for a $100 bill under the chair. Once you’ve bent as far as you can, use your hands to help push your upper body back up to a straight back as you reach your arms out to the sides, sitting up as straight as you can and squeezing your shoulder blades together. Repeat 10 times. 2. Sit to Stand: Start sitting towards the front of a firm chair. Stand all the way up from the chair until your knees and hips are straight. Use support from the arm rests and use something in front of you for balance, like a walker or another chair, for safety if you need. If you don’t need to push up from the arm rests, try folding your arms across your chest for an extra challenge. Once you’re standing up all the way, slowly sit back down without plopping back into the chair. Repeat 10 times. 3. Heel Raises: Stand in front of a counter with your hands gently resting on the countertop and your feet hip-width distance apart. Keep your knees and hips straight as you push yourself up onto your toes, lifting your heels up as far as you feel comfortable with. Hold at the top for 1 second, then slowly lower your heels back down. For an extra balance challenge, try lifting one or both hands off of the countertop when you hold at the top. Repeat 10 times. 4. Weight Shift/Turning: Stand in front of a counter with your hands gently resting on the countertop and your feet close together. For an extra balance challenge, try bringing your feet all the way together until they touch. It may be a good idea to have a chair behind you for safety. Keep your feet where they are while you slowly turn your head and torso one direction as far as you feel comfortable with, as if you’re looking all the way behind you. Slowly return your head and torso back to facing forward, and repeat towards the other side. For an extra balance challenge, try lifting one or both hands off of the counter. Repeat 10 times to each side. 5. Marching: Stand in front of a counter with your hands gently resting on the countertop and your feet hip-width distance apart. Slowly march one leg up, lifting the knee as high as you feel comfortable with while balancing on the opposite leg. Hold at the top for 1 second, then slowly lower the leg back down and repeat on the other side. For an extra balance challenge, try lifting one or both hands off of the counter while you hold at the top. Repeat 10 times per leg.
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2. Sit To Stand
4. Weight Shift/Turning
3. Heel Raises
5. Marching
1. Posture
Lyndsey O’Keefe has a Doctorate of Physical Therapy and is a Board Certified Neurologic Clinical Specialist with many years of experience in specialized neurologic care along with advanced education and training to help patients with neurologic and vestibular disorders. She is also certified as a PWR!Moves Therapist for the treatment of Parkinson’s disease. She practices at Pace West Physical Therapy in Boulder. Follow her on Instagram: @boulderbrainpt
PAR is Turning forty and Fabulous! The Parkinson Association of the Rockies has always been Fabulous, but now we are turning 40! We are extremely proud to commemorate 40 years of serving the Colorado Parkinson’s Community. As a small, independent nonprofit, this milestone would have been impossible to reach without the continuous support from our amazing community!
Since its inception in 1981, the Parkinson Association of the Rockies has been a valuable resource to the Colorado Parkinson’s community, providing direct care services including support groups, exercise programs, free case assessments, educational programs, informative newsletters and a referral and information hotline to individuals living with Parkinson’s, their families and Care Partners, as well as the general community. Our goal is to make our 40th year our biggest yet, making all our programs and events as impactful as possible. We are launching a fundraising campaign, $40K in 40 Days, help us reach our goal and ensure that 40 is the best year yet!
Want to help us reach our goal? Visit, ParkinsonRockies.org/Online-Donation/
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PARKINSON EXERCISE CLASSES
A liability waiver and a medical consent form from your doctor is required and can be found online at www.ParkinsonRockies.org. Not all classes meet every week; please check classes online for changes. There are no fees associated with classes, but we encourage participants to Pay It Forward. For more information, please call (303) 830-1839 or email Info@ParkinsonRockies.org. Due to COVID-19, the status of all programs offered by the Parkinson Association of the Rockies including exercise classes, support group meetings and educational seminars will vary. Please visit www.ParkinsonRockies.org or call us at (303) 830-1839 for more information on our current offerings. POWER PUNCH PARKINSON’S BOXING Mondays • 11:00 - Noon Tuesdays • 11:00 - Noon Carbondale Mondays • 11:00am - Noon Tuesdays • 9:00 - 10:00am Fridays • 9:00 - 10:00am Fort Collins
YOGA FOR PARKINSON’S Mondays • 1:30 - 2:45pm* Fort Collins
PAR FOR THE COURSE EXERCISE Mondays • 8:45 - 9:00am Denver
Mondays • 9:00 - 10:00am Pueblo
Tuesdays High Intensity 11:45 - 12:45pm
Tuesdays • 9:30 - 10:30am* Littleton
Mondays • 2:00 - 3:00pm Longmont
Tuesdays • 9:30 - 10:30am Fridays • 1:00 - 2:00pm Greeley
Tuesdays • 3:00 - 4:00pm Lone Tree
Wednesdays* 11:00 - Noon 12:30 - 1:30pm Denver
Tuesdays • 4:00 - 5:00pm Northglenn Tuesdays 10:00 - 11:00am 11:15 - 12:15pm Denver
Thursdays • 8:00 - 9:00am High Intensity Lone Tree
Tuesdays • 10:00 - 11:00am* Thursdays • 10:30 - 11:30am* Arvada Tuesdays • 4:00 - 5:00pm* Thursdays • 4:00 - 5:00pm Saturdays • 9:00 - 10:15am* Colorado Springs
Thursdays • 11:30 - 12:30pm Denver
High Intensity: for individuals early in the diagnosis of Parkinson’s disease
PWR!® MOVES Mondays • Noon - 1:00pm Centennial
Low Intensity: for individuals who need assistance with mobility
Tuesdays • 10:30 - 11:30am * Thursdays • 10:30 - 11:30am * Avon
Thursdays • 1:30 - 2:30pm* Englewood
Thursdays • 10:00 - 11:00am Glenwood Springs Fridays • 1:00 - 2:00pm Pueblo Saturdays • 9:30 - 10:30am Steamboat Springs
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Thursdays Low Intensity Noon - 1:00pm* Denver Fridays Noon - 1:00pm Denver
Wednesdays • 11:00 - Noon Aurora
Wednesdays • 9:30 - 10:30am Saturdays • 9:00 - 10:30am Denver
Wednesdays Low Intensity 1:45 - 2:45pm Denver
Thursdays • 11:00 - Noon Steamboat Springs
Wednesdays • 10:00 - 11:00am * Frisco
Tuesdays • 10:30 - 11:30am Thursdays • 10:30 - 11:30am Littleton
Low Intensity 1:00 - 2:00pm* Denver
STEP AND CONNECT’S BALANCE/CIRCUIT CLASS Tuesdays • 9:30 - 10:30am Thursdays • 9:30 - 10:30am Denver LOUD FOR LIFE:
VOICE CLASS FOR LSVT LOUD GRADUATES
Mondays • 1:30 - 2:30pm Centennial, CO Call (520) 444-0618 for more info
RHYTHM AND GRACE: DANCE FOR PD® Mondays • 11:00 - 12:15pm Denver Thursdays • Noon - 1:15pm* Littleton
CIRCUIT TRAINING FOR PARKINSON’S Wednesdays • 1:30 - 2:30pm Fridays • 1:30 - 2:30pm Highlands Ranch Tuesdays • 11:30 - 12:30pm Westminster WALKING GROUP Fridays • 10:00am * Colorado Springs TANGO DANCE Tuesdays • 2:30 - 3:30pm Denver MOVING THROUGH PARKINSON’S Mondays • 11:00 - 12:15pm Wednesdays • 2:00 - 3:15pm Fort Collins Wednesdays • 10:00 - 11:00am Fridays • 10:00 - 11:00am Steamboat Springs
DURANGO
EXERCISE CLASSES
*Provided through a grant from the Davis Phinney Foundation*
Mondays • 11:00 - Noon* Low Intensity
Wednesdays • 11:00 - Noon * Fridays • 11:00 - Noon* High Intensity
TREMBLE CLEFS Wednesdays • 11:00 - Noon Boulder Thursdays • 1:00 - 2:00pm Littleton
*Classes with an asterisk are
currently on hiatus. To find out how other classes are being offered, please visit our website or call (303) 830-1839
Thursdays • 3:30 - 4:30pm* Arvada, CO Call (334) 414-8193 for more info
SUPPORT GROUPS For more information on support groups and contact information for support group leaders, please contact the Parkinson Association of the Rockies at (303) 830-1839 or Info@ParkinsonRockies.org. Due to COVID-19, the status of all programs offered by the Parkinson Association of the Rockies including exercise classes, support group meetings and educational seminars will vary. Please visit www.ParkinsonRockies.org or call us at (303) 830-1839 for more information on our current offerings. ARVADA 1st Monday • 1:15pm* AURORA 2nd Tuesday • 1:00pm BOULDER 4th Tuesday • 10:00am* BRUSH Quarterly Meetings* Contact PAR
COLORADO SPRINGS/ MONUMENT Groups are provided by Colorado Springs Parkinson’s Support Group. Information can be found on: www.co-parkinson.org DENVER 3rd Monday • 10:00am* Recently Diagnosed (1-3 years) Contact PAR DURANGO 3rd Thursday • 1:00pm
BROOMFIELD 1st Tuesday • 10:30am BUENA VISTA 1st Saturday on odd months* 10:00am
EAGLE VALLEY/ EDWARDS 4th Thursday • 5:00pm*
GLENWOOD SPRINGS 4th Friday • 2:00pm* GRAND JUNCTION 1st Wednesday • 3:30pm*
LOVELAND/ JOHNSTOWN MSA/PSP/CBD North Colorado/South Wyoming 2nd Friday • 1:30pm
GREELEY 4th Thursday • 10:00am
MONTROSE Last Monday • 2:00pm*
HIGHLANDS RANCH 4th Tuesday • 10:00am* 3rd Friday • 1:00pm*
PARKER 2nd Tuesday • 10:00am
LAFAYETTE 2nd Tuesday • 2:30pm* LAKEWOOD 1st Tuesday • 1:00pm
CASTLE ROCK 4th Saturday • 10:00am*
ENGLEWOOD Recently Diagnosed (1-3 years) 3rd Wednesday • 4:00pm
LITTLETON 3rd Saturday • 3:00pm* On hiatus June - August
CEDAREDGE 1st Wednesday • 9:30am*
ESTES PARK 3rd Tuesday • 2:00pm*
CHERRY HILLS VILLAGE 2nd Wednesday • 11:00am* 2nd Thursday • 6:30pm
EVERGREEN 1st Friday • 1:00pm*
LONE TREE Young Onset Group 3rd Friday • 6:00pm
2nd Friday • 10:00am MSA/PSP/CBD Contact PAR
FORT COLLINS Recently Diagnosed/Young Onset
PUEBLO 2nd Tuesday • 11:15am* Social Group - Pour for Parkinson’s Contact PAR STEAMBOAT SPRINGS 2nd Monday • 5:00pm SUMMIT COUNTY 3rd Friday • 10:00am Contact PAR THORNTON 4th Friday • 2:00pm*
LONGMONT 2nd Wednesday • 10:00am LOVELAND 3rd Friday • 10:15am
*Groups with an asterisk are
currently on hiatus. To find out how other groups are being offered, please visit our website or call (303) 830-1839
Mondays Every 6 Weeks, Contact PAR
CARE PARTNER SUPPORT GROUPS
For more information on support groups and contact information for support group leaders, please contact the Parkinson Association of the Rockies at (303) 830-1839 or Info@ParkinsonRockies.org.
ARVADA 2nd Friday • 1:30pm* BOULDER 3rd Monday • 10:30am* BROOMFIELD Friday after 1st Tuesday • 10:30am COLORADO SPRINGS Groups are provided by Colorado Springs Parkinson’s Support Group. Information can be found on: www.co-parkinson.org
DENVER Parkinson’s Dementia & Lewy Body Dementia 3rd Thursday • 6:00pm
We care about Care Partners!
4th Wednesday • 6:30pm*
HIGHLANDS RANCH 4th Thursday • 1:00pm
ENGLEWOOD MSA/PSP/CBD 4th Friday • 10:00am Jan - Oct
LONGMONT 1st Tuesday • 11:30am*
EVERGREEN Thursday before 1st Friday • 3:00pm
STEAMBOAT SPRINGS Meets Quarterly* Contact PAR
For Care Partner and respite care tips and resources, contact Cari Friedman, LCSW at (303) 861-1810 or CFriedman@ParkinsonRockies.org
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Mission... The Parkinson Association of the Rockies connects and empowers People with Parkinson’s to thrive through educating, creating awareness, promoting research and supporting those with the disease, their families and the Colorado community.
Non-Profit Organization U.S. Postage
PAID
1325 S. Colorado Blvd., Suite 204B Denver, CO 80222 (303) 830-1839
Denver, CO Permit No. 2866
Vision... To provide the care that counts on the way to a cure for the Colorado Parkinson’s community to live their best life. www.ParkinsonRockies.org Info@ParkinsonRockies.org
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A Letter From Our Executive Director Welcome to Spring 2021! I know that we were all waiting for a miraculous change where we could go out and socialize without masks and hug our friends and families. Well, that didn’t happen, but PAR is still here to make sure you have virtual access to exercise, support groups and education! As more in our community get vaccinated, we are hopeful that we will be able to return to in-person events beginning with our Vitality 5K Walk & Run on June 6th. We can’t wait to actually SEE your smiling faces again! This is a big year for PAR – we are turning 40!!! As an organization, we have seen tremendous growth in the programs and services offered and the number of people we are able to serve throughout the state of Colorado. PAR wants to take this year to reflect not just on where we have been, but on where we are going. The board and staff take our commitment to serving this community very seriously and we want to make sure that we are offering the right programs and services that enable you to live your best life with Parkinson’s disease. This year, we continue to focus on expanding services to underserved communities including minority, newly diagnosed, young onset and satellite communities. PAR is always looking for ways to improve your experience and will continue to review exercise metrics and survey results and respond quickly to implement necessary changes. Your input is vital to our improvement so please keep sending in your suggestions to direct us how we can help you the most. Don’t forget April is Parkinson’s Awareness Month and an opportunity to not only educate people on what living with Parkinson’s disease is like, but also increase awareness of PAR within the state so people know where to go when they need help and support. The Parkinson Association of the Rockies wants to be the first place for all Colorado communities to come for care, support and resources related to Parkinson’s. Parkinson’s Awareness Month is a great way to shout that message from the Rocky mountaintops (literally!). I hope that you will join us this year as we celebrate our 40th with our many events and activities focused on bringing the community together in a fun and safe manner. Jodi Brown, Executive Director