Boxing and Parkinson’s Disease

I recently saw a news show on television that highlighted the benefits of boxing, for persons with Parkinson’s disease. While everyone interviewed identified positive results, all the way from; moving better, to being motivated and at times being pushed to participate.  Those who strongly recommended boxing never really hit the nail on the head, and told us why this sport would work so well.

Boxing and Crossing the Mid-line

Picture an imaginary line from your head to your feet cutting your body in half. Every time you do something with your right hand and arm, swinging to your left and therefore crossing your mid-line you also increase the right-left connection in your brain. Watching the show and seeing the participants either hitting a punching bag, or in a ring hitting an instructor, you can easily see the therapy involved. When they punched with their right hand they frequently crossed over their body and hit the opponent on the right side of his body.

The brains two sides coordinate with their opposite side of the body. All of the connections happen in the middle of the brain called the limbic system. Exercises that cross the mid-line, reinforce and support  the connections in the limbic system. The limbic system is also the site of emotional intelligence, explaining why people feel happy after exercise.

Creating exercises that cross the mid-line

A simple balance exercise turned into a brain exercise can include swinging arms across the body. Kicking a leg across the mid-line while holding on to a chair is a simple brain movement. Bouncing a ball in front of you, with your right hand and then switching to your left hand, crosses the mid-line. Starting with a larger bouncing ball and then scaling down to a smaller and smaller ball also improves balance.

Great games with small children such as a bean bag toss when done crossing the mid-line, is a fun way to exercise the brain. Older children enjoy playing catch, and can start by just bouncing a large ball back and forth. Till they then can catch a ball in midair and switch up to a smaller ball.

Take that even further by hitting a tennis ball, volley ball, anything that provides that movement of crossing the body. Especially so for the confused elder who enjoys just throwing a beach ball around the family circle, or maybe a wild game of balloon toss. The easiest mid-line exercise for just about everyone, is to cross your arms and give yourself a big hug. The limbic system, is why that feels so good!

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


(Part V)

It is never too late for a Therapy base line assessment. If it wasn’t done at the start of symptoms, it can be done now. As with every other discipline in the Nursing Home, the key here is a “change in condition.” If you have not written down what the current level of; walking, transferring from a wheelchair to bed/car, independent dressing, etc. you will not clearly know when there is a change. Do what we do in the Nursing Home, write everything down.

What Physical Therapy does for the elder with Parkinson’s disease in the Nursing Home?

  • Works with problems with walking and balance
  • Provides strengthening exercises especially for lower extremities
  • Improves elder’s range of motion in joints
  • Reviews any history of falls – works to reduce risk of falls
  • Improves standing balance
  • Teaches use of assistive devices

What Occupational Therapy does for the elder with Parkinson’s disease in the Nursing Home?

  • Teaches the elder how to conserve energy and simpler ways to do things
  • Teaches safe transfers from wheelchair to bed, to car, to dining chair, etc.
  • Assists in bathing, dressing, grooming – all normal activities of daily life.
  • Teaches use of assistive devices

Why Massage Therapy for elderly with Parkinson’s disease?

The gentle pressure of massage with hands-on manipulation reduces muscle spasms, decreases muscle rigidity, improves circulation and promotes comfort. Massage therapy brings sensory stimulation to those who may otherwise feel extremely disconnected. It relieves the loneliness of the disease, nurtures and provides one-on-one attention and can provoke pleasant memories. Massage fulfills that basic need for human touch.

How can a warm water pool exercise program help an elder with Parkinson’s disease?

While it is difficult to find a Parkinson’s Aquatic program, Arthritis pool programs are relatively common. Arthritis pools are warm water pools which aid in reducing muscle rigidity. Elders with Parkinson’s are buoyed by the force of the water and are able to engage in activities at an increased level. Elders with Parkinson’s disease have told me they enjoy increased energy, better balance and more independence since enrolling in a pool program.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance



(Part IV)

What would Speech Therapy in the Nursing Home do?

The speech therapist would focus on a complete assessment with the goals of:

  • Improving voice volume
  • Reducing hoarseness of speech
  • Improve speech articulation
  • Work on improving pitch patterns and thereby reduce the monotonous tone
  • Reduce drooling and improve the control of saliva
  • Assess, identify and treat swallow problems
  • Work with cognitive changes and deficits

When the elder with Parkinson’s disease is working with a speech therapist on better communication. The therapist will:

  • Give the elder plenty of time to respond (counting to 10 in your head is a good amount of time to wait) because the elder with Parkinson’s disease has a slower response time, and may even have slower thought processes.
  • Don’t ask questions that require a lengthy response, keep the communication to short responses
  • Be very careful of your tone of voice that you are not expressing impatience
  • Make sure you are on eye level with the elder
  • Don’t sit in a circle staring at Grandma while you are waiting for her to respond. I am an advocate of “doing something” when you are visiting. If you are sitting together doing a puzzle or looking at pictures, conversation can come much more comfortably than when facing someone and asking one question after another. The long pause between responses can seem so much more natural while you are doing something together.

Think about joining a “Laughter Club” or create your own opportunities for laughter:

Among the most notable characteristics of Parkinson’s disease is the mask like facial expression and loss of voice strength. A “Laughter Club,” engages in facial exercises by laughing combined with breathing exercises. A laughter club provides the exercise for the face and lungs through laughing that is difficult to otherwise receive. Laughter is also a great workout for the cardio and elimination systems.

The idea of laughter clubs was the brain child of Dr. Madan Katarie, physician and author in India. Dr. Katarie knew the benefits of laughter to affect the physical, mental, social and spiritual well-being of the sick. Laughter is said to reduce the effects of stress, support the immune system and creates a positive outlook on life.

Rent a funny movie and just sit back together and laugh!

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance



(Part III)

When you take care of the elderly in a Nursing Home, every department is involved in that person’s care. For the elder with Parkinson’s disease, a therapeutic approach addresses both symptomatic as well as restorative interventions. When care is divided into specific areas in the home, this also helps the caregiver be able to put together a plan.

The Admission Process:

Start with a comprehensive written history of the elder’s experience with Parkinson’s disease. When did anyone notice stiffness, tremors, memory loss, change in the way they walked, talked, swallowed, all the changes identified with this disease. Having this documentation creates a very unique and complete history of the progress of this disease for any future use.

What would the Nursing Department Do?

  • Timely administration of medication. (See part I of this series)
  • Have a written statement of the elder’s current ability to function in areas of walking, dressing, washing/bathing, eating, grooming and how much assistance they now need to transfer from a chair or bed.
  • Start keeping a record of how often the elder falls (also all of the circumstances of the fall-see Part II of the series on safety)
  • Watch for changes in the elder’s abilities as described above and report any changes to the doctor.
  • Coordinate the taking of medication with participation in any therapies to enable the elder to participate to their fullest.
  • Monitor elder for any signs of constipation and provide immediate intervention.

What would the Dietary Department Do?

  • Focusing the diet on providing sufficient fiber and fluids to prevent constipation.
  • Creating a history of the elder’s normal weight and then documenting changes in weight.

What would the Social Service Department Do?

  • Obtain professional support when needed due to the impact of the Parkinson’s diagnosis as well as issues associated with a chronic condition.
  • Participate in a local Parkinson’s support group for elder as well as family

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance



(Part II)

Studies of persons with Parkinson’s disease show that falls are more likely inside the home than outside.  The most likely places for the elder with Parkinson’s disease to fall are in an area where they may have to turn around, go through a doorway, back up or use stairs. The nursing home conducts on-going “Safety Rounds” to make sure the areas are safe. The home caregiver can avoid accidents also by doing their own safety rounds.

Ways to make the home safer for the elder with Parkinson’s disease:

  • To help the elder not get “stuck” going through doorways – place tape across the threshold to encourage stepping over
  • Have all thresholds made flat between rooms
  • Make sure all chairs are very sturdy,(no light-weight chairs that may move)  with armrests to assist in standing up and sitting down
  • Attach non-skid caps to chairs where appropriate
  • Watch for furniture that may trip the elder with Parkinson’s disease such as old fashioned rockers (replace with glider rockers that can be made secure when sitting and rising) and chairs that have straight legs, instead of a chair with a flared base and legs that the elder could trip over
  • Solid furniture can provide a great support for the elderly as they walk through their home – position sturdy chairs so that the elder can use the backs for support
  • Keep the placement of furniture consistent – after you have placed items in the best location for safety
  • Keep all walk ways free of any clutter – if you have a long hallway consider installing a rail on the wall
  • Remove – scatter rugs, any swinging doors, glass table tops, heating pads and electric blankets
  • Install motion sensor lights in all bedrooms, hallways and every bathroom
  • Walk through the area and make sure there are no cords in walkways
  • Make sure the bathrooms have grab bars, sturdy shower chairs, raised toilet seats and handheld shower heads

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance




Parkinson’s medications

Medications for Parkinson’s disease need to be given on time. In the nursing profession, State guidelines give the nurse a leeway, of one hour before – to – one hour after the time of a scheduled medication, for it to be given. So a medication that is ordered for 9am may be given as early as 8am or as late as 10am and still be considered “on time.” But not so with a medication for neurological functions, such as a Parkinson’s medication. In order for that person to function at their highest level they need to have a continuous delivery of the medication.  Blood levels rise and fall after every dose of the medication. The goal is to have the most constant level in the blood of the medication.

When the elderly person with Parkinson’s disease depends so immensely on their medication in order to move and function. That “need” may create anxiety in the elder, if they don’t feel they can depend on always getting that medication on time. Giving the person constant reassurance through verbalizing your understanding of this importance will be helpful. Saying, “It is 5 o’clock, here is your 5 o’clock medication for your Parkinson’s disease,” will help reinforce that the elder is getting their medication on time.

For the elder with Parkinson’s disease, after taking medication for many years, while their disease progresses, the medication will not be as effective. To have a clear report on symptoms for the physician, you do not want to have any issues or statements about medication timing side track the discussion. Such as, “I know I would be much better if she just gave me my pills on time.” Giving the elder that clarity during every dose of medication, helps keep the focus on the change or deterioration of condition, instead of it being someone’s fault.

This small effort can provide the elder the comfort of being able to count on having this important medication, in a timely way. It would be difficult to calculate how much anxiety can impact a person’s function. But for the person with a neurological disorder it certainly becomes important to give that extra bit of reassurance, that indeed the caregiver is doing everything right.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance