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A Virtual Coach Spurs Patients With Parkinson's

Ann Lukits Wall Street Journal - People with Parkinson's disease walked markedly farther and faster after a month of daily motivational chats with a virtual exercise coach, according to a study in the American Journal of Physical Medicine & Rehabilitation. Virtual coaches are animated computer characters that simulate face-to-face conversations with people. The technology has been used in studies of healthy adults, but this is the first to involve patients with a neurological disorder, researchers said. Walking is an important indicator of both disability and quality of life in people with Parkinson's, they said. Twenty Boston residents in their mid-60s with mild-to-moderate Parkinson's disease were recruited. Participants took daily walks wearing a pedometer and spent five minutes a day talking to a virtual exercise coach called Tanya. The conversations took place on a tablet computer, varied daily and consisted of a social chat, check of the subject's progress and daily exercise tip. Subjects took two walking tests before and after the study, which assessed distance covered in six minutes and gait speed, respectively. Average walking distance on the six-minute test improved from 1,508 feet to 1,588 feet over the 30-day study period. Normal gait speed improved from 3.9 to 4.1 feet per second and maximum

gait speed increased from 5.5 feet to 5.8 feet per second. All changes were statistically significant and clinically meaningful, researchers said. Virtual coaches, with their humanlike characteristics, have a unique ability to build social and emotional relationships, researchers said, and can help promote healthy behavioral changes in people with chronic illnesses. Caveat: The study was a small Phase I clinical trial that didn't include a control group.

Parkinsons disease will be diagnosed in another 60,000 Americans this year. Each one will learn that medication is critical in slowing down the incurable disorder. But the treatment wont end there. A growing number of patients in the Tampa Bay area are finding the body and mind can benefit from another prescription - one of exercise and physical therapy.

Keep it strong and big.Big step out. Stretch the arms.three moreone and back, two and back and last oneand three, finish. Good." Bruce Wrights going through the motions again, and again, and again. Diagnosed with Parkinsons eight years ago, the hospital chaplains been steadily deprived of dopamine the chemical messenger between his brain and body. Hes lost the ability to move and speak with ease. Everything is being tighter. Muscles are cramping. Movement is constrictive," he says. "Everything is done a far more restrictive plane. Prior to the therapy I just went along with it and did the best I could. The exercise-based therapy Wright learned at Florida Hospital Tampa looks like a mix of marching band drills and tai chi balancing moves. Patients and therapists face off, mirroring each others swooping arm circles, high stepping marches and vocal warm ups. The moves are so theatrical it turns the heads of hospital patients undergoing their own therapy. After being exposed to this program, I am consciously, constantly exaggerating my movements when I walk," he says, "making longer steps, trying to lift my knees up higher. Margie Moore, Wrights physical therapist, says this therapy - called "loud and big" - is only being done locally at Florida Hospital. She says the intense month-long program and continuous workouts at home retrain the dopamine-deprived brain. Any exercise like this, she says, can help a Parkinson's patient. It looks a little bit strange to others looking. So we actually do the walking with them so they arent alone," she says. "We try to explain this is really

important to try and retrain the brain, but sometimes they do feel a little but strange doing the motions. The same goes for a Parkinsons patients speech. Vocal therapist Cara Bryan says symptoms such as stuttering and weakened modulation can be improved with a little coaching. She challenges Wright to see how long he can hold his strong baritone bolstered by years of preaching and singing hymns. Ahhhhhh..That was great. Almost 14 seconds. Great job. How did that feel for you? Good. I ran out of breath. Were you using more effort? Absolutely.Bryan says these exercises helps patients measure their own loudness. Thats something they can no longer do instinctively. Unfortunately Parkinsons skews a persons perception of appropriate loudness," he says. "They may feel they are loud enough or may sense they are. Truthfully, listeners arent hearing them well. So far, Wrights voice hasnt been as big a concern as his spirit. About half of all Parkinsons patients suffer from depression, or in Wrights case, a diagnosis of profound apathy. Exercise revives lost empathy and compassion, says Wright, a fulltime chaplain at Florida Hospital and Bishop at Tampas Lifespring Community Church. He says that benefit is immeasurable. Bottom line is I feel better. I absolutely feel better," Wright says. "I feel more active. I feel like when I am moving, I am moving differently. I feel like I have more freedom in my movements. There is a definite cause and effect to the days I do my exercises at home versus the days I dont. Parkinsons is a disease that makes you want to sit in a corner, and play it safe, Wright says. He hopes others see how exercise can be a boost to the body, mind and spirit. Consciously doing the exercises, consciously and purposely doing those kinds of movements," he says, "um kind of forces you out of your recliner so to speak."

With each big step, that's what Wright plans to do - again, and again, and again. Mary Shedden is a reporter with the Tampa Tribune. You can read the print version of her story HERE.

"Nose Over Toes" By Irene D. Hicks "Nose over Toes," the therapist says, as I struggle to rise from my seat. It takes a lot of effort, but I am determined I will not be beat. You see, I have a constant companion now, who is really not a friend, His name is Parkinson and he will probably be with me until the end. Perhaps the scientists can find a cure and knock him off the track, as I really need to get this adversary off my stooped back. "Nose over toes," I say to the researchers as they struggle to succeed. Awareness, money and support are what I hear they need. "Nose over toes," I say to the lawmakers who fight the budget wars. Remember, Parkinson's research is such a worthy cause. "Nose over toes," I want to say to a friend I hadn't seen for a while. "I was going to call, she says," and I see pity in her smile. "Don't feel sorry for me," I think as I push my Rollator away. "Nose over toes," is how I try to start each day. Those of us with Parkinson's cannot go wrong, If we remember exercise and positive attitudes help us to be strong. During April, let us proclaim in one loud voice, "Nose over toes" is our daily choice.

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