As easy as riding a bike

[JonStamford]

One of the most striking aspects of Parkinson's disease is the capacity for cerebral compensation. By that I mean that alternative pathways and strategies are found to ensure that function is preserved.

We already know for instance that between 80 and 90% of all striatal dopamine must be lost before symptoms of Parkinson's even present in the clinic. It's not that we can do without 80% of our dopamine. It's more a case that the brain finds alternative, more energetically economical ways of achieving the same objective.The brain has a remarkable capacity for functional compensation.

Nowhere is this more obvious than in what we call kinesia paradoxica, that remarkable ability of even the most frozen Parkinson's patients to move rapidly in an emergency. Short lived and evanescent certainly, but striking nonetheless. Does it represent an entirely different motor pathway or is it merely the last dying embers of the dopamine system? The jury is out on this one. But the phenomenon is genuine and recognised by neurologists the world over. A simple motor behaviour accessed in an emergency context.

But imagine if more complex behaviours and motor programs could also be accessed when needed. I'm not talking about the brief few seconds of kinesia paradoxica but longer, more learnt and structured motor programs involving complex coordination of movement and balance.

Take a look at this video youtube.com/watch?v=aaY3gz5...(Not working as expected?) of a man with severe freezing. Unable to initiate movement on its own, he is transformed when put on a bicycle. A complex motor behaviour, not a panic measure. This is not kinesia pradoxica but an entirely different motor program that is unaffected by his Parkinson's. An example of cerebral compensation and illustration of the fact that loss of motor function in Parkinson's is not even across the board. Some behaviour patterns are retained. Food for thought.

[CPT_Helen Partner]

The Cure Parkinson's Trust thinks this is a fascinating area and we are working with Professor Brown in Oxford to investigate this further. 60% of PwP in a recent survey highlighted that they experienced Paradoxical Kinesis, and this reinforced our decision that this was a worthwhile area of research.

[Lindylanka]

I believe that conductive education, while not easy , uses compensatory mechanisms to re-programme the brain. In Birmingham there is a CE centre that has a specific Parkinson course.

[Lindylanka]

Jon,

I thought that when people who find it hard to walk are able to dance that was due to kinesia paradoxica - but it would seem from your post that KP is usually a short lived thing, which would make dance also a different 'program' too.

I did lots of Tai Chi prior to PD, and after, and i use it in daily life when I need to turn, so I don't have to do the 13-point shuffle, or on the bus if I need to maintain balance. When I am less conscious of what I am doing I fall easily, have poor balance, and am not fluent in movement.

Dance and cycling and Tai Chi are things we learn to do. Is this where the difference in program is...... innate or acquired?

There is an interesting video of someone who says she has overcome PD through practicing Chi Kung 3 hours a day. In China over 50's used to do daily exercise in the parks using both Chi Kung and Tai Chi. Both said to be better practiced where there are trees...... The interesting thing about these very slow exercises is that they pretty much give the fine muscles of the body a workout, which they miss with faster exercise.

I guess I am asking whether neuroplasticity could be harnessed, as they are doing with conductive education, which was pioneered with people with cerebral palsy, to improve PD, especially early on, as an adjunct or even instead of medication. They use this approach as routine with people who have had a stroke, though I do not know of anywhere where a similar approach is taken with PD...... it would be more cost effective to set up than most trials.....

There is research into cycling, and the forced aspect of tandem riding is very interesting - but it may not be everybodys cup of tea? Or like me they may never have learned to ride a bike.

And along with that question, do others have experiences with movement based acquired skills that give them the kind of freedom that the man on the bike demonstrates..........

Lindy

[DavidGreaves]

A few subjective observations about regular daily cycling

During June/July, four cyclist with Parkinson's accompanied by two able bodied riders, cycled daily for 27 days with only one day's rest for 2000 miles, averaging 80 miles a day. They were in the saddle for between 5.5 an 7.5 hours a day depending on distance and terrain. This is a respectable record for able bodied cyclists; it may have been an unprecedented achievement for people with Parkinson's.

Three of the four rode at the same standard as the able bodied riders and one of the three, out competed the best of us, despite being the oldest in the group by two years.

One of the four pwps found that his symptoms got worse and new symptoms manifested themselves.

The remaining three rode without any sign of Parkinson's as long as medication lasted,. The first indication of medication depletion was a phenomenon we christened the square leg syndrome which effected the Parkinson-weak side of the body. On analysis, we came to the conclusion that the knee was not lifting high enough to allow the foot to describe a smooth circle. The resultant clunk as the foot caught up was quite distinctive. The body became tense and the rider felt less in control. As the ride progressed we found that we had to take medication earlier to the point where it was necessary to introduce an extra dose.

With time we all became fitter, stronger, more skilled and endurance improved to the point where we could have cycled far longer each day at a higher speed. In fact the last leg of the day usually turned into a 25 mile race to our accommodation at speeds well in excess of 20 mph,

However, all of us reported a deterioration in our condition which in my case has continued even a week after the finish. I now shuffle more, am more clumsy, am slower generally and slightly more stooped and tense.

These observations are subjective but could offer clues to preparing an objective study of cycling and its effects for people with Parkinson's .