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The significance of these positive results has the potential to heavily impact society\u2019s perceptions on Parkinson\u2019s Disease and the looming sense of inevitable decline that surrounds it.<\/p>\nCurrent clinical literature is painfully lacking information regarding the efficacy of either physical rehabilitation or dietary intervention in the pathology of Parkinson\u2019s Disease.\u00a0 The information in this article will pertain to the successes of a client under my supervision who has been following my training program for one year.<\/p>\n
The significance of these positive results has the potential to heavily impact society\u2019s perceptions on Parkinson\u2019s Disease and the looming sense of inevitable decline that surrounds it.<\/p>\n
Perhaps the most vital variable to keep in mind is that my client, Mary Lou, not only has diagnosed Parkinson\u2019s Disease but was also clinically frail as defined by Fried\u2019s Frailty Phenotype.[1]<\/sup><\/a>\u00a0 According to the Gross Motor Functioning Classification System (GMFCS),[2]<\/sup><\/a> Mary Lou was also classified as a Level II individual, primarily since she required periodic support when walking and was unable to run, jog, jump, or perform any accelerated locomotive skill.\u00a0 She was also a Stage III Parkinson\u2019s sufferer based on criteria outlined in Hoehn and Yahr\u2019s Staging of Parkinson\u2019s Disease.[3]<\/sup><\/a>\u00a0 Schab and England Activities of Daily Living[4]<\/sup><\/a> scored her at a 70-80%, able to complete chores, but very slowly and with some unavoidable errors with reported issues with time required and physical fatigue.<\/p>\n It is worth noting that, in the case of Fried\u2019s Frailty Phenotype, he omitted those with PD in fear it would mislead the metrics.\u00a0 For our purposes here, this scaling has still been used because of its worth as an assessment and identification tool.<\/p>\n I used a number of general assessment tests designed to specifically determine the approximate level of functionality.\u00a0 These include:<\/p>\n Many of these tests are staples used in clinical environments.\u00a0 I included the farmer\u2019s carry variations and the bar hang as a more accurate measurement of work capacity and upper body strength (as opposed to a bar curl test which only measures elbow flexion).\u00a0 The farmer\u2019s carry also helps simulate common daily living; very often the task is not simply walking, but walking with some kind of load or over uneven terrain.<\/p>\n Mary Lou was also provided a personal nutritional consultation with me considering my sui generis<\/em> Parkinson\u2019s Polytherapeutic Protocol.\u00a0 This program provided a thorough outline of supplements, lifestyle changes, nutritional and dietary interventions, and uniquely designed physically rehabilitative training. She opted to not take any supplements with the exception of a whole-foods multivitamin.\u00a0 She also chose to follow a low-carb, high-fat, moderate-protein ketogenic diet as defined by Gasior et al.[i]<\/sup><\/a>\u00a0 Her adherence to this diet has been admittedly imperfect, but she still follows it close to 80%.\u00a0 This information was provided to me and further determined by me with access to daily food journals kept by Mary Lou.<\/p>\n All of the nutritional, nutraceutical, and physical training programs and curriculum followed according to the guidelines and clinical research provided in my Parkinson\u2019s Polytherapeutic Protocol and heavily clinically supported throughout medical literature.<\/p>\n I will list each assessment test individually, introducing the first test as she started the program, her 6-month re-test, and the final one-year assessment.\u00a0 Pertinent notes will also be shared.\u00a0 To simply see the metric data from the various tests, see Table 1 at the end of this article.<\/p>\n Mary Lou was diagnosed with Parkinson\u2019s Disease (PD) shortly after she underwent chemotherapy and surgical intervention for breast cancer.\u00a0 She has been diagnosed with PD for approximately 18 years. \u00a0\u00a0Her Parkinsonian symptoms are controlled through the standard use of levodopa, a dopamine-mimicking drug.\u00a0 She is currently undergoing various techniques to avoid the use of the drug due to the potential long-term complications suffered by its continuous use.[5]<\/sup><\/a><\/p>\n Clinically, Mary Lou was also frail according to the grading system used by Fried et al.\u00a0 This further complicated addressing Parkinson-centered rehabilitation and training since clinically frail individuals are already placed in a high-risk category.\u00a0 Prior to her cancer diagnosis and subsequent PD, Mary Lou had never engaged in any kind of physical training or athletic venture and lived an exclusively sedentary lifestyle.<\/p>\n For the sake of clarification, this test was repeated at all intervals on a chair that sat eighteen inches from the ground.\u00a0 This also serves as a worst-case-scenario approach since few sitting arrangements are at a lower height.\u00a0 This test was also conducted under a strict 30-second time limit.<\/p>\n On March 3, Mary Lou was able to stand from the seated position five times if allowed to place her palms onto her legs.\u00a0 When attempting to stand without the use of the arms, Mary Lou could not stand from the chair, even with significant torso movement.\u00a0 In the interest of having data to quantify improvements, the test was conducted instead with the client\u2019s palms on her thighs.<\/p>\n Nearly six months later, on August the 24th<\/sup>, we repeated the test with identical perimeters.\u00a0 Mary Lou was able to execute the full movement a total of twelve times in the thirty-second limit.\u00a0 This equates to an improvement of 240%.\u00a0 Of note, however, is the client\u2019s continued dependence on pressing upon the thighs with her palms.<\/p>\n On her one-year assessment, On February the 17th<\/sup>, Mary Lou repeated the same test and was still able to perform twelve repetitions.\u00a0 Although there was no discernible improvement based on pure test metrics, a drastic change involved the use of her arms.\u00a0 In the first two tests, Mary Lou required the use of her arms as stabilizers, pushing her palms onto the tops of her legs.\u00a0 For her third test, her hands remained free.\u00a0 This reported a significant, although unquantifiable, improvement.<\/p>\n Mary Lou also expressed absolute contentment with her current level of functionality in this movement with no real desire to advance any further.\u00a0 Of particular note was the seeming lack of exertion Mary Lou reported at the conclusion of the test, which leads me to question if twelve repetitions represented her maximal output.<\/p>\n Of particular concern to those suffering from Parkinson\u2019s Disease is the prevalence of gait abnormalities.<\/p>\n This test consisted of a 37-foot long room.\u00a0 The client was cued with a simple \u201cgo\u201d once the time started.\u00a0 The client walked to the end of the room.\u00a0 The time was stopped when she reached the far wall.<\/p>\n On her first assessment, Mary Lou walked the length of the room in 20.34 seconds.\u00a0 Her reassessment resulted in the same distance being traveled in 11.22 seconds, a reduction of 9.12 seconds, or an approximate 45% increase in gait speed.<\/p>\n On her one-year assessment, Mary Lou performed the same test in 10.22 seconds, a decrease of a solid second.\u00a0 Similar to her first test, Mary Lou expressed no desire to improve her gait speed and also was not even slightly fatigued.\u00a0 She finished the test clapping her hands together asking what was next.<\/p>\n On March 3rd<\/sup>, 2016, Mary Lou was unable to execute the test.<\/p>\n During her follow-up test on the 24th<\/sup> of August, Mary Lou was able to hold herself suspended for 14 seconds.\u00a0 This demonstrated an unquantifiable improvement.<\/p>\n On February 17th<\/sup> of the following year Mary Lou held herself aloft for 26.5 seconds.\u00a0 This demonstrated an 89% improvement from her previous assessment.<\/p>\n For this test, Mary Lou was asked to stand on one foot at a time with the foot staying flat.\u00a0 The other foot was kept aloft and not allowed to make contact with the ground, the standing leg, or any other object.<\/p>\n For her first test, Mary Lou was able to stand on her right leg for ten seconds.\u00a0 She was unable to perform the test with her left leg with any sureness and required a handle for stability, eliminating the validity of the test.<\/p>\n Her retest in February showed improved numbers.\u00a0 She was able to stand on her right leg for 24 seconds, demonstrating a 140% improvement.\u00a0 Mary Lou was also able to balance on her left leg for three seconds, demonstrating a 300% improvement from her previous inability to perform the test.<\/p>\n On her one-year assessment, Mary Lou was able to stand on her right leg for 48 seconds and her left leg for 8 seconds, demonstrating a 100% and 166% improvement, respectively.\u00a0 This equated to a total one-year improvement of 380% on her right leg and an 800% improvement on her left leg from her initial testing.<\/p>\n This test utilized a set amount of weight for an undetermined amount of time to assess the client\u2019s stamina under load.\u00a0 The farmer carry simulates movements performed in daily life very well; that is, moving under some form of load.\u00a0 We utilized two 15 pound dumbbells and a room that is 37 feet long.\u00a0 The client was cued when to start and instructed to simply turn and repeat the test in a back-and-forth motion until fatigue set in.<\/p>\n On the initial test, Mary Lou was able to walk with the dumbbells at her sides for 50 seconds.\u00a0 At her retest, she was able to perform the same movement and weight for 110 seconds, demonstrating a 120% improvement.\u00a0 For her final test, Mary Lou concluded her carry at the four-minute mark out of understandable boredom.\u00a0 A 240-second walk demonstrated a 118% improvement from her second test and a 380% overall improvement<\/strong>.<\/p>\n We repeated the same test as above, only instead of going for maximum time, the client performed the same weight for a limited distance to assess speed under load.\u00a0 This mimics ADL patterns very accurately.\u00a0 Loaded carries are also a strong indicator of an individual\u2019s total muscular strength, coordination, balance, and muscular balance.<\/p>\n We utilized two 15-pound dumbbells just as above, and a room that was 37 feet long.<\/p>\n In her initial test, Mary Lou was able to perform the carry in 28 seconds.<\/p>\n In her retest she was able to carry the same load for the same distance in 16 seconds, a 43% improvement.\u00a0 In the final, one-year reassessment, Mary Lou completed the same task in 11 seconds, a 31% improvement from her previous score.\u00a0 This equates to a total improvement of 61% from baseline.\u00a0 To turn a phrase, Mary Lou was able to perform the same loaded carry in less than half the time of baseline.<\/p>\n Of particular note is that Mary Lou was able to perform the same gait speed under a thirty-pound load as without.\u00a0 This reveals a potential weakness in the farmer carry as an assessment tool due to maximum measurement potential.<\/p>\n For this test we utilized the same 18\u2019\u2019 seat.\u00a0 The distance traveled was 3 meters.\u00a0 The client was cued to start, then she would rise from the seated position and move across a line drawn 3 meters from her toes.<\/p>\n On March 3 Mary Lou completed the test in 17.3 seconds.\u00a0 For her second test, Mary Lou completed the test in 11 seconds, an improvement of 6.3 seconds, or 36%.\u00a0\u00a0 Similar to the sit-to-stand test, Mary Lou completed the Timed Up-and-Go Test in the same amount of time on her final assessment, resulting in a finalized improvement of 6.3 seconds, or 36%, from baseline.\u00a0 When questioned, client again expressed absolute contentment at her current gait speed and desired no further improvement. Mary Lou also redefined both her Parkinson\u2019s and Frailty classifications.\u00a0 Due to her massive improvements, she is no longer clinically frail as defined by Fried et al.\u00a0 Her GMFCS classification also improved to a I\/II, constrained by her inability to run or jog.\u00a0 Similarly, she is a Stage III\/II Parkinson\u2019s as determined by Hoehn and Yahr Staging of Parkinson\u2019s Disease.\u00a0 At her current level of improvement, she will be firmly classified as a category II within six months.<\/p>\n Unfortunately, these testing methods still do not account for other improvements that are mentioned or witnessed in other avenues, such as the client\u2019s confidence climbing bleachers at her grandson\u2019s football game or the complimentary words of her girlfriends over coffee on Friday afternoons.\u00a0 However, even limited as it is to simple metrics and data, drastic improvements are easily noticed.<\/p>\n Working with Mary Lou has been a crowning experience and I look forward to continuing to help her cement her independence and freedom in the future.<\/p>\n\n
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About the Client<\/strong><\/h4>\nSit-To-Stand<\/strong><\/h4>\n
Gait Speed Test<\/strong><\/h4>\n
Pull-Up Bar Hang Test<\/strong><\/h4>\n
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This test was executed on a standard straight pull-up bar.\u00a0 Mary Lou was provided a step stool so that she could comfortably reach and grip the bar while still allowing her feet to support her weight.\u00a0 When cued, she lifted her feet and suspended herself in the air, holding herself aloft on the bar.<\/p>\nSingle-Leg Balance Test (Flat Feet)<\/strong><\/h4>\n
Farmer\u2019s Walk Test, Endurance<\/strong><\/h4>\n
Farmer\u2019s Walk Test, Gait Speed Under Load<\/strong><\/h4>\n
Time Up-and-Go Test<\/strong><\/h4>\n
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<\/p>\nParkinson\u2019s and Frailty Reclassification<\/strong><\/h4>\n
Summary<\/strong><\/h4>\n
Table 1: Summary of Assessment Tests\u00a0<\/strong><\/h4>\n