Physical Health and Mental Health, the two go hand in hand.

As a Physiotherapist I was trained to explore and assist with people’s physical challenges. However more and more I am realising that people’s emotional wellbeing has an equal if not greater effect on their physical health.

This becomes even more apparent when working with those who have long term neurological conditions. Despite the physical symptoms that will arise, it is often the unknowns and the unpredictable nature of how they may feel that I spend most of my time talking through with people.

For Mental Health Awareness Week 2018, I thought I would focus on Anxiety in the Parkinson’s population. However, I hope that my advice and treatment options will be useful to many more of you.

Anxiety in Parkinson’s Disease is a well-documented symptom with approximately 40% of the population reporting anxiety as a challenge. It is not known exactly what causes anxiety symptoms, but research suggests that there may be a neuro-chemical and psychological component. Feelings of uncertainty or worry are a natural emotional response to a difficult or challenging situation, however at times these feelings can become overwhelming and debilitating.

In Parkinson’s Disease, anxiety can also have a negative impact on movement and this is most commonly seen with increased tremors, freezing episodes when walking or difficulties with getting the right words out.

Physiotherapists work with many individuals who have difficulties with freezing in Parkinson’s Disease. “My feet get stuck and don’t want to move” is often how those affected describe it and as an observer this is also what you see. The cause of freezing is not known, but turning, obstacles, distractions and anxiousness are all identified triggers. The unpredictable nature of freezing can heighten the feeling of unease, particularly when in a busy, public place. This can then lead to a self-perpetuating cycle and in the worst scenario, to complete avoidance of the activity.

There are lots of helpful methods to use to try to overcome your freezing:

• Swaying before trying to step

• Using a beat or counting “1,2,1,2” to guide each step

• Distraction with another thought or moving another part of your body first

It is important to find a method that works for you and therefore you may need to try a few with the support of your Physiotherapist and family.

Below are some useful tips to help begin to manage your anxiety .

General Advice - If you feel that your thoughts are becoming more of a problem or are hindering you, speak to your GP or Parkinson’s Nurse in the first instance for their advice. - The Parkinson’s UK website has some very useful information and has a booklet dedicated to Anxiety. - Allow yourself to be worried or concerned in challenging or new situations, don’t brush it away with “I am being silly.” This is a natural human response. If you are unsure how to overcome the situation, stop and take a deep breath before trying to tackle it. You may need to ask someone for help or you may just need to pause and distract yourself with someone else for a white. Either way, give yourself time.

Talking Therapies - Talk to your friends and family. Explaining how you are feeling and the challenges that you face to those closest to you, can itself help relieve the worry you feel when you are with them. - There are many dedicated online forums if you prefer a more anonymous setting. Try to use a specific, monitored forum such as Parkinson’s UK.

- A referral can usually be made through your GP or Parkinson’s Nurse to a local NHS service.

Activities and Exercise - Yoga, Tai Chi and Pilates are great ways to bring your focus in towards yourself and away from potential worries. They focus on breathing and control of movement, so you will gain physical benefits as well! - Mindfulness and mediation are used widely to help calm anxious thoughts. Books, CDs and DVDs can be found to support you at home, or alternatively you may choose to visit a practitioner for a one to one or group session. - General physical exercise is an undisputed winner for improving health and wellbeing for all individuals. Use your local what’s on or council websites to find physical activity opportunities close to you. Try joining with a friend or family member to help keep you motivated. Even on your hardest days, exercising can really help calm your thoughts and focus your attentions elsewhere.

Enable Me Physiotherapy is set up to help you make the most of each day. We can support you to get back to exercising, provide practical advice and tips for overcoming movement challenges or allow you some “me time” in one of our neurological specific Pilates classes. Get in contact to see how we can help.

References

Walsh K, Bennett G Parkinson's disease and anxiety Postgraduate Medical Journal 2001;77:89-93.

Hgoetz Martens, Kaylena A., Colin G. Ellard, and Quincy J. Almeida. “Does Anxiety Cause Freezing of Gait in Parkinson’s Disease?” Ed. Ramesh Balasubramaniam. PLoS ONE 9.9 (2014): e106561. PMC. Web. 14 May 2018.

Parkinson’s UK website www.parkinsons.org.uk