William and Mary Kinesiology and Health Science

1. William and MaryKinesiology and Health Science Walking with Parkinson’s with the aid of Music 2010 John Yonushonis

2. MY NAME IS JOHN YONUSHONIS AND I HAVE PARKINSON’S

3. Parkinson’s • MY ENTIRE RIGHT SIDE IS SLOWER THAN LEFT • I CANNOT SEQUENCE MY RT THUMB TO MY RT FINGER • MY NIGHTTIME TREMORS ARE SUCH THAT I CAN NOT DRINK A CUP OF COFFEE • I CAN NOT FLIP MY WRIST • I HAVE COMPLETELY LOST MY ABILITY TO WRITE AND CAN NO LONGER READ BOOKS • BUT I CAN PLAY THE NATIVE AMERICAN FLUTE

4. TODAY • RAISE THE AWARENES OF PARKINSONS AND UNDERSTAND WHAT IT DOES TO THE HUMAN BODY • TALK ABOUT MUSIC THERAPY AND NATIVE AMERICAN FLUTE AS ALTERNATIVE THERAPY • SPEAK PERSONALLY ABOUT MY WALK WITH THE DISEASE • OPEN THE DISCUSSION TO ANY QUESTION

5. PARKINSON’S IS A CHRONIC, PROGRESSIVE, NEURODEGENERATIVE DISORDER WHOSE SYMPTOMS INCREASE OVER TIME AND HAS NO CURE

6. Who Gets PD? • 1 in 100 over 60 years of age • Average age of onset 60 years of age • 15% diagnosed before 50 years of age • Slightly more men than women

7. What is Parkinson’s Disease? • Chronic progressive neurological disorder • Certain brain cells or neurons in the substantia nigra (SN) die or are impaired • Those neurons produce dopamine • Responsible for coordinated movement and balance

8. Our Brain • Circuits formed by living cells called neurons • 100 billion neurons • A transmitter called an axon • Receptors called dendrites

9. Our Brain • Neurons not directly connected to one another • Tiny gap between the transmitter end of one cell and the receptor end of another cell • Gap is called a synapse

10. Our Brain - Messages • Neurons act as a communication network • Neurotransmitters carry the message across synapses from one neuron to another • This allows the nervous system to communicate with muscles and translate thought into motion

11. PD Messages • There is a defect in dopamine producing neurons • They do not properly produce and transmit dopamine • The Messages about balance, coordination and movement are impaired • Decreased stimulation of the motor cortex also occurs • Planning, control and execution of voluntary motor functions are impacted • Due to insufficient formation and action of dopamine

12. Circuits • PD is all about brain circuits • When one part is disrupted then the circuit malfunctions causing too much or too little movement.

13. Movement • Normally we don’t think about how it is possible for our bodies to move • It just happens when we want it to!

14. Dopamine • Travels from the SN to the striatum • Initiates movement • Controls movement and balance • Makes sure: • Muscles work smoothly, • Under control and • Without extra or unwanted movements

15. How does it Work? • Transmitter end of SN neurons release dopamine into the synapse • Fits into special receptors on receiving neuron • Message is passed along • After receiving cell is stimulated , excess dopamine is released back into synapse • To fine tune movement the excess dopamine us broken down in the synapse by an enzyme MAO-B • Important step in precise control of movement as too much or too little disrupts balance between dopamine and another neurotransmitter system - acetylcholine

16. Loss of Dopamine • SN degenerates  • decreased dopamineproduction • Causes lack of regulation of the movement in the control centers in the brain  • loss of control of movements  • Cardinal signs become apparent at 70-80% dopamine loss • LETS LOOK AT THE SIGNS

17. Tremor • Present in 70% of people • Involuntary movement • “Pill-rolling” movement • Most obvious at rest or when under stress • Lessens with intentional movement • Disappears with sleep

18. Bradykinesia • Slowness of movement • Incomplete movement, difficulty initiating movements and sudden stopping of ongoing movement. • Loss of spontaneous or automatic movement • Slowness may interfere with daily routines; getting dressed, shaving or showering may take much of the day. • “Freezing”, small steps or shuffling gait • Significant problem and the most disabling symptom. 

19. Rigidity • Stiffness or inflexibility of the limbs and/or trunk • Muscle tone is always stiff and does not relax – leads to decreased range of motion • Felt as “tightness” in limbs • Can cause pain and cramping

20. Postural Instability • Abnormal postural reflexes make balance and coordination difficult • Seen as a forward lean • Fall backwards – trouble keeping upright • Leads to falls • Stooped posture • Walk with series of quick small steps

21. Other Signs of PD • Small handwriting • Changes in posture – stooped and lack of arm swing • Decreased facial expression • Speech changes • Difficulty swallowing and drooling • Depression/anxiety • Pain • Sleep disturbances • Constipation • Loss of sense of smell • Urinary frequency • Sexual dysfunction • Low blood pressure • Fatigue/loss of energy • Changes in mental function over time

22. How is PD Diagnosed? • No definitive blood test or x-ray • Medical history • Neurological exam • Rule out other conditions • Should see a Movement Disorder Specialist • neurologist who specializes in PD • Positive response to PD medication

23. Why Does This Happen? • Cause unknown - lots of theories • Environmental factors • rural living, well water, herbicide use and exposure to pesticides • Genetic factors • 15-20% have close relative with PD symptoms • Aging • wearing away of dopamine accelerated • Probably result of genetic predisposition coupled with a yet unknown environmental factor

24. Goal of Treatment • Quality of life • Best way to live with PD • Know about PD • Know about drugs and how they work • Willing to make life style changes • Good working relationship between person with PD, their doctor and their family

25. MY STORY/ INPUT FROM MY WIFE ANN AT TAOS PUEBLO

26. LETS TALK ABOUT WHAT IT IS LIKE TO HAVE PARKINSON’S

27. PERSONAL STORY PART OF A SPEECH I GAVE TO BARROWS NEUROLOGICAL LUNCHEON • When I was in elementary school, I will never forget a story I read, and for the life of me, I hope someday to remember its title. It was about a dog and it’s VISION OF A ROOM with one door and what it felt like when the door closed and it was alone. It could not open the door, could not see through the door, could not see around the door and, most of all, could not do anythingto change its destiny until the dooropened again. All the little dog could do was hope. All it could do was work to overcome the fear that no one would ever open the door again. All the little dog could do was wait.

28. PERSONAL STORY • I have now talked to hundreds of people with NEUROLOGICAL DISORDERS and their story is the same: We all became the little dog in the room with no way to open the door. We only had fear to begin with, but with the help of our friends, our fear turned to hope. FOR ME IT, AND MY WIFE ANN that taught me that the room I was in was no longer small. The room I was in became a room with a window and then it became ROOM WITH AN OPEN DOOR. The flute brought me back into society.

29. ADVANTAGE OF NATIVE FLUTE • RELAXATION • COORDINATION • BREATHING EXERCISE • SOCIAL STIMULATION • FUN • FOCUS ON NOW, TODAY

30. TONY IN CAMERONTHE FLUTE AND HIS GRANDFATHER

31. THE BLESSING SONG

32. REMEMBER • A BRAIN THAT ENGAGES IN MUSIC IS CHANGED BY ENGAGING IN MUSIC • Dr Michael Thaut

33. MUSIC AS THERAPY Began after World War I and World War II when community musicians of all types, both amateur and professional, went to Veterans Hospitals around the country to play for the thousands of veterans suffering both physical and emotional trauma from the wars. The patients' notable physical and emotional responses to music led the doctors and nurses to request the hiring of musicians by the hospitals.

34. How Does Music Therapy Help • The Biochemical Theory • Music stimulates the cerebral cortex and Autonomic Nervous System, which sends vibrations and impulses through the body • The Entrainment Theory • Sounds are received through the human energy field and entrain the body’s rhythms • The Metaphysical Theory • Music is a gift from God and connects people together (For example…)

35. THE ENTRAINMENT THEORY • ADJUSTS THE INTERNAL RHYTHM OF AN ORGANISM TO EXTERNAL FREQUENCIES TO CREATE HARMONY • OUR BRAIN ENTRAINS THE FREQUENCY AND RHYTHM OF SOUND TO ENHANCE OUR NATURAL RHYTHM • IN PARKINSON’S THE ENTRAINMENT ALLOWS PEOPLE TO DANCE WHO CAN NOT WALK

36. Music Therapy Metaphysical Theory • the “ability to experience an altered state of • physical arousal and subsequent mood • by processing a progression of musical notes of • varying tone, • rhythm, and • instrumentation • for a pleasing effect.”

37. PYTHOGOREAN HARMONY THEORY • In the Mysteries the lyre was regarded as the secret symbol of the human constitution, the body of the instrument representing the physical form, the strings the nerves, and the musician the spirit. Playing upon the nerves, the spirit thus created the harmonies of normal functioning • PYTHAGORAS set HARMONY to a mathematical scale Pythagoras cured many ailments of the spirit, soul, and body by having certain specially prepared musical compositions played in the presence of the sufferer

38. WHY IS MUSIC USEFUL • PROMOTES WELLNESS • ALEVIATES PAIN • MANAGE STRESS • OUTLET TO EXPRESS FEELINGS • IMPROVE COMMUNICATION • IMPROVE PHYSICAL COORDINATION • FORCES FOCUS ON TODAY

39. Parkinson’s and Music INCREASES THE ABILITY TO OVERCOME THE DIFFICULTY GENERATING SEQUENCE • GIVES BACK RHYTHM • GIVES BACK TEMPO • GIVES BACK TIMING John Phillips Sousa • Parkinson’s patients that cannot walk but can dance • The loss of dopamine creates a lack of synchronization of movement that music may be able to somehow reorganize

40. FOCUS ON RHYTHM • My personal opinion: there is a rhythm in the soul of mankind and is manifested internally, universally similar but distinctively different in everyone and can be touched by the Native American Flute (remember Tony and his Grandfather) • Next: a healthy mind creating a healthier brain • Music helps depression you can help those with Parkinson’s

41. CAN YOUR MIND HELP THE COURSE OF THE DISEASEDr Anthony Santiago Muhammad Ali Parkinson’s • “It is the stagnation of our personal story, maintaining a rigid definition of our own meaningfulness and worth, coupled with a loss of imagination, a lack of courage to face our imperfections that defines depression, not just a particular chemical change. • Left unattended (in Parkinson’s) this molecular backdrop transmogrifies into a self fulfilling paradigm • Those actively engaged…….have a slower progression of the disease (Parkinson’s)”

42. MY WALK WITH PARKINSON’S MY PROMISE: I WOULD NOT BE EMBARASSED BY THE DISEASE I WOULD TELL EVERY ONE ABOUT IT TO INCREASE AWARENESS I WOULD HELP MY BROTHERS AND SISTERS WITH PARKINSON’S FFPNR

43. LUNCH WITH MUHAMMAD ALI BECAUSE OF MUSIC THERAPY • A

44. ALI

45. A • ALI

46. PLAY ANYTIME I GET A CHANCE AND TELL MY STORY TO EVERYONE

47. EXPERIENCESBLESSING SONG • KLAGETOH

48. EXPERIENCES BECAUSE OF MUSIC THERAPY • KLAGETOH HOGAN

49. WWW.FFPNR.ORG FOUNDATION FOR PARKINSON’S AND NEUROLOGICAL RESEARCH MISSION A WORLD WITHOUT PARKINSON’S