Regular readers of this newsletter will know that I have a consultancy with regional group of the Parkinson's Disease Sufferers Society. We meet together once a month. The group is mixed about 50/50 sufferers and careers/partners. I think it is fair to say that we are all over 50 in years! Of the sufferers some are in the early stages of the onset and others far more progressed and control the disease with a drug regime that has its own 'symptomatic' side effects.

"There is no known cure for Parkinson's disease. The goal of treatment is to control symptoms. Medications control symptoms primarily by increasing the levels of dopamine in the brain. The type of medication, the dose, the amount of time between doses, or the combination of medications used may need to be adjusted as symptoms change. Many medications can cause severe side effects, so monitoring and follow-up by the health care provider is important." "http://www.nlm.nih.gov/medlineplus/ency/article/000755.htm

In consideration of all of this - and with the evidence of my own eyes at our first session together it became obvious that strict Form practice - as a group - was not a realistic possibility. And whilst on the subject of realism I should say right now that I did not expect to be curing any disease's! No, all that I was doing was just putting together a sequence of some simple posture, movement, limb coordination and breath exercise that I hoped might be just a small step in the right direction! I did some homework and research and concluded that if Tai Chi could passably help - it would only do so if I were sympathetic to - or at least at first tried to understand the following:

1. Communication: The condition can (due to lack of muscle control in the face - see "Muscle Cramps" below) create a misleading impression, leading incorrectly to being perceived of as being difficult, deaf, disinterested, drunk or unintelligent. As a consequence many people with Parkinson's feel very isolated.

2. Speech: Can be slurred. Monotonous with lack of variation and expression. Hoarse and tremulous. Disordered in rate or rhythm. Responses may be very slow. Leads to similar misunderstanding as those detailed above.

3. Freezing: About 30% of people suffering from Parkinson's will at some times experience "Freezing" - which can also lead to an increased risk of falling.

4. Muscle Cramps:
A. Dystonia: Movement disorder. Involuntary contraction of the muscles, causing spasm. Muscles become hard due to contraction without relaxing (not the same as "cramp").

B. Akinesia: Reduction in or absence of movement, muscular rigidity, "cramp". Muscles become hard and less elastic. In Parkinson's, most common in the feet. Spasm in the calf muscles can cause the toes to curl into a claw like position. In other cases the big toe hyper-extends - pointing upwards.

5. Smaller Muscles:
'A. 'Blepharospasm': Intermittent or sustained eyelid closure, caused by the contraction of the eyelid muscle. Aggravated by stress, looking up or down, reading, driving or bright lights (photophobia: abnormal intolerance to light).

B. Sialorrhoea: Drooling a.k.a. dribbling. Saliva pooling and trickling from the mouth. Not because more saliva is produced but because the tendency to swallow every now and again (even when not eating) is slowed down (See "4B. Akinesia" above).

Aggregated by poor (stooped) posture and inadequate lip seal. Everyone has difficulty in swallowing if they cannot close their lips tightly. You try! Try to swallow with your mouth open.

In some cases, simply improving the posture can alleviate Sialorrhoea.

An apparently small and insignificant thing like swallowing and consequential eating problems can have a tremendous negative impact upon a person's quality of life at home, and in terms of their social life.
Those with the problem can become anxious about swallowing anything for the fear of choking. Many eat less than normal and loose weight. They do not enjoy eating and feel embarrassed, or experience panic or anxiety attacks at mealtimes. All of this has a demoralising effect; because eating and drinking are essential parts of life and the social aspect is as important as the practical, biological function.

Therefore, in regard this "apparently small and insignificant swallowing and eating problem" my first prescription was a series of "Head Nodding" exercises.

Pages with illustrations detailing these exercises now online as " Head Nodding " [http://www.wheelswithinwheels.net/headtotoe/headtotoe_1neck_e123.htm] These exercises formed the basis of our first two sessions together.