Motor and Non-Motor Symptoms

Motor Symptoms

Below are common motor symptoms and how often they are experienced by individuals with Parkinson's Disease. 


Coping with Motor Symptoms

There are some ways as a care partner you can help your loved one manage their motor symptoms. Below are listed some ways that you can support your loved one with their motor symptoms.

Falls

  • Wear supportive shoes, such as shoes that do not slip off easily and have good tread on them.
  • Encourage the use of their walking device if they have one.
  • Reduce tripping hazards in your home, by having clear paths from rooms, removing non-slip rugs, increasing lighting for better visibility, having railings available at all stairs, and grab bars near the shower and toilet. 

Tremors

  • Encourage your loved one to exercise regularly.
  • Supporting your loved one in reducing their caffeine intake (chocolate, coffee, tea)
  • Engage with them in a motor task. 
    • Throwing a ball
    • Flicking fingers
    • Any big movements, YouTube has many great and creative activities that you can complete with your loved one.
      • Here is a link to an example YouTube activity: https://www.youtube.com/watch?v=au67q96Xmhs 

Muscle Cramps

  • Stretching the area that is causing pain, but only stretching within their comfort zone. There should be no pain with stretching.
  • Gently massage the area, similarly, there should be no pain with the massage.
  • Engage in physical activity, such as walking, to help stretch out stiff/sore muscles.
  • Heat can be applied for 20 minutes at a time.

Non-Motor Symptoms

Below are common non-motor symptoms and how often they are experienced by individuals with Parkinson's Disease. 


Coping with Non-Motor Symptoms

There are some ways as a care partner you can help your loved one manage their non-motor symptoms. Below are listed some ways that you can support your loved one with their non-motor symptoms.

Fatigue

  • Plan activities when medication is most effective.
  • Spread out large tasks throughout the day, to allow for rest between the energy-taxing activities.
  • Eat small frequent meals to keep your energy storage up.
  • Maintain a routine sleeping schedule.

Incontinence

  • Select easy-to-remove clothing, to reduce stress when undressing for the toileting task.
    • Elastic waistbands
    • Limited zippers and buttons
    • Stretchy materials
  • Encourage the use of absorbent materials, such as disposable underwear or absorbent pads to make it easier to clean up for loved ones and you when incontinence occurs.
  • Utilizing a bedside commode or portable urinal if nighttime incontinence is common for your loved one or they have difficulty getting to the bathroom safely at night. 
  • Set a toileting schedule to help empty the bladder before an incontinence situation can occur.
    • A schedule could be to attempt to empty one’s bladder every two hours.
  • Reduce fluid intake 1-2 hours before bed to prevent nighttime incontinence.
  • Speak to your loved one’s doctor about pelvic floor exercises and possibly receiving therapy to support your loved one’s pelvic floor. 
Constipation
  • Support a balanced diet that provides foods that are rich in fiber (e.g. cereals and breads). Additionally, fruits and vegetables are important in reducing constipation. 
  • Encourage adequate fluid intake throughout the day, approximately 6-8 cups. 
  • Promote frequent activity throughout the day.
    • This does not have to be exercise, but rather moving around your home, changing positions, and completing daily activities. 
Cognitive Changes
  • Promote the use of memory aides 
    • (e.g. calendars, clocks, alarms, and visual instructions).
  • Stick to a daily routine, so that their daily cognitive load is reduced and that they can utilize their cognitive for other daily activities.
  • Put commonly used items in the same place, so that your loved one does not have to search for the items.
  • Label items in simple terms to make it easier for your loved one to locate items.
  • Participate in activities that challenge thinking with your loved one.
    • Puzzles, reading, writing, and other hobbies.
Pain
  • Moderate activity can help reduce pain if the pain is related to sore/fatigued muscles.
  • Massage the area that is painful lightly, again this technique should not be painful to your loved one.
  • Apply ice for pains that are new.
    • Application of ice should be only 10-20 minutes at a time.
  • Apply heat for pain that is more chronic in nature, meaning that it has occurred for more than 2 weeks.
    • Do not apply heat for longer than 20 minutes at a time. 
Day-Time Sleepiness
  • Daily physical exercise to help your loved one sleep throughout the night.
  • Promote naps only earlier in the day, naps that occur in the later afternoon can lead to daytime sleepiness. 
  • Encourage participation in physically and mentally stimulating activities to improve alertness.
  • Suggest getting daily sunlight through either sitting in rooms that receive ample light or spending time outdoors.

Sleep

Why is Sleep Important
  • Sleep is vital for maintaining/improving health and quality of life.
  • Without adequate sleep areas of memory, emotional regulation, cardiovascular functions, and participation in daily activities can be negatively impacted.
  • Lack of sleep can make individuals more susceptible to illness and injury.
How to Improve Your Loved One's Sleep

  • Regular sleep routine
  • Daily physical activity/exercise
  • Ample light exposure throughout the day
  • The bedroom environment should be cool and dark
  • Limit naps, they should occur before 3 p.m., and no longer than one hour
  • Encourage the use of the bathroom before bed
  • Sheets should allow for easy turns in the bed, such as satin sheets
  • Sleeping in separate rooms to limit distractions for each other
  • Use of a monitor, such as a camera to allow you to see what your loved one is doing without having to get out of bed
  • Hiring help during the night to provide supervision or having family/friends stay the night


References:

Gökçal, E., Gür, V. E., Selvitop, R., Babacan Yildiz, G., & Asil, T. (2017). Motor and non-motor symptoms in Parkinson's disease: Effects on quality of life. Noro Psikiyatri Arsivi, 54(2), 143–148. https://doi.org/10.5152/npa.2016.12758

Kieft, L. (n.d.). Excessive daytime sleepiness. Parkinson’s UK. https://www.parkinsons.org.uk/information-and-support/your-magazine/spotlight/excessive-daytime-sleepiness#:~:text=Excessive%20daytime%20sleepiness%20is%20a,Parkinson's%20drugs%2C%20especially%20dopamine%20agonists.

McDonald, C., Rees, J., Winge, K., Newton, J. L., & Burn, D. J. (2020). Bladder training for urinary tract symptoms in Parkinson disease: A randomized controlled trial. Neurology, 94(13), e1427–e1433. https://doi.org/10.1212/WNL.0000000000008931 

Mukherjee, S., Patel, S. R., Kales, S. N., Ayas, N. T., Strohl, K. P., Gozal, D., Malhotra, A., & American Thoracic Society ad hoc Committee on Healthy Sleep (2015). An official american thoracic society statement: The importance of healthy sleep. recommendations and future priorities. American Journal of Respiratory and Critical Care Medicine, 191(12), 1450–1458. https://doi.org/10.1164/rccm.201504-0767ST

News in Health. (2013, April). The benefits of slumber. https://newsinhealth.nih.gov/2013/04/benefits-slumber#:~:text=%E2%80%9CSleep%20affects%20almost%20every%20tissue,obesity%2C%20heart%20disease%20and%20infections.

Parkinson’s Europe. (n.d.). Motor symptoms. https://www.parkinsonseurope.org/about-parkinsons/symptoms/motor-symptoms/dystonia/ 

Parkinson’s Europe. (n.d.). Non-motor symptoms. https://www.parkinsonseurope.org/about-parkinsons/symptoms/non-motor-symptoms/bowel-problems/ 

Parkinson’s Foundation. (n.d.). Sleep disorders. https://www.parkinson.org/understanding-parkinsons/non-movement-symptoms/sleep-disorders#:~:text=Talk%20to%20your%20doctor%20about%20the%20over%2Dthe%2Dcounter%20sleep,when%20melatonin%20is%20not%20effective.

Picard, M. M., (2017). Occupational therapy’s role with sleep. American Occupational Therapy Association. https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/HW/Facts/Sleep-fact-sheet.pdf

Qureshi, A. R., Jamal, M. K., Rahman, E., Paul, D. A., Oghli, Y. S., Mulaffer, M. T., Qureshi, D., Danish, M. A., & Rana, A. Q. (2021). Non‐pharmacological therapies for pain management in Parkinson’s disease: A systematic review. Acta Neurologica Scandinavica, 144(2), 115–131. https://doi.org/10.1111/ane.13435

Rodriguez‐Blazquez, C., Schrag, A., Rizos, A., Chaudhuri, K. R., Martinez‐Martin, P., & Weintraub, D. (2021). Prevalence of non‐motor symptoms and non‐motor fluctuations in Parkinson’s disease using the MDS‐NMS. Movement Disorders Clinical Practice, 8(2), 231–239. https://doi.org/10.1002/mdc3.13122

Shen, Y., Huang, J.-Y., Li, J., & Liu, C.-F. (2018). Excessive daytime sleepiness in Parkinson’s disease: Clinical implications and management. Chinese Medical Journal, 131(8), 974–981. https://doi.org/10.4103/0366-6999.229889

Sprajcer, M., Owen, P. J., Crowther, M. E., Harper, K., Gupta, C. C., Ferguson, S. A., Gibson, R. H., & Vincent, G. E. (2022). Sleep disturbance in caregivers of individuals with Parkinsonism: A systematic review and meta-analysis. BMJ Open, 12(11), e062089–e062089. https://doi.org/10.1136/bmjopen-2022-062089

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