Page 32 - IDF Journal 2023

IDF – Study Weekend IDF News – Spring 2023
Walking Back to Happiness
What Parkinson’s Can Teach Us
Dr Rudy Capildeo
Examining the gait of patients with Parkinson’s we find
that the normal heel/toe action of each leg to produce walking with the natural swing of each arm is missing. The difficulty may be made worse by asymmetry i.e.
one leg affected more than the other. To correct this,
we have to concentrate on
a normal heel/toe action with contralateral arm swing (which also controls the speed of walking), whilst correcting our posture using a visual cue, such as looking at the horizon, to straighten our spine. Teaching the Parkinson’s patient how
to overcome their walking difficulties, to instil ‘left leg forward/right arm swing and at the same time (with left hand in the pocket)’ is as rewarding as prescribing Sinemet or Madopar to a newly diagnosed patient. Daily and even hourly exercise activity will keep the Parkinson’s patient
well as well as our aging community who may not have Parkinson’s but may have other orthopaedic problems that affect walking.
James Parkinson, GP, political activist, palaeontologist and author is best known for his ‘An Essay on the Shaking Palsy’ published in 1817 when he was 62 years old. It is a study of just 6 patients – 3
of whom were seen in his GP Practice
at 1 Hoxton Square, Shoreditch and 3 observed walking in the street. Parkinson observed “involuntary tremulous motions (tremor) with lessened muscular power (palsy) and with a propensity to bend the trunk forwards (forward stoop) and to pass from a walking to a running pace (festination)”. Reassuringly, Parkinson added that “the senses and intellects being uninjured”. He also noted that
the condition began asymmetrically (differentiating it from what we now
call Parkinson’s Plus Syndromes, and dementia is absent).
Since Parkinson’s time, the condition became known as Parkinson’s Disease, suggested by Charcot (1872) who rejected the terms ‘Paralysis Agitans and Shaking Palsy’ since patients were not particularly weak nor did they all have tremor (perhaps 50 per cent).
Today, we recognise that 85 per cent
of patients with Parkinson’s have a ‘Dopamine Depletion Disorder’ (my term). It is still remarkable today, to see that
2 tablets of Sinemet Plus (125 mg) will turn the clock back for patients by 2, 3
or more years. The key to treatment is to supplement the patient’s own dopamine production and not suppress it, or replace it so that they become dependent on medication: “The right dose of medication at the right time is key.” Even today, too many patients are chronically overdosed leading to significant side-effects and long-term disability. The remaining 15 per cent of patients have some Parkinsonian features but they are very different, particularly with regard to cause, clinical signs, response to dopamine treatment, and prognosis.
In the UK and USA the term ‘Parkinson’s Disease’ has been changed to Parkinson’s. The term and concept of this condition being a disease has been dropped.
In the UK and USA
the term ‘Parkinson’s Disease’ has been changed to Parkinson’s. The term and concept of this condition being
a disease has been dropped.
Walking disorder in Parkinson’s
In his second case, Parkinson describes a man of 62 years, the greater part of his life spent as an attendant in a magistrate’s court. He had suffered 8 to 10 years “all the extremities considerably agitated (speech affected and much bowed). He walked almost entirely on the fore-part
of the feet and would have fallen every step if he had not been supported by his stick”.
Investigations
In 1979, with my colleague Beryl Flewitt, we measured normal and Parkinsonian gait using Polgon Goniometry. A beam of polarised light was directed from the Polgon at right angles to the direction of gait. We placed photoelectric sensors covered with polarised material to thigh, calf, ankle of the leg which recorded angular movement of the knee and ankle which was plotted against each other on a 2 channel XY pen recorder/rate of 50 angles per second. Stride was measured separately.
The recordings of Parkinsonian patients indicated that, unlike the normal subject, the Parkinson’s gait was ‘toe-down’ to the ground and the knee more flexed than usual.
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