Choir provides music therapy for Alzheimer’s patients

27 August 2010 Last updated at 19:07 Help

Singers in Norfolk are feeling the benefits of a choir with a difference, one that is brought to life by members of the public affected by dementia.

The Alzheimer’s Society, which backs the scheme, says that music therapy is having fantastic results on those taking part.

This report by Clive Lewis features Heather Edwards from the Alzheimer’s Society and Maureen Guest, who is affected by Alzheimer’s.

By MEREDITH JEAN MORTON
News Chief correspondent

Published: Sunday, August 22, 2010 at 4:01 a.m.
Last Modified: Sunday, August 22, 2010 at 2:20 a.m.

( page of 5 )

Many people have seen martial arts performed in movies and on television, most likely as a means of defense against opposing forces in battle scenes. However, in Winter Haven, a form of martial arts – tai chi – is being used as a means of defense against an internal opponent – Parkinson’s disease.

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Parkinsons patients Bob Harmon, left, and Laura Williams perform Tai Chi with instructor Michael Carey and assistant Kate Gilbert at the Main Street Dojo’s, Inc. on Central Avenue in Winter Haven. Tuesday, August 17, 2010.

George Aycrigg / News Chief

Click to enlarge

Bob Harmon, left, follows the precise movements of instructor Michael Carey during Tai Chi. Tuesday, August 17, 2010.

George Aycrigg / News Chief

Funded as part of a grant by the University of South Florida neurology department, Dr. Michael Carey has been offering free tai chi classes in Lakeland to Parkinson’s disease patients for two years. This summer, he started offering the classes in Winter Haven.

Parkinson’s disease patient Laura Williams began taking the classes in Lakeland and switched to the Winter Haven classes when they became available.

“I knew what tai chi was, but I didn’t know how it could help people with Parkinson’s disease,” said Williams of her decision to start the class two years ago. “I heard about the class through my doctor, and I decided to go. It has helped so much with my balance, because my balance wasn’t that good because of Parkinson’s. The class has been good for that.”

Williams said that because of tai chi’s slow, deliberate movements, the exercise is one she can practice at home to supplement the once-a-week class.

Hoehn and Yahr Staging of Parkinson’s Disease, Unified Parkinson Disease Rating Scale (UPDRS), and Schwab and England Activities of Daily Living

Disclaimer: The information and reference materials contained herein are intended solely to provide background information. They were written for an audience of physicians. They are in no way intended to constitute medical advise. For medical advise a physician must, of course, be consulted.

Address for Correspondence:
Emad N. Eskandar, M.D.
Massachusetts General Hospital
15 Parkman St. ACC # 331
Boston, MA 02114

E-mail: eeskandar@partners.org
Patient Appointments: 617.724.6590
FAX: 617.724.0339

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Hoehn and Yahr Staging of Parkinson’s Disease

1. Stage One
   1. Signs and symptoms on one side only
   2. Symptoms mild
   3. Symptoms inconvenient but not disabling
   4. Usually presents with tremor of one limb
   5. Friends have noticed changes in posture, locomotion and facial expression
2. Stage Two
   1. Symptoms are bilateral
   2. Minimal disability
   3. Posture and gait affected
3. Stage Three
   1. Significant slowing of body movements
   2. Early impairment of equilibrium on walking or standing
   3. Generalized dysfunction that is moderately severe
4. Stage Four
   1. Severe symptoms
   2. Can still walk to a limited extent
   3. Rigidity and bradykinesia
   4. No longer able to live alone
   5. Tremor may be less than earlier stages
5. Stage Five
   1. Cachectic stage
   2. Invalidism complete
   3. Cannot stand or walk
   4. Requires constant nursing care

This rating system has been largely supplanted by the Unified Parkinson’s Disease Rating Scale, which is much more complicated.

Unified Parkinson Disease Rating Scale (UPDRS)

The UPDRS is a rating tool to follow the longitudinal course of Parkinson’s Disease. It is made up of the 1) Mentation, Behavior, and Mood, 2) ADL and 3) Motor sections. These are evaluated by interview. Some sections require multiple grades assigned to each extremity. A total of 199 points are possible. 199 represents the worst (total) disability), 0–no disability.

1. Mentation, Behavior, Mood
   • Intellectual Impairment

     0-none

     1-mild (consistent forgetfulness with partial recollection of events with no other difficulties)

     2-moderate memory loss with disorientation and moderate difficulty handling complex problems

     3-severe memory loss with disorientation to time and often place, severe impairment with problems

     4-severe memory loss with orientation only to person, unable to make judgments or solve problems

   • Thought Disorder

     0-none

     1-vivid dreaming

     2-”benign” hallucination with insight retained

     3-occasional to frequent hallucination or delusions without insight, could interfere with daily activities

     4-persistent hallucination, delusions, or florid psychosis.

   • Depression

     0-not present

     1-periods of sadness or guilt greater than normal, never sustained for more than a few days or a week

     2-sustained depression for >1 week

     3-vegetative symptoms (insomnia, anorexia, abulia, weight loss)

     4-vegetative symptoms with suicidality

   • Motivation/Initiative

     0-normal

     1-less of assertive, more passive

     2-loss of initiative or disinterest in elective activities

     3-loss of initiative or disinterest in day to say (routine) activities

     4-withdrawn, complete loss of motivation

2. Activities of Daily Living
   • Speech

     0-normal

     1-mildly affected, no difficulty being understood

     2-moderately affected, may be asked to repeat

     3-severely affected, frequently asked to repeat

     4-unintelligible most of time

   • Salivation

     0-normal

     1-slight but noticeable increase, may have nighttime drooling

     2-moderately excessive saliva, hay minimal drooling

     3-marked drooling

   • Swallowing

     0-normal

     1-rare choking

     2-occasional choking

     3-requires soft food

     4-requires NG tube or G-tube

   • Handwriting

     0-normal

     1-slightly small or slow

     2-all words small but legible

     3-severely affected, not all words legible

     4-majority illegible

   • Cutting Food/Handing Utensils

     0-normal

     1-somewhat slow and clumsy but no help needed

     2-can cut most foods, some help needed

     3-food must be cut, but can feed self

     4-needs to be fed

   • Dressing

     0-normal

     1-somewhat slow, no help needed

     2-occasional help with buttons or arms in sleeves

     3-considerable help required but can do something alone

     4-helpless

   • Hygiene

     0-normal

     1-somewhat slow but no help needed

     2-needs help with shower or bath or very slow in hygienic care

     3-requires assistance for washing, brushing teeth, going to bathroom

     4-helpless

   • Turning in Bed/ Adjusting Bed Clothes

     0-normal

     1-somewhat slow no help needed

     2-can turn alone or adjust sheets but with great difficulty

     3-san initiate but not turn or adjust alone

     4-helpless

   • Falling-Unrelated to Freezing

     0-none

     1-rare falls

     2-occasional, less than one per day

     3-average of once per day

     4->1 per day

   • Freezing When Walking

     0-normal

     1-rare, may have start hesitation

     2-occasional falls from freezing,

     3-frequent freezing, occasional falls

     4-frequent falls from freezin

   • Walking

     0-normal

     1-mild difficulty, day drag legs or decrease arm swing

     2-moderate difficultly requires no assist

     3-severe disturbance requires assistance

     4-cannot walk at all even with assist

   • Tremor

     0-absent

     1-slight and infrequent, not bothersome to patient

     2-moderate, bothersome to patient

     3-severe, interfere with many activities

     4-marked, interferes with many activities

   • Sensory Complaints Related to Parkinsonism

     0-none

     1-occasionally has numbness, tingling, and mild aching

     2-frequent, but not distressing

     3-frequent painful sensation

     4-excruciating pain

3. Motor Exam
   • Speech

     0-normal

     1-slight loss of expression, diction,volume

     2-monotone, slurred but understandable, mod. impaired

     3-marked impairment, difficult to understand

     4-unintelligible

   • Facial Expression

     0-Normal

     1-slight hypomymia, could be poker face

     2-slight but definite abnormal diminution in expression

     3-mod. hypomimia, lips parted some of time

     4-masked or fixed face, lips parted 1/4 of inch or more with complete loss of expression

   • Tremor at Rest
     • Face

       0-absent

       1-slight and infrequent

       2-mild and present most of time

       3-moderate and present most of time

       4-marked and present most of time

     • Right Upper Extremity (RUE)

       0-absent

       1-slight and infrequent

       2-mild and present most of time

       3-moderate and present most of time

       4-marked and present most of time

     • LUE

       0-absent

       1-slight and infrequent

       2-mild and present most of time

       3-moderate and present most of time

       4-marked and present most of time

     • RLE

       0-absent

       1-slight and infrequent

       2-mild and present most of time

       3-moderate and present most of time

       4-marked and present most of time

     • LLE

       0-absent

       1-slight and infrequent

       2-mild and present most of time

       3-moderate and present most of time

       4-marked and present most of time

   • Action or Postural Tremor
     • RUE

       0-absent

       1-slight, present with action

       2-moderate, present with action

       3-moderate present with action and posture holding

       4-marked, interferes with feeding

     • LUE

       0-absent

       1-slight, present with action

       2-moderate, present with action

       3-moderate present with action and posture holding

       4-marked, interferes with feeding

   • Rigidity
     • Neck

       0-absent

       1-slight or only with activation

       2-mild/moderate

       3-marked, full range of motion

       4-severe

     • RUE

       0-absent

       1-slight or only with activation

       2-mild/moderate

       3-marked, full range of motion

       4-severe

     • LUE

       0-absent

       1-slight or only with activation

       2-mild/moderate

       3-marked, full range of motion

       4-severe

     • RLE

       0-absent

       1-slight or only with activation

       2-mild/moderate

       3-marked, full range of motion

       4-severe

     • LLE

       0-absent

       1-slight or only with activation

       2-mild/moderate

       3-marked, full range of motion

       4-severe

   • Finger taps
     • Right

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

     • Left

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

   • Hand Movements (open and close hands in rapid succession)
     • Right

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

     • Left

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

   • Rapid Alternating Movements (pronate and supinate hands)
     • Right

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

     • Left

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

   • Leg Agility (tap heel on ground, amp should be 3 inches)
     • Right

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

     • Left

       0-normal

       1-mild slowing, and/or reduction in amp.

       2-moderate impaired. Definite and early fatiguing, may have occasional arrests

       3-severely impaired. Frequent hesitations and arrests.

       4-can barely perform

   • Arising From Chair (pt. arises with arms folded across chest)

     0-normal

     1-slow, may need more than one attempt

     2-pushes self up from arms or seat

     3-tends to fall back, may need multiple tries but can arise without assistance

     4-unable to arise without help

   • Posture

     0-normal erect

     1-slightly stooped, could be normal for older person

     2-definitely abnormal, mod. stooped, may lean to one side

     3-severely stooped with kyphosis

     4-marked flexion with extreme abnormality of posture

   • Gait

     0-normal

     1-walks slowly, may shuffle with short steps, no festination or propulsion

     2-walks with difficulty, little or no assistance, some festination, short steps or propulsion

     3-severe disturbance, frequent assistance

     4-cannot walk

   • Postural Stability (retropulsion test)

     0-normal

     1-recovers unaided

     2-would fall if not caught

     3-falls spontaneously

     4-unable to stand

   • Body Bradykinesia/ Hypokinesia

     0-none

     1-minimal slowness, could be normal, deliberate character

     2-mild slowness and poverty of movement, definitely abnormal, or dec. amp. of movement

     3-moderate slowness, poverty, or small amplitude

     4-marked slowness, poverty, or amplitude

Schwab and England Activities of Daily Living

Gillingham FJ, Donaldson MC, eds., Third Symp. of Parkinson’s Disease, Edinburgh, Scotland, E&S Livingstone, 1969, pp.152-7.

Rating can be assigned by rater or by patient.

• 100%-Completely independent. Able to do all chores w/o slowness, difficulty, or impairment.
• 90%-Completely independent. Able to do all chores with some slowness, difficulty, or impairment. May take twice as long.
• 80%-Independent in most chores. Takes twice as long. Conscious of difficulty and slowing
• 70%-Not completely independent. More difficulty with chores. 3 to 4X along on chores for some. May take large part of day for chores.
• 60%-Some dependency. Can do most chores, but very slowly and with much effort. Errors, some impossible
• 50%-More dependant. Help with 1/2 of chores. Difficulty with everything
• 40%-Very dependant. Can assist with all chores but few alone
• 30%-With effort, now and then does a few chores alone of begins alone. Much help needed
• 20%-Nothing alone. Can do some slight help with some chores. Severe invalid
• 10%-Totally dependant, helpless
• 0%-Vegetative functions such as swallowing, bladder and bowel function are not functioning. Bedridden.

Unified Parkinson’s Disease Rating Scale

From Wikipedia, the free encyclopedia

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The Unified Parkinson’s Disease Rating Scale (Unified Parkinson’s Disease Rating Scale) is a rating scale used to follow the longitudinal course of Parkinson’s disease.

It is made up of the following sections^[1]:

1. Part I evaluation of Mentation, behavior, and mood;
2. Part IIself evaluation of the activities of daily life (ADLs) including speech, swallowing, handwriting, dressing, hygiene, falling, salivating, turning in bed, walking, cutting food;
3. Part III clinician-scored motor evaluation;
4. Part IV Hoehn and Yahr stating of severity of Parkinson disease.
5. Part V Schwab and England ADL scale.

These are evaluated by interview and clinical observation. Some sections require multiple grades assigned to each extremity.

Clinicians and researchers alike use the UPDRS and the motor section in particular to follow the progression of a person’s Parkinson’s disease. Scientific researchers use it to measure benefits from a given therapy in a more unified and accepted rating system. Neurologists also use it in clinical practice to follow the progression of their patients’ symptoms in a more objective manner.^[2]

Following the UPDRS scores over time provides insight into the patient’s disease progression. For instance Michael J. Fox‘s symptoms started with a slight tremor so his motor score would have been less than 10. For most patients, the “mentation, behavior and mood” scores increase later in the disease, but there is a subset for whom those symptoms develop early on. ^[3]

[edit] Similar rating scales

Other rating scales for Parkinson’s disease are Hoehn and Yahr scale and Schwab and England Activities of Daily Living Scale.

[edit] External links

• Unified Parkinson’s Disease Rating Scale on National Parkinson Foundation site
• Unified Parkinson’s Disease Rating Scale on Movement Disorders Virtual University site

[edit] References

1. ^ Comprehesive pharmacy review, Leon Shargel, 6th edition, p998
2. ^ http://www.pdf.org/en/pins_res_center/question/8421
3. ^ Understanding Parkinson’s disease By Richard B. Rosenbaum 2006

Scale Measures Parkinson’s Disease

by Parky Bill on July 21, 2010

It’s called the Scale for Outcomes of Parkinson’s disease — or SCOPA for short.  It’s a great way to get a fairly accurate assessment of where one sits in the progression of a progressive disease.

In fact there’s a whole boatload of SCOPA tests that measure the various symptoms in the constellation of Parkinson’s disease… SCOPA-AUT for autonomic symptoms (excessive sweating, swallowing difficulties, etc.), SCOPA-PC for psychiatric complications, SCOPA-PS for psychosocial consequences of Parkinson’s disease, SCOPA-SLEEP for sleep problems related to PD, and SPES-SCOPA which mirrors the Unified Parkinson’s Disease Rating Scale (UPDRS).

So, let’s go through each of these and see where I am on this late July morning in 2010.

SCOPA-COG

Gail helped me with the SCOPA-COG test last night.  It measures cognitive areas such as memory, attention, executive function and visuospatial skills.  I scored 27 out of 43 possible points (62.8 percent).  I aced the attention and visuospatial questions, missed only 2 pts. in the executive function area, and truly “screwed the pooch” in memory.  So my total SCOPA-COG score is slightly below the average of all PD patients who took the test in the initial study (me=62.8%, them=65%, control group=74.6%), but my memory score was well below average for the same group of PD patients (me=36.4%, them=42%, control group =52%).

So, SCOPA-COG shows I’m doing fairly well in three of the four areas they measure, and poopy in the area of memory.

SCOPA-AUT

This is a questionnaire with 23 questions where each question has a value of 0 to 3 points (0=never, 3=often).  It’s broken into six areas of autonomic function — gastrointestinal, urinary, cardiovascular, thermoregulation, pupilomotor dysfunction, and sexual dysfunction.

My total score was 31, which places me in the “severe” group.

Gastrointestinal – 8 – severe

Urinary dysfunction – 11 — severe

Cardiovascular dysfunction — 0 — PRISTINE!!! 

Thermoregulatory dysfunction — 4 — severe

Pupillomotor dysfunction — 1 — severe (my eyes take forever to adjust to bright light)

Sexual dysfunction — 6 — severe

Bottom line — My PD has progressed to the point where I have severe autonomic difficulties.  Big news.

SCOPA-PC

This one measures any psychiatric problems a Parky may be having.  Seven questions are scored 0 to 3.  The total score range is from 0 to 21.

The average of all Parkies who took part in the initial study was 3.2.  I scored a “6″.

SCOPA-PS

In this questionnaire, they inquire about problems which we Parkies may encounter as a result of our illness in the areas of (social) activities, contact with other people, and on an emotional level.  It’s 11 questions that score from 0 (not at all) to 3 (very much).

I scored a total 17.  You get the final score by getting a percentage — 17 pts/33 possible.  I came up with 51.5%.  That places me in Hoehn & Yahr Class IV.

SCOPA-SLEEP

By means of this questionnaire, they assess what extent in the past month we Parkies have had problems with sleeping.

Thanks to modern chemicals, I’m not having any trouble in this area at all, scoring only 15.2 percent out of the possible 33 points.

Finally…

SPES-SCOPA

This is the one that mirrors the UPDRS.

The good thing is, my deep brain stimulation keeps my Motor Impairment scores relatively low — 13 pts., which puts me at Hoehn & Yahr III.

My Activities of Daily Living Score is 10, which also puts me in H&Y III.

And there you have it!

To sum up…

The SCOPA-COG says my cognition is pretty well preserved, except for immediate recall memory, which is in the “severe” category.

SCOPA-AUT says I’m having some pretty severe autonomic difficulties, except in the area of cardiovascular function.

SCOPA-PC says I’m a bit nuttier than the average Parky, but nowhere near the high end.

SCOPA-PS says I have some pretty severe psychosocial complications of the disease.

SCOPA-SLEEP says, thanks to my nite-nite pills, I’m a pretty good sleeper.

SPES-SCOPA says my DBS is doing a fairly decent job controlling my motor symptom and activities of daily living, but my disease continues to progress.  As it will.

Samsung’s new blood-testing device, IVD-A10A

The Korean electronics giant is looking to invest 12 trillion won ($9.85 billion) in the healthcare business by 2020 with the goal of achieving 10 trillion won in annual sales that year.

The new device, which checks levels of glucose, cholesterol and 17 other substances in the blood, is smaller and cheaper than conventional blood-testing equipment, and targets small- and medium-sized hospitals.

The company claims it takes only 12 minutes to conduct a blood test with the device, whereas it usually takes two to three days with traditional equipment.

Samsung will partner with Choongwae Pharma Corp., a Korean pharmaceutical manufacturer, to exclusively sell the device to hospitals nationwide.

Samsung has developed the medical equipment with a 30 billion won investment with Samsung Advanced Institute of Technology for the past four years.

Samsung Group, the parent group of Samsung Electronics sees medical equipment as one of the five new growth drivers, along with solar cells, rechargeable cells for hybrid electric vehicles, light emitting diode technologies and biopharmaceuticals.

In May, Samsung Group announced a plan to spend 23.3 trillion won on its five new businesses by 2020. Samsung Electronics seeks to reduce its reliance on TVs, handsets, memory chips and displays and develop “health, environment and life care,” along with “infotainment” as new growth drivers.

 

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