A brief report on the use of laser pointers to assist in the treatment and early diagnosis, of Parkinson’s disease.
17th April 2016.
Historical background
I was born in London UK in December 1940, as an only child. In 1956, I fell from a bicycle and sustained a fracture of my skull at the intersection of the parietal and frontal area just above the sphenoid and was treated for 3 days in Atkinson Morley Hospital.
In 1958, I trained as a Land Surveyor and was thus interested in the science of measurement.
I suffered occasional double vision whilst playing badminton at college if the shuttlecock came vertically down from a neon light cluster, but, since then, this only effected me very rarely when backgrounds of moving stripes or squares caught my line of vision, e.g. the reeded treads on an escalator.
In 1976, I emigrated to South Africa, where I presently live.
In 1995, I lost my sense of smell almost overnight.
In January 2009, I was diagnosed as having arthritis of both knees; after treatment by a bio-kineticist from February to July 2011, we noticed a difficulty in balancing on the left leg whilst on a 50mm foam mat.
In August 2011, I had developed a tremor in my right hand and I was diagnosed as having Parkinson’s disease by a neurologist and was prescribed daily Azilect and Sinemet. Also I was advised to have weekly treatment by my biokineticist.
During a presentation of work-related pictures on Power Point, one of my colleagues suggested that I should use the laser pointer to refer the audience’s attention to certain details. On doing this, we noticed that the oscillation of the laser dot described a very regular ellipse inclined at about 30 degrees to the horizontal, with a major axis of about 6cm and a minor one of about 2,5cm. Rotation was anticlockwise at about 6–7 cycles per second. This was with the right hand; with the left, the oscillation was clockwise and described a 1,5cm circle, with a similar frequency. The distance from pointer to the screen was about 5m.
We then experimented with several people, none of whom could produce the regularity of the oscillations nor the consistency of size, to any degree.
On my next visit to my biokineticist, in October 2011, I showed her the movements of the laser pointer and we put a target on the wall of her gym and, over the coming weeks observed the pattern and behaviour of the laser pointer.
For consistency, I hold my medial epicondyle against the top of my anterior superior iliac spine, at a distance of 5m, and effectively “shoot from the hip” to keep the oscillation measurements on the target consistent.
We have used the laser measurements before and after biokinetic exercises and used the results to determine which type of exercise has the greatest reduction of the ellipse.
The overall effect has been noticeable by my neurologist who has stated that she can normally identify PD sufferers by eye and if I had come newly into her rooms, she would not have been able to identify me as having PD.
We have also compared the oscillations when I hold the pointer with a horizontal straight arm in front of me, which increases the amplitude a little. If I stand in a down-hill skiers crouch, balanced on one leg, with the pointer held in front of me, the oscillations increased to 30 to 40 cms in amplitude although the frequency remains similar. The movement rapidly deteriorates to 60 t0 100cms after a short time.
If the original “shoot from the hip” posture is resumed, the oscillations return to less than 2 to 3 cms.
As this is usually done after an hour’s exercise, there is a consistent reduction in the amplitude.
We have tried various people with the laser pointer and we have yet to find anyone who can produce the mechanical precision of both amplitude and frequency, who has not been diagnosed as having PD.
Patients who have PD have shown similar results of consistency but without any appreciable relationship to any particular exercise.
My biokineticist, Amy Lichtenstein, now Pearce, has added the following:-
“You can mention we do have another patient who we use this testing with and she is currently undergoing a reduction in her meds as she is a candidate for the DBS procedure. We have noticed an increase in the amplitude of her oscillations and also an increase in the number of oscillations. With certain exercises we notice a decrease in both of these. The exercises change constantly as week to week certain exercises either improve or worsen her brady and dyskinesia, but we can consistently predict based on her oscillation pattern which exercise has been effective and which has not. We then initiative those while they work and when the pattern changes we change the exercises again. This is one of the reasons we recommend one-on-one treatments with a therapist two- three times per week in severe cases as we can constantly change the protocol to suit the patient at the time.
It has been highly effective. I would be keen to do further research on this option of 1. Early diagnosis, 2. Pre-therapy testing as a gauge of severity, and 3. as a test-retest method before certain exercise protocols and after (ie: comparing weight bearing versus vibration training as an example.) We could also use the testing as a possible assessment of the use and dosage of medications. “
From the above, I feel that there is a distinct possibility of early diagnosis by the use of a laser pointer, together with a measurement tool to help with the choice of particular exercises by providing an instant feedback.
Both Amy and I would welcome any comments from your research staff.
Bryan Russell
M.C.Inst.C.E.S.; A.A.Arb
Independent Chartered Surveyor
Mobile: +27 82 415 1321
e-mail: caltrop@iafrica.com