Rehabilitation Is About a Path to Well-being Using a Total Health Approach

 MARCH 1, 2019 BY DR. C

Rehabilitation, the “R” in the CHRONDI Creed, is about the path to well-being. It is an action plan aimed at doing all that is possible to live well with a chronic disease. A well-designed rehab plan can make that journey easier. Think of a rehab plan as an expanded treatment plan that includes not just symptom treatment, but also all those actions that contribute to quality of life — a total health approach.

In previous columns, I have covered a range of topics, reflecting the total health approach of a rehab plan: freezing (body), deep fatigue (body), mindfulness (mind), terror management (heart), lightness of being (soul), and the importance of showing compassion and gratitude (support environment). These columns reflect parts of my personal rehab plan and they illustrate the diversity of domains that need to be addressed when taking the CHRONDI Creed into battle against a chronic disease.

My PhD is in rehabilitation counseling with many years of writing rehab plans. Most often a rehab plan is thought of as a “back to work” plan following an injury or substance abuse. But it can also be thought of as a “back to well-being” plan when facing a chronic disease. A rehab plan includes care for the following: body, mind, heart, soul, and support environment. The well-designed rehab plan includes actions that address each of these care needs in connection with the path to well-being, while also placing emphasis on the strengths of each person, not just the symptoms. It is a total health approach.

It has taken me close to a decade to arrive at a rehab plan for this chronic disease. There has been a lot of trial and error, many consultations with professionals, support from family, and a ton of research. The plan is not a static thing. It is always getting tweaked to keep ahead of the chronic disease’s changing demands.

The hardest thing for me has been to remain on the middle path, to not be too serious (intense, righteous), and at the same time, to not become too flippant (not caring, lost in the clouds). The middle path is also about monitoring actions in all realms (body, mind, heart, soul, environment) to keep an even balance in thought and action. The middle way is about using just the proper amount of action applied to any situation, and as a result, getting back just the right consequences. The balance of the middle way can be built into the design of a rehab plan, and in doing so, aid the path toward well-being.

Every rehab plan is individually tailored, and the more closely it matches the needs of the individual, the more likely it will be successful. But this can be a difficult goal to achieve. If you are a strong self-advocate, as I am, then there are hours and days of self-reflection and examination behind matching the rehab plan to personal needs.

But self-examination is not always accurate. There are times when what I want doesn’t match what I need. When that happens, it is good to have the ear of a trusted caregiver. If you are a caregiver helping to develop a plan, then the question that needs to be continually revisited is, “How well do I know this person and their needs?”

Walking in another’s shoes and having evidence that this has been accomplished can reveal a person’s true needs. There are varying degrees of empathy, and it takes skill to understand and apply them. Not understanding a person’s needs is like giving a thousand wool blankets to desert nomads because you thought it was the compassionate thing to do. Misinterpreting another’s needs is a major obstacle to designing and delivering a successful total health rehab plan.

When living with a chronic disease, the opportunity for well-being to be present does not fall from a tree — we must go pick it when it is most ripe. It is hard work to design a detailed, individually tailored rehab plan focused on total health. It is also challenging to put that plan into action, learn from it, tweak it (over and over again), and come up with an improved version. It takes courage, perseverance, and support.

What actions have you taken to develop a total health rehab plan? Share them in the comments below so that our readers may benefit from your experience.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

https://parkinsonsnewstoday.com/2019/03/01/rehabilitation-is-about-path-well-being-using-total-health-approach/

Parkinson’s Patients on DBS Aren’t More Impulsive, Study Finds

MARCH 1, 2019 BY JOSE MARQUES LOPES, PHD

Parkinson’s patients treated with deep brain stimulation (DBS) are not more impulsive than other patients or healthy people toward food or monetary rewards, according to new research.

The study, “Deep brain stimulation of the subthalamic nucleus and the temporal discounting of primary and secondary rewards,” was published in the Journal of Neurology.

Although DBS of the subthalamic nucleus (STN) — a brain region hyperactive in Parkinson’s and implicated in motor control — is an effective way to ease the disease’s hallmark motor symptoms, it may induce confusion and changes in behavior and in decision-making processes, such as those regarding food. This may lead to a tendency toward risky decision-making in gambling tasks and increased impulsivity.

Aiming to better understand impulsivity in this patient population, a research team from Italy used a task called delay discounting, in which the patients had to decide whether they preferred an immediate, smaller reward over a larger one later. A preference for the immediate reward would be expected from impulsive participants. However, studies using monetary rewards in people with Parkinson’s who underwent DBS have led to contradictory results.

While money is a secondary reward, food is a primary reward as it is necessary for one’s survival. In rats, stimulation of the STN increased the motivation to obtain food, but reduced motivation toward cocaine, a secondary reward.

In accordance, Parkinson’s patients undergoing DBS attributed increased value to food rewards, which was associated with weight gain, a common non-motor side effect of the surgery.

The 45 participants were divided into three groups: 15 Parkinson’s patients who underwent bilateral DBS into the STN (mean age 62.8 years, 4.4 years since the surgery), 15 patients without DBS on dopaminergic replacement therapy (mean age 69.1 years) and 15 healthy controls (mean age 67.7 years).

All patients were tested under their best medical treatment condition, which means on stimulation in DBS and on medication for dopaminergic treatment.

All participants performed three computer tasks where they had to choose a smaller reward immediately or a reward that was larger but delayed — by two days, two weeks, one month, three months, six months, or one year.

“In these tasks, the choice usually depends on the time that passes between one option and the other: if it is very short, delayed gratification is chosen and vice versa,” Marilena Aiello, the study’s lead author, said in a press release.

In the food task, the participants were asked to choose from six foods, three sweet and three salty. When using discount vouchers as rewards, they had to choose from six hobbies or activities presented through pictures — a theater trip, a restaurant visit, book purchases, gardening equipment, sewing tools, or tools to paint — for which they would like to get a discount voucher.

The results revealed no differences in food or discount voucher choice comparing the three groups, even in patients who experienced weight gain and/or eating alterations after DBS.

The data further showed greater preference for immediate rewards — greater impulsivity — in patients with fewer years since DBS, on higher doses of levodopa, and with better memory.

“Our study confirms that patients with DBS are no more impulsive in this kind of situation and they do not try to find gratifications more hastily than the others,” Aiello said.

The investigators said, “In addition, our results also extend the current literature by showing, for the first time, that this result is independent of the type of reward.”

https://parkinsonsnewstoday.com/2019/03/01/parkinsons-patients-on-dbs-arent-more-impulsive-study-finds/

Excess Activity in Striatum May Underlie Parkinson’s Symptoms, Mouse Study Suggests

MARCH 1, 2019  BY CATARINA SILVA

The loss of dopamine causes neurons in the striatum — a brain region involved in voluntary movement control — to change their activity, explaining some of Parkinson’s hallmark symptoms.

Instead of firing in sequence, some of these neurons are overactive and fire simultaneously, making the mice have a repetitive rotation behavior — a common feature of rodent models of Parkinson’s disease.

The research, “Synchronized activation of striatal direct and indirect pathways underlies the behavior in unilateral dopamine-depleted mice,” was published in the European Journal of Neuroscience.

The loss of dopamine-producing neurons in the midbrain of a Parkinson’s disease rodent model causes a decrease in body movement, deviated posture, and spontaneous circling behavior toward the lesion side.

It was also reported that reducing the number of dopamine-producing neurons within the striatum increases the activity of the remaining striatal neurons on the lesion side.

“When you take dopamine away, the cells reorganize, and that reorganization leads to most of the symptoms of Parkinson’s,” Gordon Arbuthnott, PhD, senior author of the study and principal investigator of Japan’s Okinawa Institute of Science and Technology Graduate University (OIST) Brain Mechanism for Behaviour Unit, said in a news release.

Striatal projection neurons usually don’t fire simultaneously, but research shows that these cells start overworking themselves, and doing so rhythmically, in the absence of dopamine.

Dopamine D1 and D2 receptors are the most abundant dopaminergic receptors in the striatum. Although there’s still no consensus about the function of D1 and D2 neurons, D1 cells are thought to help initiate movement while D2 neurons suppress it. In a healthy scenario, these nerve cells work together to adapt a person’s response to a given motor situation.

Blocking dopamine receptors D1 and D2 in striatal projection neurons has been shown to provoke akinesia (loss of the ability to move muscles voluntarily) in a way that mimics what happens when there is dopaminergic neuronal loss, but evidence suggests the previously mentioned hyperactive rhythmic phenomenon is greatly influenced by D2 neurons.

OIST investigators set out to further understand the role of dopamine in striatal projection neurons. To do so, they used a technique called calcium imaging to evaluate the neurons’ activity.

In neurons, calcium signals regulate processes including cell death, brain chemical messengers’ release, and neuronal activation. By using fluorescent dyes that bind to calcium molecules, scientists can directly measure the dynamic calcium flux within neurons.

Sixty-four transgenic mice had an enhanced green fluorescent protein (eGFP) attached to D1 and D2 receptors within dopaminergic neurons. This protein allowed researchers to observe, under a microscope, the location of such molecular receptors.

Then, researchers injected 6‐hydroxydopamine (6‐OHDA), a neurotoxin that causes the death of dopamine-producing neurons, into the left substantia nigra pars compacta — a midbrain area important for muscle control.

A dopamine agonist called apomorphine is commonly used to trigger rotational behavior (circling) to assess whether the 6-OHDA-induced neuronal death is successful. Of note, the more an animal moves in circles, the greater the 6-OHDA lesion is.

A week after the injection, mice were administered apomorphine and turning behavior was assessed for 5 minutes. Only the animals that turned over 5 times per minute were considered to have adequate dopamine depletion and were included in subsequent testing.

After that, scientists generated adeno-associated viruses (AAV) carrying a light-sensitive protein, which enables light-induced neuronal activation, and a calcium indicator dye. The AAV combination was injected into the animals’ striatum.

In control animals, D1 and D2 striatal projection neurons had sparse spontaneous activity. However, the loss of dopamine in 6-OHDA-treated animals triggered a significant and synchronous increase in the number of these nerve cells, in comparison to the control sample.

Researchers found that the pattern of light stimulation caused different behaviors in animals.

“With continuous light (15 seconds), animals displayed turning behavior similar to 6‐OHDA- treated animals, that is, toward the side stimulated. With stimulation in patterned pulses (14 Hz) animals displayed turning behavior opposite to the stimulated side,” they said.

“The fact that, when I changed the stimulation, the animal turned to the opposite side — that was shocking,” said Omar Jaidar, PhD, first author of the study and a postdoctoral scholar in the Arbuthnott Unit at the time of the research.

Researchers also noted that both D1 and D2 neurons had three sets that generated sequential activity states. The state that had the largest number of active striatal projection neurons dominated the other two. Further analysis revealed that such cells projected into other brain regions.

“You need a certain sequence of muscles to contract to execute any movement, and it’s the same with [striatal] neurons,” Jaidar said.

Contrary to previous research, this study shows that D1 and D2 striatal projection neurons equally contribute to the unusual neuronal activity observed in Parkinson’s disease models. In conclusion, scientists should combine efforts to determine brain network activity so that disease-specific treatments can be developed based on network functional abnormalities.

https://www.blogger.com/blogger.g?blogID=4282591254614897626#editor/target=post;postID=4793033157868421427;onPublishedMenu=template;onClosedMenu=template;postNum=0;src=postname

Group Therapeutic Singing via Telemedicine Improved Respiratory Function of Parkinson’s Patients in Rural Iowa, Study Finds

 FEBRUARY 28, 2019 BY JOSE MARQUES LOPES, PHD 

Parkinson’s disease patients living in rural areas in Iowa show improved respiratory function with group therapeutic singing delivered via telemedicine, according to a pilot study.

The study, “The Feasibility of Group Therapeutic Singing Telehealth for Persons with Parkinson’s Disease in Rural Iowa,” was published in the journal Telemedicine and e-Health.

Voice impairment affects most patients with Parkinson’s, but only a small minority undergo speech therapy. That is why new approaches to help improve voice and respiratory impairments in Parkinson’s patients are needed, especially for those living in rural areas where access to care is limited.

Telemedicine may be an effective answer, as it has led to positive results in the treatmentof depression in Parkinson’s patients, as well as in group therapy, and education and support sessions.

Previous studies have suggested that singing may ease voice and respiratory impairments in people with Parkinson’s. In particular, researchers at Iowa State Universityhave shown that group therapeutic singing effectively maintains the voice and significantly improves respiratory control in these  patients. However, whether it can be delivered through telemedicine — and whether it would lead to similar results as in-person group therapeutic singing — remains to be determined.

Aiming to address this topic, researchers tested an eight-week prerecorded group therapeutic singing program in nine idiopathic (of unknown cause) Parkinson’s patients (eight men, age 67-82) living in the rural Iowa towns of Rockwell City and Storm Lake.

All participants were on a stable regimen of antiparkinsonian medications for 30 days, did not smoke, and had received no speech therapy within the past two years. None had significant cognitive impairment, major psychiatric disorders, history of head or neck cancer, asthma, chronic obstructive pulmonary disease, or untreated hypertension.

The group therapeutic singing program was filmed before recruitment, with Parkinson’s patients who attended weekly in-person sessions. Each session included vocal exercises followed by group singing of familiar songs. The intervention targeted breath support, vocal intensity, and frequency range.

The assessments were made one week prior and one week after the intervention at the same time of day to avoid fluctuations in medication. Voice outcome measures included phonation (vocalization) duration and range, and vocal intensity, each tested in three trials.

Specifically, phonation duration was assessed as the total time a participant sustained the vowel sounds ‘‘ah’’ and ‘‘ee.’’ To determine phonation range, the team recorded the lowest and highest pitch with an iPad app, then calculated the difference. The loudest sound produced on a sustained ‘‘ah’’ indicated vocal intensity.

Respiratory outcome measures included maximal inspiratory and expiratory pressures (breathing in or out as forcefully as possible for two seconds)   recorded with a portable respiratory pressure meter.

One participant dropped out at week three. Five attended all eight sessions, two completed seven sessions, and one participant attended six sessions. The overall compliance was 93.75%.

Analysis of the eight patients completing all sessions revealed that the changes in phonation range and vocal intensity were not statistically significant. However, both respiratory outcome measures improved significantly.

The results were in line with those of in-person sessions, suggesting similar effectiveness with the two approaches, the team noted. The different results seen in phonation duration — an increase with in-person, but a slight decrease with the pre-recorded program — may have been due to the small number of participants in the study using telemedicine, the team noted.

“This study has established that using a prerecorded GTS [group therapeutic singing] program is feasible and effective for persons with [Parkinson’s] in rural areas,” researchers wrote. “Thus, this pilot work suggests that the use of prerecorded GTS may be a viable treatment option for those with limited access to care,” they added.

https://parkinsonsnewstoday.com/2019/02/28/group-therapeutic-singing-telemedicine-helps-respiratory-function/

Changes in Fatty Acid Metabolism May be Linked to Parkinson’s Severity, Rat Study Finds

FEBRUARY 28, 2019 BY CATARINA SILVA 

The metabolism of certain types of fats, namely palmitic acid and stearic acid commonly found in animal and vegetable fats and oils, may be altered in Parkinson’s disease, according to a study in rats.

The study, “Palmitate and Stearate are Increased in the Plasma in a 6-OHDA Model of Parkinson’s Disease,” was published in the journal Metabolites.

Studying small molecules produced by metabolism — commonly known as metabolites — within cells, biofluids, tissues, or organisms holds promise for the discovery of potential diagnostic biomarkers, which may shed light on susceptibility to Parkinson’s, disease prognosis, and therapeutic response to treatment.

In fact, an increase in metabolites of fatty acid-related molecular pathways has been reported in the plasma and cerebrospinal fluid of Parkinson’s patients, which correlated with disease progression. An increase in amino acid (protein’s building blocks) metabolism in urine samples of Parkinson’s patients has also been reported.

Evidence also suggests that metabolic profiling of cerebrospinal fluid is useful for distinguishing between newly diagnosed Parkinson’s patients and healthy individuals.

Although studies indicate that an array of molecular changes have the potential to become disease biomarkers, there is still no consensus on which markers are more informative from a diagnostic, prognostic, or even therapeutic point of view.

King’s College London researchers set out to investigate changes in brain, plasma, and liver metabolism of a rat model of Parkinson’s to discover small molecules that are associated with dopaminergic cell loss — a hallmark of the disease.

Thirteen rats were injected on one side of the brain only (unilaterally) with 6-hydroxydopamine (6-OHDA), a neurotoxin that causes the death of dopamine-producing (dopaminergic) neurons. Another 13 animals were injected with saline into the same brain region and used as a control sample.

Two weeks after injection, the animals were given two behavioral tests for researchers to assess their motor function.

“Unilateral lesions of 6-OHDA successfully resulted in the manifestation of motor symptoms, as observed by [behavioral tests] indicating the intensity of the lesions,” the researchers wrote.

Tissue analysis of the animals’ substantia nigra — a midbrain area important for muscle control that is commonly damaged in Parkinson’s disease — revealed that rats injected with 6-OHDA only had 28% of dopaminergic neurons on the injection side, compared with the other side that was not injected. Control samples had similar dopaminergic neuronal cell count on both brain sides.

Scientists then performed a metabolic analysis on the animals’ plasma, midbrain, cerebellum, and liver samples.

Results showed significantly high plasma levels of palmitic acid and stearic acid, both saturated fatty acids, within the Parkinson’s disease modeling group, which were found to be associated with motor dysfunction.

Lipid metabolism involves the degradation of triglycerides, a type of fat, into smaller chain fatty acids and subsequently into monoglycerides (glycerol molecule combined with a fatty acid) by specific enzymes.

Monoglyceride forms of palmitic acid and stearic acid, also known as monopalmitin and monostearin, respectively, were reduced in the midbrain of animals injected with 6-OHDA. Low levels of myo-inositol, a sugar alcohol molecule that has been used to decrease hormonal changes in polycystic ovary syndrome, were also found in the midbrain.

Compared with the control group, 6-OHDA rats showed a tendency toward lower levels of monopalmitin, monostearin, and myo-inositol in the cerebellum, but statistical significance was not reached.

No fatty acid-related molecular changes were observed in the animals’ livers.

“Our results show that saturated free fatty acids, their monoglycerides and myo-inositol metabolism in the midbrain and enteric circulation are associated with 6-OHDA-induced [Parkinson’s disease] pathology,” the researchers wrote.

“Changes of the midbrain metabolites may be associated with neuronal loss elicited by 6-OHDA while palmitic acid and stearic acid showed a high correlation with behaviour tests, indicating a possible association with disease severity,” they said.

https://parkinsonsnewstoday.com/2019/02/28/changes-fatty-acid-metabolism-linked-parkinsons-rat-study/

UTSW Names the First Director of the O’Donnell Brain Institute

March 1, 2019   by Will Maddox

Dr. William T. Dauer (Courtesy of: UTSW Medical Center)

UT Southwestern Medical Center has named Dr. William T. Dauer the first director of the Peter O’Donnell Brain Institute. The neurologist and researcher will also be a professor of neurology and neurotherapeutics, and will begin in July.

Dauer is known for his research into dystonia and Parkinson’s disease, has discovered novel treatments for the involuntary movements associated with the diseases. He is currently is the Director of the Movement Disorders Group and Director of the Morris K. Udall Center of Excellence for Parkinson’s Disease Research at the University of Michigan, where he teaches neurology and cell and developmental biology.

The institute was established in 2015, and connects over 500 doctors and researchers to better understand how the brain works and apply the discoveries to treating brain, spine, nerve and muscle disorders. They study autism, brain tumors, Alzheimer’s disease, epilepsy, multiple sclerosis, psychiatric disease, sleep disorders, stroke and traumatic brain injuries. The institute will be housed in the 12-story tower atWilliam P. Clements Jr. University Hospital, which is should be complete in 2020. There is an additional nine-story tower being built to house research facilities as well. The building will have 590,342 square feet, an estimated cost of $453.8 million, and should be complete in 2022.

“Dr. Dauer’s broad experience as a neurologist and a scientist positions him to provide strong leadership as the Peter O’Donnell Jr. Brain Institute works to accelerate the translation of fundamental discoveries into cutting-edge treatments for a broad spectrum of brain disorders,” said Dr. W. P. Andrew Lee, Executive Vice President for Academic Affairs, Provost and Dean of UT Southwestern Medical School via release.

“The personal and societal burden of neurological and psychiatric disease is great and increasing. The Peter O’Donnell Jr. Brain Institute represents the bold and visionary commitment of UT Southwestern President Dr. Daniel K. Podolsky and the medical center’s leadership to tackle the challenge of improving the lives of individuals with brain disease,” Dauer said via release. “The success of the Institute is uniquely possible at UT Southwestern because of its world-leading scientific culture and unprecedented institutional commitment to brain science and clinical care. I am extraordinarily honored and excited to direct the Institute and to join the remarkable UT Southwestern community.”

https://healthcare.dmagazine.com/2019/03/01/utsw-names-the-first-director-of-the-odonnell-brain-institute/

Clinical trial at UB to test new treatment for Parkinson’s disease dementia

March 1, 2019    By Ellen Goldbaum

One of the challenging characteristics of Parkinson's disease dementia is 'imposter syndrome,' where patients believe that a loved one has been replaced by an identical imposter.

BUFFALO, N.Y. – After Alzheimer’s disease, Lewy body dementia and related Parkinson’s disease dementia (PDD) are some of the most common types of dementia affecting older adults, but they are severely understudied. While PDD patients are often prescribed medications that treat psychosis and Alzheimer’s disease, there are no medications designed specifically to treat these illnesses.

Fortunately, that’s changing. This year, Eli Lilly and Company has launched a clinical trial for the first treatment designed to benefit patients with mild-to-moderate PDD.

The University at Buffalo is among 72 sites nationwide that are recruiting patients for this 12-week, randomized, placebo-controlled drug trial.

“Participating in this trial could help push this drug more quickly through the pipeline,” said Kinga Szigeti, MD, PhD, associate professor of neurology in the Jacobs School of Medicine and Biomedical Sciences at UB, who is principal investigator at UB. Interested patients will be seen at UBMD Neurology, where Szigeti is director of its Alzheimer’s Disease and Memory Disorders Center.

For more information on getting screened for the UB trial, contact Connie Brand, clinical research coordinator at UBMD Neurology, at 716-323-0549.  

PDD and Lewy body dementia affect an estimated 1.4 million Americans. The condition often occurs after a patient has been diagnosed with Parkinson’s disease, the symptoms of which often begin with the inability to control movements but then progress to affect cognition. In Lewy body dementia, cognitive decline is the first symptom, frequently followed by Parkinsonian features. Both diseases are characterized by abnormal protein deposits called synuclein, which form Lewy bodies in the neurons.

“The neuropsychiatric symptoms can make this kind of dementia much more challenging for families to deal with than Alzheimer’s disease.”

Kinga Szigeti, MD, PhD, Associate professor of neurology and director of the Alzheimer's Disease and Memory Disorders Center

Jacobs School of Medicine and Biomedical Sciences

Neuropsychiatric symptoms

A key distinction between PDD and most other kinds of dementia are the neuropsychiatric symptoms that can occur, such as hallucinations and Capgras or “imposter syndrome,” where patients believe that a loved one has been replaced by an identical imposter.

“The neuropsychiatric symptoms can make this kind of dementia much more challenging for families to deal with than Alzheimer’s disease,” Szigeti said.

PDD symptoms also include a tendency to sleep for long periods at a time, sometimes 14-16 hours per day. “Sleeping so much can cause patients to lose muscle mass, becoming more frail and more prone to infection,” Szigeti explained. “Changes in the nervous system can lead to an unhealthy drop in blood pressure, and patients become more prone to falls.”

For these reasons, she noted, patients with this kind of dementia have a lifespan that is much shorter than for Alzheimer’s patients.

“Lewy body dementia has been very understudied in clinical trials,” said Szigeti.

While some medications used to treat psychosis can mitigate certain aspects of Lewy body dementia, many of them also increase the risk of stroke or even death.

Between a rock and a hard place

“For that reason, many patients and their families feel they have no options,” said Szigeti. “They find themselves between a rock and a hard place.”

But now, Western New York patients have an opportunity to participate in the first clinical trial to test a medication for Lewy body dementia at the Jacobs School.

The advantage of the new drug, known as LY3154207, is that it has a novel mechanism of action on dopamine, the brain chemical that Parkinson’s disease rapidly depletes. The drug was designed to maximize the brain’s response to the remaining dopamine, therefore improving cognition, motor function and boosting wakefulness. It is taken in pill form.

“We are for the first time offering hope to these patients and their families, and an opportunity to participate in this trial,” Szigeti said.

http://www.buffalo.edu/news/releases/2019/03/001.html

UD startup tests Parkinson’s disease device with Michael J. Fox Foundation funding

Article by Karen B. Roberts Photos by Kathy Atkinson March 01, 2019

 When activated from a smartphone app, the device vibrates and sensors collect data about the person’s position and gait.

GOOD VIBRATIONS

Parkinson’s disease (PD) is a progressive nervous system disorder that slowly isolates people by taking away their mobility and fine motor control. 

An estimated 1 million people in the United States are living with Parkinson’s and suffer from symptoms including tremor, stiffness and impaired balance. Sixty percent of these individuals experience freezing of gait, a phenomenon where individuals feel as if their feet are stuck to the ground and their ability to walk is blocked.

The severity of freezing of gait symptoms can last only a few seconds followed by resumption of walking, or lead to minutes of total immobility, all of which can result in falls and injuries. Unfortunately, medications rarely help with this problem and, in some cases, can actually worsen the problem.

Now, a Mid-Atlantic research team with roots at the University of Delaware has received a $440,000 grant from The Michael J. Fox Foundation for Parkinson’s Research (MJFF) to test a device, called VibeForward, that uses vibration therapy to reduce symptoms of freezing of gait in patients with Parkinson’s. Non-invasive, lightweight and portable, and equipped with a rechargeable battery, the device is worn on the foot inside of a shoe, making it ideal for use in everyday life.

An accelerometer inside the VibeForward device measures how fast and in what direction the wearer’s leg is moving. It’s the kind of data that might help a clinician or physician pinpoint when a patient “got stuck.”

VibeForward was developed by Resonate Forward LLC, a UD startup company.  It evolved from early work on the PDShoe at UD’s Parkinson’s Clinic by former faculty member Ingrid Pretzer-Aboff, who is now at Virginia Commonwealth University (VCU). Resonate Forward is loaning VCU several VibeForward devices to test the effects of vibration on Parkinson’s tremor and on Parkinson's gait and balance issues.

The new funding is part of an MJFF initiative launched last fall to evaluate non-pharmacological interventions for the treatment of gait and balance disturbances that have the potential to significantly improve the daily lives of people with Parkinson’s.

Only eight projects from around the world were awarded grants, according to an MJFF announcement.

Device design is an iterative process that takes collaboration, communication and even some humor. Pictured from left to right: Prof. Richard Martin, UD junior Theodore Fleck, Prof. Scott Jones and Ingrid Predtzer-Aboff, senior nurse scientist at Virginia Commonwealth University.

A step forward using vibration

While at UD, Pretzer-Aboff’s work with the PDShoe aimed to help people with Parkinson’s to walk more steadily and smoothly by providing vibration that was synchronized to the heel strike and toe-off of the person wearing it.

Early evidence showed that vibration therapy applied to the feet can help reduce freezing of gait. The researchers don’t know with certainty how the mechanism works. Pretzer-Aboff, now a VCU senior nurse scientist, said the vibration may trigger an alternative pathway for movement generation in the brain. It also may be that the vibration is stimulating the nervous system, thus enhancing the communication channel between the brain and foot.

Resonate Forward licensed the PDShoe technology through UD’s Office of Economic Innovation and Partnerships and developed it into a miniaturized, patient-friendly prototype that can be discreetly worn on both feet and ankles. Seed funding from UD’s Horn Entrepreneurship Blue Hen Proof-of-Concept program and Delaware’s NSF Established Program to Stimulate Competitive Research (EPSCoR) provided support to get the startup off the ground and enabled technical advances on the device. Specialized training through the NSF I-Corps Sites program, administered by Horn Entrepreneurship, fostered the team’s innovation mindset as they work to transition the technology into a marketable product.

Richard Martin, UD associate professor of electrical and computer engineering, joined the Resonate Forward team as chief technology officer in 2017. He and his student Theodore Fleck, a junior studying computer engineering, have been working to improve VibeForward’s electronics and communications capabilities. It’s both a professional and personal labor for Martin, whose father has Parkinson’s and experiences freezing of gait.

“I remember walking with him at a church service and he just stopped and said ‘I can’t move my feet.’ It’s hard to understand, but it just does that,” said Martin.

UD junior Theodore Fleck (far left) demonstrates the web interface he helped build to remotely control the device’s vibrating motors and log the data collected by sensors for Prof. Scott Jones and Ingrid Pretzer-Aboff, senior nurse scientist at Virginia Commonwealth University.

Initial work under the MJFF grant will focus on determining how large a dose of therapeutic vibration is needed, for how long and at what intensity, in order to reduce the occurrence and severity of freezing of gait episodes. 

“We’re starting to piece together what is working, or not, and why. This new funding is validation that what we’re doing is important for the people we want to serve,” Pretzer-Aboff said.

Members of the Resonate Forward team include:

• Bruce Chase, a former DuPont Fellow and research professor in UD’s Department of Materials Science and Engineering;
• Scott Jones, professor of accounting in the Department of Accounting & Management Information Systems in Alfred Lerner College of Business and Economics;
• Theresa Litherland, a UD alumna and former DuPont engineer who earned her MBA in entrepreneurship/entrepreneurial studies from Lerner College in 2016; 
• Rick Martin, a UD alum, a former W. L. Gore engineer and currently an associate professor in UD’s Department of Electrical and Computer Engineering;
• John Rabolt, a former IBM Research Scientist and Karl W. and Renate Boer Professor in UD’s Department of Materials Science and Engineering;
• Ingrid Pretzer-Aboff, a UD alumna and associate professor of nursing at Virginia Commonwealth University; and
• Param Sreekanth, an expert in new ventures and mergers and acquisitions, formerly with DuPont.
  
  
  https://www.udel.edu/udaily/2019/march/resonate-forward-startup-parkinsons-device/