Friday, October 27, 2017



 In addition to medications, exercise plays a great role in the management of Parkinson's disease. It is highly recommended by experts that every Parkinson's patient engage in a regular exercise program. However, many reports have shown that only a very small number of Parkinson's patients are motivated enough to exercise on a regular basis. This lack of motivation to exercise has a negative effect on the quality of life of Parkinson's patients. Although Dr. Rana, a Canadian neurologist says, "Exercise can help every Parkinson's patient at every stage of this disease", he also said, "My biggest challenge with Parkinson's patients is to get them to exercise regularly". Since World Parkinson's Program (WPP) is dedicated to improving the quality of life of Parkinson's patients, WPP has released the second edition of Rana Exercise Diary for Parkinson's. This diary is a humble effort to inspire Parkinson's patients to exercise on regular basis.  This diary provides illustrations and details of exercises with a daily log which may benefit many Parkinson's patients. This diary can be downloaded free of charge by visiting the resource centre on the website of WPP or by clicking the following link. 

Parkinson's clinics and Movement disorders centers can also request hard copies of this diary by emailing WPP at

Restless Legs Syndrome and Parkinson’s:


September 23, 2017 - RLS Awareness Day

Patients with RLS usually describe a feeling of aching deep in their calves or a desire to move their legs which mostly occurs in the evenings or at bedtime and is partially or completely relieved with walking. These symptoms do interfere with sleep at night and may cause excessive daytime drowsiness. Patients find difficulty in sitting for prolonged periods, such as watching movies, taking long car rides, or plane flights. Low iron levels have been associated with Restless Legs Syndrome. Patients with Parkinson’s disease are especially more bothered by symptoms of Restless Legs Syndrome because they have difficulty walking due to their poor mobility and therefore feel very distressed.

Because of the overlap of symptoms of RLS and restlessness in wearing off periods the true prevalence of RLS in Parkinson’s disease is difficult to determine. RLS prevalence in general population may be around 5 – 7%, whereas in Parkinson’s disease, the prevalence of RLS may be as high as 15-20 %.

It is not yet known whether RLS is associated with increased risk of developing Parkinson’s disease. Parkinson’s patients should make note of such symptoms and discuss them with their neurologist at regular appointments. Physicians usually rule out other causes with similar symptoms such as neuropathy, arthritis, degenerative disc disease affecting the lower back, pregnancy, iron deficiency, or kidney failure. Some individuals may find soaking in warm water and massaging their legs helpful. Application of warm and cold packs can partially relieve some of the symptoms of RLS. Compression stockings, moderate and regular daily exercise, and following principles of sleep hygiene may provide some benefit as well.

Z. Sarfraz, MB(Can) and R.K. Rana, BSc (Can), Muhammad Rana, World Parkinson’s Program, Toronto, Canada



Any one may feel a little shaky when they are nervous, such as giving a talk first time to a group of people they don’t know. However, having a tremor in normal conditions is not normal. Tremor may be the first sign of Parkinson’s; thus, it should not be ignored.

Tremors are involuntary and rhythmic oscillations of muscles which induce an involuntary movement of a limb. Tremors can be due to many different causes. Two of the common causes of tremor are below,

-Essential tremor (ET) is the most common movement disorder, and is quite different from Parkinson’s disease tremor. Most cases of Essential Tremor are usually mild, and don’t require treatment. When symptoms do manifest they can include both postural and action tremors.

-Parkinson’s disease Tremor is typically a resting tremor and occurs when the affected body part is at rest. Resting tremor in Parkinson’s disease usually begins in one hand, arm or in a leg. A resting tremor usually dampens upon the initiation of a movement especially in the early stages of Parkinson’s. Resting tremor may just begin in thumb and/or index finger in some patients resembling pill rolling movements i.e. pill rolling tremor. The presence of a resting tremor in a patient with suspected Parkinson’s disease is supportive of the diagnosis. While tremor is the most common initial presenting symptom of Parkinson’s disease, only 70-80 % of patients have a resting tremor. The remaining 20-30 % of patients will demonstrate no signs of a tremor at all; making the identification of other symptoms essential. A tremor of Parkinson’s disease can involve the lips or chin, but usually does not involve head or voice.

Z. Sarfraz, MBBS (Can) and R.K. Rana, BSc (Can), Muhammad Rana, OS (Can) World Parkinson’s Program, Toronto, Canada



Loss of flexibility and postural instability due to Parkinson’s disease can place an individual at risk of falling. Falls become a significant problem as Parkinson’s disease progresses. About 70% of patients with Parkinson’s disease experience falls each year, and 13% of them fall more than once a week. Risk factors include age, disease duration, loss of balance, drop in blood pressure on assuming upright position, delayed reaction time, dementia, and slowness of movements.

Other factors that contribute to falls in elderly include poor vision, decreased mobility, muscle weakness, and arthritis. Falls may result in fractures and significant disability. Many falls occur in bathroom, one should follow the strategies given below to reduce the risk of falling in bathroom,

1.      If you have any concerns about your mobility in the bathroom, do not lock the door. If in doubt, do not bathe when you are alone.
2.      Avoid using towel rails and soap dishes for support when getting in and out of the shower, or on and off the toilet as they are not safe.
3.      Properly installed grab bars will give support and stability and promote independence.
4.      Non-skid strips and/or bath mats can stop slipping. Sitting to shower is recommended for those with balance difficulty. A hand- held shower, bench, or shower seat enables you to remain safe and independent and minimizes the risk of falling.
5.      Getting up in the middle of the night may be risky, particularly if you experience “wearing off” or prolonged “OFF” periods. Rather than struggling to walk to the toilet, consider using a portable commode or urinal by the bedside.
6.      You should not buy any equipment or make any adaptive changes to your home without the advice of an occupational therapist. Contact your local health unit and ask to speak to the community therapist for your area and discuss your difficulties. They can advise the use of appropriate aids such as grab bars, and shower chairs, etc.

Z. Sarfraz MBBS (Can) and R.K. Rana, BSc (Can), World Parkinson’s Program, Toronto, Canada

Thursday, June 22, 2017

Dementia and Parkinson’s -Seven Do’s and Don'ts

About half of the individuals develop dementia and significant memory or cognitive problems in the course of Parkinson’s disease.Initially, patients have slow thinking and may need more time to respond to questions. Most patients with Parkinson’s disease do not have memory problems in the beginning of the course of the disease. The memory and intellectual functioning gradually gets worse and negatively affects the activities of daily living. Initially,Parkinson’spatients may experience mild cognitive deficits with impaired planning, organization of goal-directed activity, visuospatial deficits, impaired problem-solving, and problems with learning.  Once patients develop evident dementia, their condition may deteriorate, increasing their disability and need for long-term placement.

Suggestions for those noticing memory issues with Parkinson’s!
1.When making a decision, give yourself enough time and avoid stressful situations.
2.To remember something specific, repeating several times may help to recall it later.
3.Relaxing and waiting may also help recalling.
4.Write down tasks and grocery items.Notepads can be very handy, use it to write down important information. Read the list a second time and keep it in your pocket.
5.Using a calendar to note important dates and events.
6.Staying positive is essential. Doubting your memory may cause you to become forgetful.

7.Always place things where they should be so it is easier to locate them later. 

Suggestions for care partners and others! 
1.Try not to argue with patients or correct each trivial mistake or tell them that they are wrong.
2.While talking to them one should not say “Remember when…”
3.One should avoid assuming that they can’t speak for themselvesand should let them speak for themselves as much as possible.
4.They should not be reminded of death of their loved ones or things that usually upset them.
5.They should not be addressed with other than their preferred name.
6.One should never lose patience with them, or tell them, “I just told you” or “you have already asked me” or “you are repeating same thing.”
7.One should not talk about them to others in front of them or discuss their situation in front of them to others.

Wednesday, June 14, 2017

Anthony Chambers Receives Dr. Rana International Parkinson's Community Service Award

Anthony Chambers a  Medical Assistant in the Neurology Associates, San Antonio, Texas, USA, receives Dr. Rana International Parkinson's Community Service Award for the Year of 2016.

World Parkinson’s Program announces the names of two recipients for the Dr. Rana International Parkinson’s Community Service Award for the year 2016, Anthony Chambers and Dr.Robert Wilcox. World Parkinson’s Program highly appreciates the passion of these inspiring individuals to improve the lives of those struggling with Parkinson’s.

The spirit and dedication of World Parkinson’s Program to make medical treatment of Parkinson’s disease available for every single individual affected with Parkinson’s in every part of the world continues through the efforts of such front-runners. Join us in congratulating the recipients of this prestigious award.
World Parkinson’s Program is a Canadian based global charitable organization which provides medications, walking aids, educational literature in more than 20 languages, and other supportive services to Parkinson’s patients in order to improve their lives every single day. These services aid the daily needs of every person affected with Parkinson’s and we strive to improve the “TODAY” of every individual fighting this debilitating disease around the globe. Dr. Rana International Parkinson’s Community Service Award is given yearly to a maximum of three individuals nominated globally.

Thursday, May 25, 2017



Halima joined the World Parkinson's Program as a volunteer while completing her Bachelor of Science degree at the University of Toronto. She has co-authored multiple research papers, which have been published in peer reviewed journals.
Halima primarily contributes her writings to blogs for the World Parkinson's Program and has a special interest in raising awareness for issues women with Parkinson's disease may face in various parts of world and their struggles with the adverse effects of Parkinson’s disease.
Given the continued rise in Parkinson's and its debilitating effects on the daily lives of patients, Halima hopes to create awareness, propagate knowledge and generate a push for supportive measures to improve existing conditions for Parkinson's disease patients through her writing efforts.