The #1 Key to Combating Parkinson's Apathy and Low-Motivation (with Dr. Sarah King, PT, DPT)

By: Invigorate Physical Therapy and Wellness

- Hey guys, welcome back to Canada. I wanted to check in real fast here. We're in day two from the Movement Disorder Society's International Parkinson's and Movement Disorder Congress. And we're taking a little quick break but I wanted to check in because this morning at one of our workshops we touched a lot on Parkinson's apathy and low motivation. And I feel like I hear this a lot from most of you out there if you're in my booster tribe or if you are working with me one-on-one or even if we're just kind of chatting as friends.

I feel like I hear this Parkinson's apathy, I don't feel like I have enough motivation sometimes to work out, to be consistent with my work out over time. And we talked today, there was a talk. There was a talk by Anthony Phillips talking about dopamine levels and how they correlate with apathy and motivation. And this sentence stuck out, and it's the quick-hitter that I want to give you guys today. He said that dopamine levels rise with the anticipation of a positive reward and is sensitive to the reward magnitude. So those are a lot of kind of medical words, dopamine and anticipation and all that good stuff, but essentially the take-away is that as a person with Parkinson's, your dopamine levels are already low. So in order to boost them up, we need you to be anticipating a reward. Which means that goal-setting is really important for you.

So it's not actually the dopamine levels don't rise more significantly when you actually receive a reward or achieve a goal, it's that the anticipation of achieving that goal where the dopamine levels rise. And the sensitivity, the amount the dopamine levels rise in your brain is sensitive to the magnitude of the reward. So a bigger goal, anticipation of that bigger goal is important. So an example might be when you're working with a physical therapist or setting your goals for your fitness program if you're working out on your own, setting a goal of I want to be able to walk to the mailbox and back. Now that may be a huge goal for you. That may be a large, large goal.

But for some of you that might just be yeah, it'd be nice if I could do that, but there's not a lot of internal drive there as far as something really exciting that gets you really anticipating achieving that. So to kind of mirror that, to get to the next level, it's like if you're setting a goal with your physical therapist. Maybe your goal is to be able to walk your daughter down the aisle in six months. You are using a walker now but you want to be able to hold arms with her and walk confidently down an entire aisle in front of a bunch of other people.

The #1 Key to Combating Parkinson's Apathy and Low-Motivation (with Dr. Sarah King, PT, DPT)

That's a big goal, and it's also meaningful to you. So you need to, when you're working out the take-away is really having big, bigger, and biggest goals that you set that are realistic to you that you feel like are achievable over time. And not just setting goals that you think maybe your spouse would want you to be able to do or your doctor wants you to be able to do or something your physical therapist told you you should be able to do. So I know we're guilty of this as physios. We're like you need to be able to stand on one foot for ten seconds. And that's a goal that we impose upon you but when you're working with your therapist and setting your goals for your fitness program you should be the one that's directing those goals and they should be the support team.

So with my clients I always ask them what do you want to achieve by the time we're done working together? In my online booster program, the exercise program that I have through Invigorate, we go through an entire process of goal-setting and we talk about what you want to achieve and why you want to achieve it, why it's meaningful to you, so your brain can be prepared to do the work to get you to that goal. You're anticipating that reward and that's when the dopamine levels really kick in. Let's see if I have anything else there. So you need to just kind of set goals that are valuable around what you want to achieve instead of what you think other people want to achieve for you. And the next little nugget is about motivation. And I just wanted to hit this home, and I talk about it all the time, but we were talking about disorders in the brain and just different levels of dopamine that can challenge someone's motivation and why that happens. So the motivation deficits that are often seen in Parkinson's are caused by multi variables. So it's lots of things that could come in.

You have some deficits in the way that your brain makes decisions and the way that it identifies patterns just by default of how your neurotransmitters, your brain chemicals, are affected by Parkinson's and your Parkinson's medications. And then you also have some of these emotional deficits where you feel kind of social withdraw or just lack of interaction with people and that affects the way your brain works, too. And that can affect your overall motivation. So the thing that I wanted to really hit home here is that recognizing those feelings of low motivation are not a reflection of the person that you are on the inside.

You're not lazy, I hear that a lot. I must just be lazy because I can't get myself to do this on my own. You feel like it's willpower that you're lacking and I just want to reinforce that it's not willpower, it's not you, it's not that you're broken or that you don't have the capacity to be motivated.

It's the way that Parkinson's has affected your brain chemicals. And the important part of that is there are strategies that you can use like goal-setting, joining a group to do exercise, seeing a physical therapist, talking to anyone about your diagnosis to help you kind of cope and use strategies for anxiety. There's so many things that you can do because you're not broken. You just need different strategies than the rest of us, who don't have a Parkinson's diagnosis, do. So I just want to hammer that home and just let you know that it's not you, you're not lazy, but you do need some different strategies and powerful strategies to compensate for what's going on in your brain. So I hope that was helpful, I am going to try to check back in a little bit later today.

I'm hanging out with some of my great friends. If you are really eager for a lot of these updates I just want to give a little shout-out to Naomi Casiro over at NeuroFit BC. She's doing some live updates from the Parkinson's Congress and some exercise videos. Nate Coomer from Seattle, the Parkinson's Fitness Project, he hopped on Facebook Live a little bit earlier.

So if you're really craving a lot of this information and golden nuggets, seek those people out. I know that Reactive Physical Therapy out of California is here as well. Ali is giving some updates over there, Ali Elder.

So you have plenty of us Parkinson's PTs, Parkinson's physios that are trying to keep you updated. So check them all out, give them some love, like their pages. Everyone here has stuff to offer you and we appreciate you listening. So if you guys thought that this was helpful or you feel like you know someone who's struggling with apathy and motivation, please share this video with them so that they know they're not alone and that they know that it's not them and there are definitely things that they can use to get back on track and achieve the things that they want to achieve every single day.

So I appreciate you all, and I will talk to you very soon. Alright, bye guys.


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