Commentary on Power Forward by Richard L.,on "Neurology Now", Feb 2016
By Justiniano F. Campa MD, Senior Neurologist, Charlottesville, VA
I read with much interest this inspirational Neurology Now article, Power Forward by Richard L, featuring Brian Grant’s courageous struggle with Parkinson disease while highlighting the relevant role of exercise in the treatment of this condition.
It is very encouraging to hear from leaders like Joseph Jankovic that there is now “compelling evidence that exercise may slow the progression of the disease.” This could be a major addition to the known exercise benefits against immobility and depression, among the most common symptoms of Parkinson
What I find puzzling in this article is the neurologists consensus registered by Dr. Zigmond, that, “we don’t know what type of exercises are best” (for Parkinson patients). The same uncertainty can be noted in the Michael Fox Foundation site and in all other sites resourced in this article. However, in Michael J. Fox site, https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?exercise&navid=exercise there is reference to exercises that are “favored” by patients with Parkinson such as bicycling, dancing, boxing and fencing. Not listed is walking or hiking using a walking stick, but a photo on their site, shows Michael J. Fox leading a group march with a walking stick in hand. One has to assume that Michael also “favors” walking exercise with a walking stick. The latter preference is in agreement with my long experience prescribing this particular mode of exercising to my patients
The benefits of a walking stick can actually be measured by comparing the number of steps needed to cover a fixed distance without and with the use of a walking stick, as documented in two videos in this link http://www.neurostaff.com/parkinsons-videos.html
It is not my point that the use of a walking stick is the superior mode of exercising for Parkinson patients, rather that the incorporation of the arms with the legs in a whole body motion creates a synergy of proprioceptive sensations that provides better balance and hence confidence while carrying on that exercise. Further, that all the exercises listed as “favored’ by Parkinson patients share one common denominator with that of using walking sticks – the participation of the arms in a whole body kinesis. This beneficial effect will be defeated if their synergy is separated as in some demonstration videos of Parkinson boxers hitting the punching bag “with feet glued to the ground.”
Every neurologist knows that our nervous system has an operational pathway, “the ascending spinal cord pathway” that carries proprioceptive (position sense) signals to the brain in order to maintain a safe posture at all times, but our layman readers and patients could use this link to an illustration I chose from online samples: http://www.wileyessential.com/neuroanatomy/flashcards/c11_1/c11_1.html .
The diagram shows how nerve fibers from arms and legs travel together in the same nerve bundle and reach the brain cortex in continuity at the same ‘sensory strip” usually depicted as a funny person “the homunculus.” What the diagram does not show is that the motor strip that continuously commands posture corrections, lays conveniently adjacent to that sensory strip processing the incoming signals. Even without understanding how proprioception is processed in our brains, we have to marvel at this system architecture.
This pathway is the neurological substrate for the proprioceptive synergy of whole body kinesis. There is no reason to doubt that that synergy may be obtained with appropriate modifications of all the exercises now “favored” by our Parkinson patients.
I might finally add that even the stretches and 5 minute warm up exercises that must precede aerobic exercise, will benefit likewise with the inclusion of the arms in their performance. That could be accomplished with wall-mounted bars at waist level, chin up bars and parallel bars. Aside from simply hanging from the bars or holding backward in stretches, the chin up and the parallel bars are suitable for low impact running in place, with less body weight
I welcome the scrutiny of your neurologist and exercise therapist community and I encourage them to try my suggestions, but I would especially be rewarded to hear from Michael J. Fox and Brian Grant. And one last message for Brian, shooting hoops fully qualifies as a preferred exercise as it is “a whole body exercise with arm participation while handling the ball” which is why you like it. Keep on doing it!
Justiniano F. Campa – Senior Neurologist- Charlottesville, Va.
February 26, 2016
This Commentary was sent for publication in " NEUROLOGY NOW" a layman magazine published by the Academy of Neurology for neurologists "waiting rooms reading" featuring mainly "celebrities" struggling with different neurological conditions, in this instance the basketball star Brian Grant.
Responding to Stacey Gordon
I actually have a model, the All Around, designed, as you suggested for indoor use without the terrain inclines expected in outdoors. Managing the inclines requires a longer 12" handle to have a sort of gear shift for best mechanical leverage.
See Testimonial by Bess and Betty two heights people with two lengths staff, both holding at elbow level