Challenge Your Parkinson's Symptoms

Help your brain COMPENSATE for its dysfunctional pathways.

Check out these pages for more information:

Let the medical professionals search for solutions to Parkinson's.
This site proposes practical compensation techniques available to you.


Parkinson's is primarily brain damage caused by the slow demise over time of dopamine manufacturing cells in the Substantia Nigra of the midbrain. The damage causes a distortion of the neuronal signals to other parts of the brain which, in turn, causes the observed symptoms. The brain tries to compensate for the distortions, but eventually becomes overwhelmed. PWP can continue to compensate for the symptoms by consciously controlling many of the well-learned behaviors (i.e. automatic activities). The primary, often unspoken, needs of persons living with Parkinson's (PWP) are safety and independence but the recommendation by health professionals is "EXERCISE" "EXERCISE".
  • Foster, E,R. (2014).
  • Instrumental activities of daily living performance among people with Parkinson's disease without dementia.
  • The American journal of occupational therapy : official publication of the American Occupational Therapy Association.
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  • States, R.A., Sweeny, T.L., Rossi, A., Spierer, D.K., and Salem, Y. (2016).
  • Physical Functioning After 1, 3, and 5 Years of Exercise Among People With Parkinson's Disease: A Longitudinal Observational Study.
  • Journal of geriatric physical therapy.
  • Epub ahead of print.
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  • Taubert, M., Villringer, A., and Lehmann, N. (2015).
  • Endurance Exercise as an "Endogenous" Neuro-enhancement Strategy to Facilitate Motor Learning.
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  • Duchesne, C., Gheysen, F., Bore, A., Albouy, G., Nadeau, A., Robillard, M.E., et al. (2016).
  • Influence of aerobic exercise training on the neural correlates of motor learning in Parkinson's disease individuals.
  • NeuroImage. Clinical [electronic resource]
  • doi: 10.1016/j.nicl.2016.09.011.
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Exercise is recommended for ALL apparently healthy older adults, which MAY include people living with Parkinson's.
  • Papa, E.V., Dong, X., and Hassan, M. (2017).
  • Skeletal Muscle Function Deficits in the Elderly: Current Perspectives on Resistance Training.
  • Journal of nature and science. [electronic resource]
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  • Bray, N.W., Smart, R.R., Jakobi, J.M., and Jones, G. (2016).
  • Exercise prescription to reverse frailty.
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Additionally, PWP need to compensate for their increasingly dysfunctional habitual activities by strengthening alternative brain pathways.
  • Fritz, N.E., Cheek, F.M., and Nichols-Larsen, D.S. (2015).
  • Motor-Cognitive Dual-Task Training in Persons With Neurologic Disorders: A Systematic Review.
  • Journal of neurologic physical therapy : JNPT.
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  • The how and why of arm swing during human walking.
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  • van den Heuvel, M.R., Kwakkel, G., Beek, P.J., Berendse, H.W., Daffertshofer, A., and van Wegen, E.E. (2014).
  • Effects of augmented visual feedback during balance training in Parkinson's disease: a pilot randomized clinical trial.
  • Parkinsonism & Related Disorders.
  • 20(12):1352-8
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The mode, intensity, and duration of an exercise program are irrelevant for compensation purposes.
  • Abbruzzese, G., Marchese, R., Avanzino, L., and Pelosin, E. (2016).
  • Rehabilitation for Parkinson's disease: Current outlook and future challenges.
  • Parkinsonism & Related Disorders.
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The exercise must promote attentional endurance and conscious control of normal daily activities.
  • Kluger, B.M., Brown, R.P., Aerts, S., and Schenkman, M. (2014).
  • Determinants of objectively measured physical functional performance in early to mid-stage Parkinson disease.
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Those who cannot or refuse to exercise, e.g. people who may be apathetic or depressed, can still learn attentional endurance to help keep themselves safe by consciously controlling risky activities.
  • Boonstra, T.A., Schouten, A.C., van Vugt, J.P., Bloem, B.R., and van der Kooij, H. (2014).
  • Parkinson's disease patients compensate for balance control asymmetry.
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Their highest risk of injury exists when they switch to their dysfunctional automaticity because of distractions, fatigue, or boredom.
  • Wu, T., Hallett, M., Chan, P. (2016).
  • Motor automaticity in Parkinson's disease.
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Working with PWP is about training cognitive control of their particular ADL and IADL needs. Health professionals must make training attentional endurance and conscious control the primary focus for persons struggling to maintain their safety and independence.

For years your brain has been COMPENSATING for the loss of dopamine without you noticing.
  • Navntoft, C.A. and Dreyer, J.K. (2016).
  • How compensation breaks down in Parkinson's disease: Insights from modeling of denervated striatum.
  • Movement Disorders.
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When you begin to notice your slower pace, your softened voice, or choking a little more lately you compensate by consciously speaking louder, walking faster, or swallowing carefully. But if you do not pay attention, all those annoyances show up again. Your neurologist can help suppress some, but not all, movement symptoms.
  • Martinu, K. and Monchi, O. (2013).
  • Cortico-basal ganglia and cortico-cerebellar circuits in Parkinson's disease: pathophysiology or compensation?
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  • Kawagoe, T., Suzuki, M., Nishiguchi, S., Abe, N., Otsuka, Y., Nakai, R. et al. (2015).
  • Brain activation during visual working memory correlates with behavioral mobility performance in older adults.
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More importantly, you can do a lot for yourself. You can train your brain to consciously control habits that threaten your safety and independence. Changing a habit is difficult but probably easier the sooner you get started.
  • Yan, L.R., Wu, Y.B., Zeng, X.H., and Gao, L.C.. (2015).
  • Dysfunctional putamen modulation during bimanual finger-to-thumb movement in patients with Parkinson's disease.
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  • Note:This article was included because the recommendations for people with MS are appropriate for PWP, as well.
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Start by training yourself to be aware of activities or postures you would like to change. Then supplement your exercise by consciously overriding those risky habits every day. This site presents training suggestions.

IMPORTANT: Discuss this subject with your neurologist.

You can: [x]


Move Safely

Parkinson's Rule # 1: Practice Attentional Endurance during your everyday activities.

Distractions will become more imposing. Refocus often.

Avoid freezing in place. Practice weight transfer.

Balance problems? Use a ski pole.


Parkinson's Rule # 2: Consciously control your critical movements to maintain your safety and independence.

Do things for yourself.

Being alert builds confidence.

Practice safe movements when you walk, turn, and stand up.


Parkinson's Rule # 3: Build your resilience to the life changes of PD.

Learn, be creative.

Pursue your life purpose.

Maintain a positive attitude.

  • Develop your strategy to maintain your Safety and Independence
    1. Focus attention to enhance awareness of risky habits.
    2. Consciously control movements to safely override risky habitual activities.
    3. Keep learning to build new brain connections ("use it or lose it").
    • Vandenbossche, J., Deroost, N., Soetens, E., Coomans, D., Spildooren, J., Vercruysse, S., et al. (2013).
    • Freezing of gait in Parkinson's disease: disturbances in automaticity and control.
    • Frontiers in human neuroscience [electronic resource].
    • 6:356. doi: 10.3389/fnhum.2012.00356.
    • [PubMed]
  • Build your confidence with safe, consciously controlled activities. Parkinson's affects every person differently. Seek out information about opportunities and support to make the changes you want.
    • Soleimani, M.A., Bastani, F., Negarandeh, R., and Greysen, R. (2016).
    • Perceptions of people living with Parkinson's disease: a qualitative study in Iran.
    • British Journal of Community Nursing.
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    • Mathis, S., Neau, J.P., Pluchon, C.1, Fargeau, M.N., Karolewicz, S., Iljicsov, A., et al. (2014).
    • Apathy in Parkinson's disease: an electrophysiological study.
    • Neurology research international [electronic resource]
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  • Start by training your Attentional Endurance every day.
    • Levin, O. and Netz, Y. (2015).
    • Aerobic training as a means to enhance inhibition: what's yet to be studied?
    • European Review of Aging and Physical Activity : official journal of the European Group for Research into Elderly and Physical Activity.
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    • Diamond A. (2013).
    • Executive functions.
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    • University of California - Santa Barbara. (2013).
    • Mindfulness improves reading ability, working memory, and task-focus.
    • Science Daily.
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These ideas are not new!
  • Attentional endurance is a learned skill.
  • Conscious control is a coping mechanism.
  • The primary mobility objective must be your safety and independence.
  • The chief cognitive training benefit may be in delaying the onset of dementia.

If cognitive training, attentional endurance, and conscious control are worth the effort to you, read on.

  1. Housework, walking outside, playing tennis are activities.
  2. Maintain your best posture.
  3. Do something that you used to do, but have stopped doing.
  4. Include some exercise in your daily activities.
  1. Learning is key to brain training - do something different.
  2. Change your daily routine, just a little.
  3. Plan out your day and write it down.
  4. Visit a new place or exhibit.
  1. Consider what motivates you.
  2. Talk about what you value.
  3. Say what you would do to preserve those values.

NOTE: Recent plans to improve care delivery to persons living with Parkinson's include teaching PWP to self-manage the symptoms.

  • Connor, K., Cheng, E., Siebens, H.C., Lee, M.L., Mittman, B.S., Ganz, D.A., et al. (2015).
  • Study protocol of "CHAPS"randomized controlled trial protocol of Care Coordination for Health Promotion and Activities in Parkinson's Disease to improve quality of care for individuals with Parkinson's disease.
  • BMC Neurology [electronic resource].
  • 15:258. doi: 10.1186/s12883-015-0506-y.
  • [PubMed]
  • Gage, H., Grainger, L., Ting, S., Williams, P., Chorley, C., Carey, G., et al. (2014).
  • Specialist rehabilitation for people with Parkinson’s disease in the community: a randomised controlled trial.
  • Health Services and Delivery Research (HS&DR) [Book].
  • Southampton (UK): NIHR Journals Library; 2014 Dec. Health Services and Delivery Research.
  • [PubMed]
  • Advocat, J., Russell, G., Enticott, J., Hassed, C., Hester, J., and Vandenberg, B. (2013).
  • The effects of a mindfulness-based lifestyle programme for adults with Parkinson's disease: protocol for a mixed methods, randomized two-group control study.
  • BMJ open.
  • 3(10):e003326. doi: 10.1136/bmjopen-2013-003326.
  • [PubMed];

Helpless? Perhaps Not!

Richard uses exercise to keep
the symptoms under control.
Anya shooting bball.
Sue (left) and Anya enjoying basketball practice.
Windmill exercise
Sue focuses her attention on the stretch.
Stride it out.
When you walk -- STRIDE.
Practice dual tasking.
Practice catch while moving.
Practice basketball.
Anya aims high.