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Bethesda in Willmar, Minn., develops pilot project specializing in Parkinson's disease

Jim Dahl tries an exercise during a class designed for people with Parkinson's disease. The classes at Bethesda Wellness Center in Willmar, in addition to physical therapy, help preserve strength, balance and range of motion. The program uses the "big" principle of large, amplified movements, a concept developed two decades ago to address the types of neurological issues seen in Parkinson's disease. (Tribune photo by Gary Miller)1 / 4
Jim Terhune says that his Parkinson's symptoms have stabilized since participating in physical therapy classes at Bethesda. (Tribune photo by Gary Miller)2 / 4
Hub Schiro works on movements that incorporate a chair during one of the weekly classes. The approach of large, amplified movements has been found to produce better outcomes for Parkinson's patients. (Tribune photo by Gary Miller)3 / 4
Melissa Wentzel, left, director of Bethesda's wellness club, demonstrates an exercise as Jim Dahl gives it a try during a Parkinson's wellness recovery exercise class at Bethesda Wellness Center in Willmar. (Tribune photo by Gary Miller)4 / 4

WILLMAR -- Jim Terhune, 82, was set to drive to the Twin Cities -- a 200-mile round trip -- for intensive daily therapy to help manage Parkinson's disease.

But it turned out he could receive therapy much closer to home, through a comprehensive Parkinson's care program launched this year by Bethesda Health and Housing.

Since completing the physical therapy classes a few months ago, his symptoms have stabilized, Terhune said. "I'm not losing. It's a tremendous help."

Better yet, access to an ongoing weekly exercise program that's close to home is "saving me lots of time," said Terhune, a retired educator.

Leaders at Bethesda say there's a significant unmet need in the region for services for people with Parkinson's disease. It's a gap they hope to fill with their program, which was established in partnership with the Park Nicollet Struthers Parkinson's Center in Golden Valley. The emphasis is on evidence-based therapy coupled with a focus on quality of life.

"Looking forward, I just see tremendous growth potential here," said Doug Dewane, Bethesda chief executive. "We are looking at both inpatient and outpatient therapy. We are looking at the full continuum of care. We want this to become a magnet."

Nearly 1 million Americans have Parkinson's disease, a number expected to grow as the population ages. The neurological disease most often strikes after age 50. Symptoms can be complex and challenging to manage: tremors, rigidity, slowed movement and speech, balance and coordination difficulties.

"It really can impact every aspect of a person's life," said Ruth Hagestuen, a registered nurse and community relations partner with the Park Nicollet Struthers Parkinson's Center.

"People with Parkinson's are looking not only for the right kind of care at the right time. They are looking for places where they can go for care where Parkinson's disease is understood," Hagestuen said.

Creating "a knowledgeable community that is sustainable" is the goal of the pilot project between Bethesda and the Struthers Center, she said. "It's like a laboratory. We're looking at this together."

Project leaders said knowledge and understanding of the disease are key in delivering competent care to people with Parkinson's and their families.

Take the role of medications. Although prescription drugs can be effective for symptoms such as tremors or speech difficulty, different combinations may be needed at different stages of the disease. The daily timing of each pill is often critical in keeping symptoms to a minimum. Then there's the ongoing research into treatment options such as deep-brain stimulation, and the role of physical activity in managing Parkinson's and possibly slowing the progression of the disease.

For optimal care, all of this needs to filter down to those who provide direct care -- and it needs to happen at the community level, Hagestuen said. "People look for the right care where they're living."

Because regional surveys indicate that education about Parkinson's often isn't provided for nursing home workers, a training program was launched for Bethesda staff this year to build their competency.

Every employee, from certified nursing assistants to housekeepers, will complete core training. Additional modules are being provided for those who work in direct care.

Jill Baker, a registered nurse and staff development coordinator at Bethesda Heritage Center, thought she knew about Parkinson's disease. But after going through the training and visiting firsthand with clients about their experiences, "you understand it," she said. "I think Parkinson's disease has been misunderstood for many years."

Bethesda staff -- and clients -- are already beginning to see the fruits of their efforts.

On a recent sunny day, Melissa Wentzel, director of Bethesda's wellness club, was leading a Parkinson's wellness recovery exercise session.

"Big steps! Swing those arms," she urged as she led the participants, who ranged in age from 82 to 91, through a series of reaches and stretches.

Members of the class had already gone through intensive physical therapy with Bethesda's physical therapy staff. Now they come in every week for exercise to help preserve their strength, balance and range of motion.

The program uses the "big" principle of large, amplified movements, a concept developed two decades ago to address the types of neurological issues seen in Parkinson's disease.

This approach has been found to produce better outcomes in a patient population for whom traditional exercise often isn't effective, said Dennis Eickhoff, physical therapist at Bethesda.

"Within a week you can see differences," he said. "You actually feel like you can help them."

Of the clients with whom occupational therapist Teri Schueller has worked so far, "every single one of them has made some progress in some area," she said. "A lot of people say it's easier to get out of a chair. Their balance is better. People have said, 'My spouse has noticed a difference.'"

Bethesda was already providing many of these services "but this is so much better," Eickhoff said. "It is research-driven."

Over the next year Bethesda will be collecting data to measure the effectiveness of its pilot program with the Struthers Parkinson's Center. Are clients receiving their medication on time? Has the number of Parkinson's-related falls decreased? Are clients and families satisfied with the care they're receiving?

"We feel that we can develop a model that would be replicable in other parts of the country," Eickhoff said.

It has been a challenge for Bethesda to commit time and money to developing the program, Dewane said. "But we believe that it's a good investment and that ultimately we will get a good return."

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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