Aquatic exercise therapy is beneficial for those with Parkinson's disease.

Parkinson's disease is a brain ailment where a neurodegenerative problem primarily damages neurons generating dopamine in the significant region of the brain, resulting in stiffness or slowing down of movement, overall brain damage, and uncontrollable shaking of body parts (Westenberger & Klein, 2012). Dopamine links brain and nervous system regions that coordinate and regulate bodily movements. Movement-controlling brain regions are unable to function properly due to injured nerve cells that produce dopamine, resulting in sluggish and aberrant movement (Segura-Aguilar, 2014). The true origin of cell degeneration is still unknown in the medical field, despite experts' speculation that the disorder may be brought on by a combination of genetics and environmental factors. The treatment of Parkinson’s until now remains unknown; scientists have only come up with ways of mitigating the symptoms through physical and speech therapy (Fargel et al., 2007). The recent developments have seen the advanced therapies such as aquatic therapy inculcated into treating Parkinson’s. Aquatic therapy employs water-based approaches to counter-mobility and functional delimits brought about by the condition (Vivas et al., 2011). Parkinson’s disease history dates back to 1817 when a British apothecary, James Parkinson wrote and published an essay titled the shaking palsy. With the advancement of knowledge and medical equipment, the condition was later in the 20th Century studied in detailed and named it after him, James Parkinson.









Causes of Parkinson’s disease

The actual cause of Parkinson’s disease is still a medical mystery, but research has attributed some genetic and environmental factors as the known causative or trigger factors.

Genetic Factor

Statistics show that 10-15% of Parkinson cases arise from genetic causes through gene mutation and family inheritance (Tatton et al., 2005). Medical research shows that the risk of having Parkinson’s increases by twofold if first-degree relatives such as mother or father have the condition. 1 in 20 cases of Parkinson’s is inheritance related.

Elevated risk of Parkinson’s disease has been linked to abnormalities in particular body genes. These genes include PARK2 (parkin), LRRK2 (leucine-rich repeat kinase 2) and glucocerebrosidase (GBA) (Brice, 2005).

GBA mutation is the general leading cause within the genetic factors. LLRK gene mutations are common within certain ethnic groupings such as North African Arabs and Ashkenazi Jewish descents.

Mutations in protein alpha-synuclein have been found to be a causative trigger in Parkinson’s (Ahn et al., 2008). This case is however very rare.

The study however shows that these genes do not work in isolation but in a complex liaison with environmental factors. This relationship has been equated to that of loading the gun and pulling the trigger. Genes load the gun while the environment pulls the trigger (Shafique, 2011).



Environmental Factors

The global medical conglomerate has not established a clear relationship between environmental causes with Parkinson’s diagnosis because the time taken between exposure and appearance of symptoms is usually long (Lai et al., 2002). It is therefore difficult to establish a one to one connection between the two. Exposures to certain chemicals used in farming, industrial processes and military activities have been listed as possible causes of this condition. Experimental data indicate that neurotoxicants which come from the exposures above can replicate neurochemical and pathological components of idiopathic Parkinsonism. These toxicants seep in through the plasma membrane of the dopamine transporter contaminating the dopaminergic neurons with toxic species.

Pesticides and herbicides have been found to be putative risk factors. Increased duration of exposure to certain pesticides is concomitant with a minimal increase in risk (CureJoy, 2017).

The interplay between both environmental and genetic factors can be conclusively said to be the closest attempt scientist have come to establishing the actual cause of Parkinson’s. Over 70% of other Parkinson’s cases remain inexplicable.



Symptoms of Parkinson’s Disease

Although Parkinson’s is characterized by typically motor manifestations, non-motor symptoms outstandingly indicate the disease. These symptoms vary from person to person, early signs are mild and in most cases go unnoticed or may not be directly pointed to the disease. The symptoms are characterized by motor and non-motor.



Motor Symptoms

Tremor. Tremor is usually among the early signs of Parkinson’s. Tremor is seen through violent or mild shaking which begins at the limb, often the hand or finger. A tremor of the hand or leg when it is at rest is palpable; it gets more when that body part is moved. The tremor may first appear on one side of the body be it the arm or leg. It may also affect the lips, tongue or chin. With the progress of the disease, the tremor spreads to both sides of the body.

Stiff muscles and rigidity. It is a common symptom in most of the people living with Parkinson's. There is decreased arm swing on one side when one is walking. Most motor muscles become stiff and sluggish. Rigidity in some instances affects the muscles of the legs, neck and face among others in different parts of the body. The stiffness which limits movement range may cause muscle ache and tiresomeness.

Slowed movement (bradykinesia). Parkinson’s reduces the ability to move and slows normal body movements. There is a generally slowed body movement caused by muscle stiffness especially when moving from a resting position (Mayo Clinic, 2015). Simple tasks and movements become laborious and time-consuming. Victims find it difficult when walking out of a seat.

Reduced posture and balance. People are living with Parkinson's often lose body posture and balance. A person with Parkinson’s takes small steps with feet shuffled together and a slight forward bend at the waist. The imbalance may cause frequent falls. Both imbalance and reduced body posture are as a result of muscle stiffness body motor regions.

Loss of involuntary body movements. Individuals with Parkinson’s are usually unable to perform unconscious movements such as blinking, smiling and arms swinging. Writing also becomes difficult and minute. There is a total change in writing and is at times accompanied by body freezing where the body experiences sudden and brief inability to move.

Speech changes. Speech difficulty is common among people with Parkinson’s. The speech problems are as a result of rigid muscles in the speech organs such as the tongue and lips. One may tend to speak with a slur, hesitation, softly or quickly unlike before. The speech may be more of a monotone devoid of usual inflexions.

Non-motor Symptoms

Non-motor symptoms are common and may be more adverse. Research shows that these symptoms come early before one is actually diagnosed with Parkinson’s. They include:

Mood disorders such as depression, irritability and anxiety become common. At least half of Parkinson’s patients are likely to suffer from clinical depression at some point during ailment. Hallucination and delusions are also common.

Cognitive changes such as slowing of thought, reduced focus attention, memory difficulty, dementia and personality changes are evident.

Patience experience sleep disorders such as excessive daytime sleepiness (EDS), insomnia, sleep talking and walking/moving, restless legs syndrome (RLS) and vivid dreams.

There is the likelihood of either of the following, constipation and early satiety, pain, fatigue, excessive sweating, vision problems, loss of sense of smell, weight loss/gain, sexual problems, increased dandruff and increased urinary urgency and frequency.





The Stages of Parkinson’s

Parkinson’s has five main stages where the severity of symptoms increases with each stage (Holland, 2016).

Stage 1

The symptoms only affect one side of the body. In the first phase, symptoms are mild and may go unnoticed. Noticeable symptoms include tremors and shaking limbs. Patients lead normal lives with little disease interference.

Stage 2

The symptoms begin to affect motor movement on both sides of the body. One may have trouble walking and maintaining body balance. There is increased difficulty in performing physical tasks. Medication begins at this stage.

Stage 3

The symptoms become more distinct. There is difficulty in walking and other physical movements. At this stage, most patients can still maintain independence without external assistance.

Stage 4

This stage is marked by severe and disabling symptoms. Assistance is needed when walking, standing and moving. Motor difficulties are difficult to overcome. Caregivers become instrumental at this stage.





Stage 5

Symptoms are most severe, and one becomes wheelchair bound or bedridden. There is a huge decline in the quality of life. Almost all physical movements are impossible without help. Non-motor symptoms begin to severely manifest. Treatments and medicine at this point provide little or no relief.

Global Demographics and Bias

Over 10 million globally have Parkinson’s disease (Pringsheim, 2014). This number is bound to rise if studies and statistical discrepancies are addressed. China is the leading country with over 1.7 million patients. The world’s highest prevalence is in South Cairo along River Nile where they have a prevalence of 1,103 per 100,000 people. Susceptibility increases with age. The disease is globally common among the elderly above the age of 60. There are more men with Parkinson’s as compared to women worldwide; this, however, differs from country to country. The racial difference exists, in the USA, Parkinson’s was more common in Whites who had 45 incidences out of 100,000, Latinos had 40 per 100,000 and African-Americans at 23 per 100,000.

Treatment

Parkinson’s disease is an incurable, but medication can help manage the symptoms. Surgery and therapy too help in controlling symptoms. Lifestyle changes can help mitigate the severity of symptoms. Physical therapy that focuses on balancing and stretching and speech therapy to help with speech problems may help deal with the respective impairments. The benefits reaped from using aquatic exercise therapy are unimaginably immense.



Benefits of Aquatic Exercise Therapy

Aquatic therapy is an exercise or therapy that is carried out in a monitored and controlled water environment (Andresa, 2014). It is mostly done inside a heated pool to improve fitness, personal physical resilience and to improve overall body conditions. The benefits of this therapy to people living with Parkinson's are:

Reduced fear of falling

Patients with Parkinson’s have issues with balance. Being in water reduces the fear of falling. The buoyancy of water is important in restoring mobility confidence among patients. Aquatic therapy, therefore, comes in handy since the pools are safe and enable patients to regain body balance. Buoyancy renders anyone submerged feel lighter then he or she would be on land. Movements in water are thus a little effortless.

Easier movements

Assisted buoyancy permits larger and easy body movements. Patients practised normal and exaggerated walking as well as an array of other motions. Water resistance sharpens the otherwise faded balance. The soothing warm water aids in muscle relaxation lessening pain and rigidity. The water also reduces body tremor, and patients can focus on movement.

Hydrostatic pressure

Pool hydrostatic pressure has a wide range of benefits which include reduced swelling, reduced pain, boost in blood circulation, reduced pooling of blood within the extremities in addition to reduced sensory input to the brain (Hydroworx, 2016).



Variety of exercises

With aquatic therapy, it is possible to carry out some advantageous exercises which would otherwise be difficult and excruciating on land as explained below.

Standing exercise. Patients try standing and stretching within the pool to improve core strength. They can focus on building strength and postural stability.

Walking exercise. Patients are submerged in water and are at first helped with support bars, but with time they can regain their agility, coordination and balance. Patience can walk forward and backwards enjoy low-impact aerobic exercise inside the pool.

Whole body healing

Because of the ease of walking in water as compared to land, patients regain the much-needed confidence. The disability of walking on land is substantiated by the ability to walk in the water which enhances personal resilience which is imperative in mitigating the ills of Parkinson’s.

Conclusion

The exact cause and treatment of Parkinson’s disease is still shrouded in mystery calling for extensive and intensive research to unravel this century-old medical puzzle that is threatening the future of many. The iota of knowledge on this conditions beckons global co-operation in bringing together both material and knowledge resources to help dig deeper and find out more about Parkinson’s especially on using technology to manage and controlling the ailment and enable patients experience long quality life.











References

Ahn, B., Kim, Y., Park, S., Lee, S., Min, J., Kim, J. & Kim, M.et al (2008). α-k Synuclein gene

duplication present in sporadic Parkinson’s Disease. Neurology 70: PubMed.

Andresa, R., Alison, M. & Verrier, M. (2014). The effects of aquatic therapy on mobility of

individuals with neurological diseases: A systematic review. Sage Journals.

Brice, A. (2005). Genetics of Parkinson’s Disease. LRRK2 on the rise. Brain 128. PubMed.

CureJoy. (2017). Genetic and Environmental Causes of Parkinson’s Disease. Retrieved on 23rd

October 2017 from https://www.curejoy.com/content/causes-of-parkinsons-disease/

Fargel, M, Grobe, B., Oesterle, E. et al (2007). Treatment of Parkinson’s Disease. Clinical Drug

Investigation. Retrieved on 24th October 2017 from

https://doi.org/10.2065/00044011-200727030-00004

Holland, K. (2016). The Stages of Parkinson’s. Retrieved on 24th October 2017 from

https://www.healthline.com/health/parkinsons/stages-of-parkinsons

Hydroworx. (2016). Parkinson’s Disease Aquatic Therapy Helps Patients. Retrieved on 24th

October 2017 from https://www.hydroworx.com/blog/aquatic-exercise-benefits-people-with-parkinsons-disease-free-webinar/

Klein, C. & Westenberger (2012). Genetics of Parkinson’s. Cold Spring Harb Perspect Med.

Lai, B., Marion, S., Teschke, K. & Tsui, J. (2002). Occupational and Environmental Risk Factors

for Parkinson's Disease. Parkinsonism & Related Disorders; 8: 297-309

Mayo Clinic (2015). Parkinson’s Disease. Retrieved on 24th October 2017 from

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/symptoms/con-20028488

Pringsheim, T., Jette, N., Frolkis, A. & Steeves, D. (2014). The prevalence of Parkinson’s

disease: A systematic review and meta-analysis. Doi:10.1002/mds.25945

Segura-Anguilar, J., Paris, I., Munoz, P., Fabio, Z. et al (2014). Protective and toxic roles of

dopamine in Parkinson’s disease. Journal of Neurochemistry, Volume 129.

Tatton, G., Chalmers-Redman, R., Brown, D. & Tatton, N. (2003) Apoptosis in Parkinson’s

disease: signals for neuronal degradation. Ann Neurol; 53: S61–S72.

Shafique, H., Blagrove, A. et al (2011) Causes of Parkinson’s disease: Literature Review. DOI: 10.7157/jprls.2011v1n1pp5-7

Vivas, J., Arias, P. & Cudeiro, J. (2011). Aquatic therapy versus conventional land-based

Therapy for Parkinson’s disease: An open-label pilot study. Arch Phys Med Rehabil.