Parkinson’s Post to educate, inspire and empower individuals affected by Parkinson’s

Spring 2019 Parkinson’s Post! Julie Pavelka, MS, APRN-NP Movement Disorders | Department of Neurological Sciences | Nebraska Medicine [email protected]

Welcome to the Spring 2019 edition of Parkinson’s Post!

The Movement Disorder Team continues attitude on the court. During his 12-year career, planning our upcoming Symposium, he played for five teams and became a strong Parkinson’s Disease in 2019: A Conference contributor to his surrounding communities. Inside this issue for Patients, Family, and Caregivers that Today, Brian continues to inspire as a speaker, • Walk with Confidence is Monday, October 14, 2019 from 8 a.m. – philanthropist, and a patient who insists on 3:30 p.m. at Embassy Suites and Conference thriving with Parkinson’s disease. His mission is • Parkinson Disease , La Vista, NE. The Symposium offers an to help people become their best, even when and Swallowing excellent opportunity for all individuals affected it seems impossible. Brian started his career by Parkinson’s to network with Parkinson at where he was Player of • Fuel #2: Protein Disease Experts; vendors representing the Year twice for the Midwestern Collegiate • Your Voice: How treatments, products, and services specific to Conference. He was drafted in the first round, Parkinson’s Disease Parkinson Disease; and others who understand eighth overall, in the 1994 NBA draft by the the daily struggles, battles, and triumphs that . His career continued Can Affect It patients, families, and caregivers endure daily. • Exercise Your Mind – The curriculum includes sessions presented How Physical Activity by our Movement Disorder Team including our Physicians, Therapy Department (Physical, Can Improve Brain Occupational, and Speech) and Nutritionist. Function and Mood

Registration for the Symposium will begin • Occupational August 5, 2019 and we will be emailing Therapist Tips on How and mailing Registration Forms – it is to Use Your Pets/ essential to submit your registration in a timely manner as there will again be a Animals for Therapy space limitation to this very popular event. • Using Wearable There also are Sponsorship, Vendor, and Devices to Monitor Donor opportunities for the Symposium available – contact me for further details. Tremor

As detailed in the previous Parkinson’s Post, • Gait in PD our Keynote Speaker for the Symposium is • Upcoming Events Brian Grant who was an NBA idol, known for his tenacious rebounding and a fearless Brian Grant • Reliable Resources

cont. pg. 2

Spring 2019 cont. from pg. 1 with the , Miami through the pain or get better with time. background. Brian is also on the Trail Blazers Heat, , and Phoenix He was scared and humbled, yet fiercely Alumni Ambassador Corp and he loves to Suns. During this time, Brian also served determined to be as healthy as possible. fish, surf, and enjoy the mountains in Oregon. underprivileged youth and sick families in his This motivation launched the Brian Grant Brian learned from his coaches that you community. His contributions earned him Foundation, for those with Parkinson’s who can’t always control the ball, but you can the J.Walter Kennedy Citizenship Award. want to lead active and fulfilling lives. control your effort. As a father of eight, In 2006, Brian retired from professional Since then, Brian has become a sought he wants to show his kids that quality . Only two years later, he was after keynote speaker. Companies and of life takes sweat and determination, diagnosed with young-onset Parkinson’s organizations nationwide are drawn to his but the results are always worth it. disease at age 36. It was hard for him to authenticity and captivated by his stories believe that his athletic body couldn’t push that unite us as people, regardless of age or

Walk with Confidence Jennifer McKune, PT Physical Therapist | Nebraska Medicine

Walking is the primary means of locomotion for most people and often an activity that we take for granted. It is something we have done most of our lives. Walking is a wonderful method of exercise and can improve strength, endurance, and overall health. But what happens when walking is affected due to symptoms associated with Parkinson’s disease? Some individuals experience reduced arm swing and poor posture. Others have shortened step length and limitations with stride. Often, an individual develops a “running” type of gait (a person’s manner of walking) that leads to unsafe mobility and increased risk of falls. It may become difficult to transition over different types of flooring, to walk through a balance and walking to reduce risk of falls. 5. When walking through a doorway, look doorway, to walk in crowds, to turn around It might be necessary to trial different gait beyond the threshold and focus on to change directions, to go up and down aides to improve safety with walking and an object you are moving toward. stairs, and even to initiate gait. When this increase independence. Learning specific 6. Place colored tape on the threshold happens, we realize just how challenging gait strengthening exercises for your core and of various doorways to serve can be. There are strategies and techniques legs can also help with gait and balance. as a cue for stepping over it. that can help with gait difficulties. Utilizing Other techniques that you can begin 7. Take wide steps when turning and internal cues and external cues can be helpful. using right away might include: avoid pivoting. Try using rhythmic Internal cues consist of self-talk to tell 1. Avoid rushing to get somewhere. movement and counting or say “right, yourself to step big or step long, to stand left, right, left” to aide in turning. 2. Keep floors clear of clutter and tall, to take a step with the right leg, then the rearrange furniture to create open 8. To begin walking or re-start when left leg, to step wider, and to shift weight. spaces/pathways within your home. freezing occurs–stop, take a deep breath, External cues may consist of visual or shift your weight, visualize stepping over 3. Use night lights to illuminate the auditory stimuli such as tape on the floor, a an object, and tell yourself to step big. bedroom, hallways, and the bathroom. laser light, a metronome, music, or counting. So walk with confidence and keep moving! Working with a physical therapist is beneficial 4. Let others get on/off elevators or to learn and practice various gait strategies. enter a room before you so you do The PT can teach techniques to work on not feel pressure to move quickly.

Parkinson’s Post | 2 Parkinson Disease and Voice/Swallowing Jayme Dowdall, MD Otolaryngologist | Assistant Professor | Department of Otolaryngology – Head and Neck Surgery | University of Nebraska Medical Center

What is new with voice and Why do I need a scope before Any new surgical techniques swallowing? I do Lee Silverman Voice for voice and swallowing? I very much enjoyed the session for the Therapy? Vocal fold augmentation can be performed Parkinson’s Support Group in May “A Hard in the office or the operating room. This is Lee Silverman Voice Therapy is very effective Pill to Swallow: What’s New for Swallowing performed for glottic insufficiency which for Parkinson’s hypophonia. The diagnosis for Patients with PD.” It was such a vibrant there is too much air escape between the of Parkinson’s hypophonia is made by and interactive experience with many key vocal folds. We inject a filler agent in the listening to the voice, a patient history and an questions from patients and family members vocal folds to add bulk to the vocal folds. In examination of the voice box (larynx). Patients which I’ll try to address with this post. Parkinson’s, this has been shown to help with have other diagnoses for their voice troubles voicing and has also shown some benefit in such as cancer in the voice box and blood swallowing (Howell, 2019, Dashtipour, 2018; What do you have here at blisters (hemorrhagic polyps) that will not be Sinclair, 2013). UNMC/Nebraska Medicine treated, or made worse, by Lee Silverman that is different from my ENT Voice Therapy. Why do we advocate for at another hospital? What simple things can I do singing? Last year, I very enthusiastically joined an for my voice and swallowing? There are now multiple studies that show that incredible laryngology program started by individual and group singing for patients with The appropriate amount of moisture for the Dr. Chris Bingcang in 2013. This is a unique Parkinson’s can have a number of benefits. mucous membranes is critical for swallowing practice model with the only two fellowship Benefits of singing include improvements in and for voicing. It’s very much like Goldilocks trained Laryngologists in the state of voice, breathing, swallowing, gait and mood and the Three Bears – hard for the body to Nebraska. Our entire practice is focused on (Tamplin, 2019, Han 2018, Stegemöller, 2017, get it “just right.” voice, airway and swallowing so we are able 2018). These benefits can be seen in person to stay up to date on these topics. We enjoy Swallowing is like a water slide. If you or via telehealth (Stegemöller, 2019). collaborating closely with the movement swallow pills on a dry throat they are most disorders neurology group here. Together, likely to stick in the many nooks and crannies we have a full range of medical and surgical of your throat. Simple tricks like sitting down voice, airway and swallowing services for when swallowing pills and drinking a few sips patients. We very much enjoy collaborative of water prior to taking your pills to wet the practice with speech language pathologists in throat can be helpful. Taking one pill at a time the region to develop personalized patient- rather than a handful can be helpful. If you centered treatment programs. look at your pills and they are the size of nuts, Dance consider adding slime in the form of sugar like nobody During a visit, why do you talk free pudding, yogurt or applesauce to prevent is watching about my voice and breathing sticking. why I’m having a swallowing Sometimes medications can be quite drying problem? to the throat. Many patients with Parkinson’s experience decrease saliva and dry mouth. The larynx is involved in separating the airway Love This can have implications for swallowing like you’ll from the esophagus to keep food and liquid and voice and also dental health (Barbe, from going down the wrong pipe. Breathing, never be hurt 2017, 2019). Having a humidifier on your voicing and swallowing involve the voice box nightstand or exploring nasal saline products (larynx) as well. We will ask questions and like Ocean Saline Nasal Spray and Ayr Gel assess all of those functions so that we can can keep the mouth and throat moist. The keep the entire system strong. Treatments nose is the humidifier for the throat. The like the expiratory muscle strength trainer Sing vocal folds vibrate much better if they are like nobody (EMST.com) which seem focused on moist. Dryness can lead to thick mucous. breathing can be used to strengthen is listening Swallowing the mucous, rather than trying swallowing. Also, there data to support Lee to clear the throat or “hock a loogie, can be Silverman Voice Therapy can strengthen more gentle for the voice. swallowing (Miles, 2017). Live Other patients may experience too much like it’s heaven saliva (hypersalivation) or drooling which can on earth be addressed as well (Ruiz-Roca, 2019).

Spring 2019 | 3 Fuel #2: Protein Jenna Paseka, MS, RD, LMNT Nutrition Therapist | Neurological Sciences Nebraska Medicine

Last newsletter, carbohydrates were highlighted as the first of our main macronutrients in our diet. The next nutrient is protein.

What does protein do for us? The first thing that usually comes to mind is that protein helps our muscle mass. Not only does it help build muscles, but it also helps our bones, cartilage, skin and blood. Protein can make enzymes, hormones and other chemicals the body needs. The Dietary Reference Intakes and 2015 – 2020 Dietary Guidelines recommendations are to consume between 10 to 35 percent of calories from protein. also be consumed in the form of protein or less effectively. You may need to take shakes using protein powder, nutrition carbidopa-levodopa 30 minutes before a Protein sources can come from animals or supplements (Ensure®, Boost®, Carnation meal or 60 minutes after a meal to help the plants. Animal sources of protein include Breakfast Essentials®, etc.) or protein bars. medication work more effectively. Some chicken, turkey, pork, beef, fish, eggs, people, though may need to take carbidopa- milk, cheese, cottage cheese and yogurt. People with Parkinson’s disease who are levodopa with a meal that has protein to Plant-based protein is found in soy milk, taking carbidopa-levodopa may need to be help alleviate side effects, such as nausea. peanut butter, almond butter, nuts, seeds, cautious with the timing of their protein intake Talk to your doctor about the right timing of beans, lentils, quinoa, edamame, and and when they take their medication. Protein taking your medication and protein intake for tofu. Try to get a variety of these sources may interfere with the absorption of levodopa, best control of your Parkinson’s symptoms. or pick something new to try! Protein can causing the medication to work more slowly Look out for the next issue of the Parkinson’s Post to learn about the last macronutrient, fat!

Your Voice: How Parkinson’s Disease Can Affect It Vicky Czerwinski M.S. CCC-SLP Speech-Language Pathologist | Munroe-Meyer Institute for Genetics and Rehabilitation | University of Nebraska Medical Center

Your ability to communicate is one of the SPEAK OUT! Is a two-part therapy approach you know how loud or soft you sound many parts of you that can be affected that helps you regain and maintain your to others. It consists of sixteen sessions by Parkinson’s Disease. Some of the speaking ability. It specifically targets targeting both structured tasks, ‘trigger’ tasks, most commonly reported speech issues your ‘intent’ and teaches you to speak and conversation. For more information by those with Parkinson’s Disease and with purpose, deliberation, and intention. It please see www.lsvtglobal.com. their loved ones are soft/quite voice, consists of twelve therapy sessions targeting If you are interested in either of these hoarseness, monotone, mumbled speech, six different exercises. Following the twelve therapies, you can search for a certified and rapid speech. These are all things therapy sessions you are able to join the clinician near you on their websites. However, that can be targeted in speech therapy. ‘LOUD CROWD’ which is a weekly speech you do not have to complete one of these therapy group consisting of the SPEAK OUT! In the world of speech therapy and its role programs to receive speech therapy. Your exercises. For more information please in the management of Parkinson’s Disease, local speech-language pathologist may be see www.parkinsonvoiceproject.org. there are two well researched therapies: able to provide a more generalized care plan SPEAK OUT! and LSVT LOUD. Both target LSVT LOUD trains you to use your voice for you. A doctor’s order will be required for the same deficits (soft voice, monotone), at a more normal loudness at home, work, the speech pathologist to evaluate and treat however they do it in very different ways. or in the community. The key to treatment you, either your primary care physician and/ is the help you ‘recalibrate’ your voice so or your neurologist will be able to fulfill this.

Parkinson’s Post | 4 Exercise Your Mind: How Physical Activity Upcoming 2019 Can Improve Brain Function and Mood Events Darin Bottger, SPT Physical Therapy Student | College of Allied Health Professions | University of Nebraska Medical Center Nebraska Medicine/UNMC Lauren Kesteloot, PT, DPT Parkinson Disease Support Group Physical Therapist, Rehab Services Lead | Nebraska Medicine - Bellevue Every Third Friday at 10 a.m. Fred & Pamela Buffett Cancer Center, Parkinson Disease is a condition that Not only do many of these exercises provide 505 S. 45th St., Omaha, NE currently affects more than ten million people positive benefits for your brain health, but June 21 worldwide. I assume many of you are familiar they are beneficial in slowing the overall Dr. Amrita-Amanda Vuppala with the common symptoms of Parkinson’s progression of PD! Assistant Professor, Department of which include tremor, shuffling gait, forward Neurological Sciences, University flexed posture, and rigidity or stiffness. Resistance Training of Nebraska Medical Center Although these are the most commonly Resistance training is exercise that is aimed Eye Findings in PD: What Your Neuro- treated symptoms, it is also estimated that at improving muscle strength. This training Ophthalmologist Can Do For You! up to 50 percent of people with Parkinson’s usually used weighted objects or machines, July 19 disease suffer with either depression, or mild but can be done simply by moving the weight Lisa Day cognitive impairment (difficulty with memory, of your own body! In addition to aerobic Sr. Manager Education and Clinical language or thinking). Luckily, research has exercise, resistance training has been shown Development Global Kinetics Corporation shown that aerobic and resistance exercise to improve both mood and brain function. Measurable Change to can be beneficial in improving brain function Parkinson’s Management. and overall mood! Where Do I Start August 16 While many forms of exercise can be Dr. Khashayar Dashtipour Aerobic Exercise performed with a low risk of injury, it is Loma Linda University, Murrieta, CA Aerobic is a fancy word that means as you important to consult your doctor first to Parkinson’s Disease: More exercise you will be using more oxygen (you’ll ensure that you are safe to begin an exercise Than Motor Symptoms. be breathing faster). Research has shown program. If you are appropriate, you may be September 20 that this form of exercise not only improves referred to Physical Therapy to begin working Round Table Discussion for your endurance, but can help to improve on strength and endurance, or you may be Caregiving Strategies your ability to problem solve, and remember appropriate to start an exercise program on After entering the front of the Fred & Pamela recent events. There are a variety of ways to your own. Buffett Cancer Center, walk to the left of the perform this type of exercise, but here are registration desk and you will be directed The current exercise recommendations for some common methods: to the appropriate meeting room which is people with Parkinson’s disease include on the MAIN FLOOR (Conference Room 1. Walking aerobic training three days a week for 30 0.12.103). Available parking will be in GREEN PARKING, across teh street from the Fred 2. Boxing minutes a day, and resistance training two & Pamela Buffett Cancer Center – there also 3. Water aerobics to three days per week targeting all major is a circle driveway in front of the Cancer 4. Cycling muscle groups. Although 30 minutes is Center that can be utilized for dropping off the recommended time per day, research and picking up. 5. Ballroom dancing has shown that as little as ten minutes of If you are unable to attend the support group, continuous exercise can provide beneficial but would like to watch the meeting from effects for both mood and cognition. your computer, please utilize the following link to watch the meeting live: http://www. unmc.edu/livevideo/unmc_live2.html Please contact Julie Pavelka, Facilitator, with any questions/concerns and RSVP (one week prior to meeting): parkinson.network@ nebraskamed.com

Parkinson Disease in 2019: A Conference for Patients, Family, and Caregivers October 14 | 8 a.m. – 3:30 p.m. Embassy Suites Convention Center 12520 Westport Pkwy, La Vista, NE

Spring 2019 | 5 Occupational Therapist Tips on How to Use Your Pets/Animals for Therapy Narmean Pedawi, OTR/L Occupational therapist | Nebraska Medicine

Research shows that regular exercise helps Horse lovers or owners- the many people with Parkinson’s disease (PD) connection between person improve symptoms. Pets, trained service and horse offers great animals or not, can provide meaningful emotional growth. Horses rewards in more ways than one. Having behave similar to humans pets around the home not only provide in social and responsive that companionship but can also help behaviors so connecting incorporate physical activity, movement, with a horse is easy. Take balance and hand/arm functioning skills. it a step further by working on grooming connecting brain hemisphere coordination Pets offer good distractions by allowing a horse’s hair or mane. Work on standing required in completing these movements. an individual with PD to focus on other balance and tolerance as you brush their Feeding your pets-pet health is vital. One things other than their disease. Pets can hair. Using large or small arm movements, way on working balance, strength, range allow one to include a more positive routine working on object stabilization in hand even of motion and combination of movements in their day by forcing one to get up and with a tremor. You can also use fine motor for arm and hand coordination could include get going. Here is list of activities that you control and coordination by trying to even filling your pets’ food/water dispenser. could be doing with your pets while still braid/unbraiding their mane. Be aware of Pouring water or food into their dishes engaging in movement and physical activity the caution and proper ways of braiding. If requires control and coordination. Reaching for your symptoms of Parkinson’s disease: you are unfamiliar with horses then have the into cabinets or on shelves allow for larger horse owner present with you for their tips Walk your dog-an excellent source of arm movement and involves some light and recommendations for horse grooming. exercise. Make it purposeful using large arm weight lifting as well. Filling bird feeders also swings, heel strike and upright posture Yoga-what dog or cat does not like to see incorporate finer motor movements of the their loved one on the floor with them. upper extremity along with standing balance. Playtime with your cat-using fine motor skills Beware of extra excited dogs who see you for grip and repetitive big movements by No matter how little or how much you on the floor and prepare for lots of kisses. using a laser light or toy wand waving it back do, it is always better to use “it” rather Stretching is essential for management and forth with emphasis through each joint than lose “it.” Movement is essential for of joint stiffness and rigidity. Chair or of your arm from shoulder, elbow and wrist. Parkinson’s disease. Animals have a way of assisted floor yoga help in stability of providing us with the care we need. With Play Frisbee or catch- focusing on using gait and reduces tremor. Include music their devout loyalty, you as their owner large movements, expanding the length of with your yoga for improvements with and loved one should provide them with your arm and using full hand movements. endurance, strength, range of motion and the same care back. In doing so, you Incorporate balance and working through hand coordination. Movements improve also benefit in your own care and health stiffness by twisting through your hips while Parkinson’s symptoms when you work in managing the Parkinson’s disease. standing during the toss of the ball or Frisbee. on crossing the middle of your body

Gait in PD Nabeel Muzaffar Syed Fellow, Movement Disorders | Department of Neurological Sciences | University of Nebraska Medical Center

Patients with Parkinson Disease (PD) different. Patients tend to take longer to they used to. As the posture is stooped, the face several challenges while walking. A stand up and as the disease progresses, use center of gravity is always falling forwards; seemingly routine task of standing up, their hands to push themselves up, until the patients often must take multiple steps walking to the kitchen to get a glass of water, they are not able to stand up by themselves. quickly to prevent from falling forwards. This turning, and then walking back to the chair is When they stand, the posture is stooped, is called festination and it appears mostly not so much smooth or automatic anymore. with varying degrees of neck and trunk when the patients want to stop. Since There are a number of reasons for that and bending forwards. The postural reflexes the whole process of gait is not so much we’ll try to describe some of them and then become impaired which means that sudden ‘automatic’ and rather requires attention, will briefly suggest recommendations. forces that tip the balance to a side tend to patients often stop walking before talking, make it harder for patients to maintain their especially if they must answer a question. The hallmark of PD is slowness of all posture and not fall. When they walk, the voluntary movements and walking is no steps are short, and the arms don’t swing as Gait cont. pg. 7

Parkinson’s Post | 6 Using Wearable Devices to Evaluate Tremors Gait cont. from pg. 6

Danish Bhatti, MD Freezing means that the feet seem to get Assistant Professor | Co-Director Comprehensive Parkinson Disease Clinic Director, International Neurology Program | Associate Director, Movement Disorders Fellowship Program stuck on the floor are difficult to lift. The Department of Neurological Sciences | University of Nebraska Medical Center patient can be seen as struggling with this, with repeated attempts to lift their feet. One of the hallmark feature of Parkinson are not compatible with the current iOS Freezing is especially problematic at the Disease (PD) is a tremor that is present at version). We found that the App1 detected beginning of the walk, before the first step rest and usually start on one side, typically in OT tremor in 22/24 patients and App2 is taken and also while turning and passing the arm but can be seen also as a starting in detected tremor in 21/24 patients. When through narrow doorways. In most patients, the leg. This PD tremor is very characteristic we combine both applications together, all freezing is worse in the off periods (when and can be separated from other tremors, 24 patients had tremor on at least one of the levodopa is not working) and after the the most common being essential tremor the two apps but most of the time on both next dose of levodopa kicks in, the freezing or benign familial tremor. It is a common apps giving a sensitivity of 100 percent. improves. Such patients benefit from mistake by most physicians especially increasing their dopaminergic medication This led us to conclude that smartphone primary care physicians to diagnose patients (levodopa and other drugs used for PD), applications either on the phone or in with the new onset tremor as essential either by increasing the dose or frequency. wearable watches can be used in a tremor (ET) even when the tremor clearly In other patients however, freezing is not reasonable way to screen for rare tremors is a Parkinsonian tremor. The ability to affected by the ON and OFF states and that are hard to diagnose such as orthostatic separate a Parkinson’s tremor from essential may even get worse in the ON state. The tremor. The movement disorder team tremor needs to be learned with training that latter, so called ‘ON freezing’ might improve at the University of Nebraska Medical may be achieved only after a full fellowship by lowering the dopaminergic medication. Center also partnered with the electrical in Movement Disorders to be able to Apart from adjusting dopaminergic engineering student in Pakistan to look pick them apart. There are many other medication, numerous maneuvers or at developing a wearable watch that can causes of tremors such as this Dystonic tricks have been shown to counteract be paired up with a smartphone to pick tremor, Rubral tremor, Medication-Induced freezing. Some of them are: taking a step up tremor and see if it can pick up tremor tremor etc. which makes diagnosing back before going forward, counting loudly frequency reliably which will be useful a PD based on the new onset tremor or in their head with each step, stepping for making a diagnosis and also tremor very hard and thus easy to be missed. over the handle of an inverted cane and amplitude which could be used for looking having visual cues on the floor to overcome With development of wearable devices at response to treatment. The idea was for example stripes or a laser pointer. or smart watches there is an interest to very successful and the team won many see if they can pick up the tremor and awards internationally and many accolades. If the gait is overall better in the ON state, other features of PD. We looked at use of However, the project was eventually given then increasing the dopaminergic medication applications or apps in a smartphone such up as keeping up with updates on the generally helps. Rhythmic visual and auditory as iPhone to see if those are good enough hardware was an unnecessary burden and cues including singing have shown to improve to pick off tremor at bedside. For this very reliable hardware is already available the gait. Physical therapy is very helpful project we studied Orthostatic tremor as on the market such as Apple watch. in improving the overall gait performance that tremor is particularly hard to diagnose and reducing falls. Repeated reminders to The next plan is to develop a customized and is extremely dependent on an accurate the patient to ‘keep their head up’, ‘take software or application for an Apple Watch analysis requiring surface electromyography bigger steps’ and ‘swing their arms’ help. that could potentially use built-in sensors or muscle recording. In this project we to pick up the tremor reliably and can evaluated 24 confirmed orthostatic tremor Unfortunately, PD is a progressive disease differentiate between a Parkinson’s tremor patients and 15 age matched controls, and the gait problems worsen over time. It an essential tremor thus making it a useful using two different smartphone application is imperative to realize when the patient tool to be used at bedside by an untrained called Lift pulse (by Lift Labs now owned is no longer safe to walk on their own. As physician such as primary care physician by Google) and iSeismometer (by object time goes on, the patients might need to or nurse practitioners to make or increase graph LLC) both of them available for free use a cane and then a walker. Falls can the reliability of a diagnosis of Parkinson’s from iTunes app at that time. (Off note have devastating consequences including disease and decreasing misdiagnosis. the Lift Pulse was made by liftlabs which fractured hips and subdural hematomas. We also make the tremor spoon to reduce should make every effort to prevent them, the effect of tremor on eating with tremor even if it means having to use a wheelchair. cancellation due to a specially designed Reference: motor and a sensor and also off note Fahn S, Jankovic J, Hallett M. Principles and that both of these applications are not Practice of Movement Disorders E-Book: Expert available on the iTunes store anymore and Consult. Elsevier Health Sciences; 2011 Aug 9.

Spring 2019 | 7 Neurological Sciences 988440 Nebraska Medical Center Omaha, NE 68198-8440

unmc.edu

Reliable Parkinson Resources

NOTE: This list is not complete, nor is it endorsed by UNMC or Nebraska Medicine

American Parkinson Disease Parkinson’s Action Network Association www.parkinsonaction.org www.apda.org Parkinson’s Foundation Davis Phinney Foundation www.parkinson.org for Parkinson’s Parkinson’s Foundation www.davisphinneyfoundation.org Heartland Chapter International Parkinson and Movement www.parkinson.org/heartland Disorders Society (WE MOVE) Parkinson’s Nebraska www.movementdisorders.org To download a copy of ALL www.parkinsonsnebraska.org Parkinson’s Post newsletters, Michael J. Fox Foundation Parkinson’s Resource Organization for Parkinson’s Research please visit: www.parkinsonsresource.org www.michaeljfox.org The Parkinson Alliance www.unmc.edu/ Movement Disorder Society www.parkinsonalliance.org neurologicalsciences/ www.movementdisorders.org The Parkinson’s Disease Foundation news/newsletters National Institute of Neurological www.pdf.org Disorders and Stroke www.ninds.nih.gov The Parkinson’s Resource Organization www.parkinsonsresource.org

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