PingPong Parkinson
   

 

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Table tennis, a rediscovery

PingPongParkinson - the name says it all - a program that I paid no attention to in 2019 when I was diagnosed with Parkinson's. Revolving too much around myself, hoping too much for classical medicine with its numerous drugs, I paid no attention to non-drug therapies. It was only over time that I learned that movement was good for me and that it didn't matter what kind of movement it was.

It started with extensive walks and Nordic walking, later Tai Chi and the usual workout programs in the gym were added. As good as it was for me, I didn't really like anything and the way from the armchair to the sneakers was often difficult or not even started.

In 2021, on the occasion of my complex therapy in Bad Göggingen, I discovered a table tennis table in the fitness room and immediately the pictures from my childhood and youth came to mind, in which we played table tennis regularly and with great joy in the garage in winter and in the garden in summer . Lo and behold, not only cycling but also table tennis does not seem to be forgotten....

...

 The path was actually already mapped out. It began with small matches in the Munich parks, which thankfully are well equipped with table tennis tables and ends today with me as head of the Upper Bavaria region for PingPongParkinson eV and the journey is certainly not over yet.

At the end of May I attended my first table tennis tournament, the PingPongParkinson German Open 2022 in Bad Homburg, and I can say that in recent years I have never felt so comfortable and fit as during these 4 days in Bad Homburg.

I am not able to judge why table tennis in particular has such a positive effect on me and obviously on others as well. There will be many reasons, the type of movement maybe, the game itself, the friendly competition, the feeling of togetherness, the knowledge and understanding of the needs of the "opponent", whatever it may be - there is a lot of research on this topic already - I can only warmly recommend it to everyone. Look at the site www.pingpongparkinson.de when and where the next regional group trains and just try it out.

Incidentally, some may object that his degree of impairment would not allow such a sport. I can only reply: Far from it, just look at the video impressions I brought from Bad Homburg and you will see that the severity of the impairment only plays a minor role and, above all, does not detract from the joy of playing. 

 

via PingPongParkinson

The PingPongParkinson Germany e. V. is the nationwide association of individuals and self-help groups who volunteer to take care of people with Parkinson's and their families using table tennis.

The association was founded on February 02.02.2020nd, XNUMX. Honorary members are Jörg Roßkopf and Nenad Bach.

The focus of PPP's activities is to offer information and mutual exchange to those affected and their families. Table tennis has proven to be ideal for this.

The concept of PingPongParkinson is based on the fact that it wants to offer table tennis for everyone with Parkinson's, regardless of their personal abilities, i.e. from beginners to world champions.

Even if there is currently no scientific evidence, all those affected who have tried it are sure: the progressive worsening of the symptoms of Parkinson's disease can be caused by playing table tennis as a physical Therapy be slowed down.

And there's more

  1. supports the PingPongParkinson Deutschland e. V. the PingPongParkinson initiative worldwide, for example by maintaining the corresponding internet offer and in weekly telephone conferences with Nenad Bach in New York or by supporting the Danish friends in their plan to organize their own PPP meeting.
  2. PPP is actively working on counseling services for those affected and their families. The corresponding online offer is in preparation.
  3. PPP takes part in scientific congresses, e.g. B. at the 8th joint annual conference of the German Society for Neurorehabilitation eV and the German Society for Neurotraumatology and Clinical Neurorehabilitation e. V. from 10.-12. December 2020 with the lecture "PingPongParkinson Germany. Table tennis improves symptoms in Parkinson's patients”
  4. PPP is in discussion with universities for further research into the effects of table tennis on neurological diseases.
  5. Would PPP like to expand the undisputed positive properties of table tennis for neurological diseases in the future and also offer the offer, for example, to people suffering from dementia.

Sounds unusual at first glance. But it isn't!

Many of the potential symptoms of Parkinson's, apathy, fatigue, depression, anxiety, hypersalivation, incontinence, tremors, and restricted mobility can cause social withdrawal.

Social isolation is generally associated with a deterioration in health. In pwp (individuals with Parkinson's disease), the effects of loneliness and social isolation on the severity of Parkinson's disease are even greater than under the influence of stress.

dr Indu Subramanian from the University of California Los Angeles, USA, presented the results of an analysis of self-reported loneliness and social isolation in a total of 1.746 patients diagnosed with idiopathic Parkinson's disease who participated in the CAM-Care-PD study. [1]

The main results were:

  • Patients who reported feeling lonely had significantly higher PRO-PD scores than patients who did not feel lonely; the impact on severity was greater than that of smoking and stress
  • PRO-PD scores showed a strong association between severity and time since diagnosis
  • Quality of life assessments found that exercising 7 days a week was beneficial for patients, just as feeling lonely was detrimental
  • Quality of life was higher for patients who were married or in a partnership than for those who were single or divorced

dr Subramanian said health systems need to be more proactive in helping vulnerable pwp. She offered a number of practical tips for clinicians. Probably the most important:

"Help patients connect with support groups!"

The exchange of the participants, but also their relatives, the mutual information and help - that is the way that the PingPongParkinson bases go. Another reason why PingPongParkinson deliberately decided to call his groups "bases", they should be real support points for the people.

The basis of the work in the bases is an active and proactive approach to dealing with the disease. Participation means a plus in quality of life, also with fun and sociability. The group thus eliminates the isolation of the individual and thereby strengthens self-confidence and solidarity.

The at least weekly meetings create a supportive cohesion that gives understanding and comfort and encourages new activities and changed behavior.

In addition to the direct health effects of table tennis, PingPongParkinson has the support potential of a real self-help group thanks to the automatic mutual exchange between the participants. With the further psychological advantage of not going “to help yourself”, but to table tennis.

There are two people who can't get past PingPongParkinson's "history" - Nenad Bach and Will Shortz. 

Nenad Bach was born in Zagreb, Croatia in 1954, graduated in civil engineering from the University of Rijeka and moved to New York in 1984. He was already making music while he was studying. He performed the song "Can We Go Higher?", written as a call for peace during the wars in Croatia and Bosnia-Herzegovina, in 1994 in Woodstock, United States and in 1995 in Modena, Italy, at the "Pavarotti & Friends" concert.

When Bach was diagnosed with Parkinson's, he stopped playing the guitar. Instead, at the invitation of a friend, he began playing table tennis with Will Shortz, owner of the Westchester Table Tennis Center (WTTC) and crossword editor of the New York Times.  

He had never picked up a racquet before, but from that point on he played regularly. He noticed an improvement in his Parkinson's symptoms, which even went so far that he could play instruments again.

This encouraged him and in 2017 Nenad Bach founded PingPongParkinson USA, a 501 c3 non-profit organization with the aim of using table tennis as a form of physical therapy for Parkinson's disease. You can find it on the World Wide Web here more information. Based at the Westchester Table Tennis Center, 175 Tompkins Avenue, Pleasantville, approximately 35 miles north of New York City. The first ITTF Parkinson's Table Tennis World Championships, initiated by Bach, also took place there in October 2019.

Thorsten Boomhuis and Harry Wißler also successfully took part in this world championship. Immediately afterwards, it was clear to both of them that they wanted to follow the example of the Americans and set up a “Germany branch” of PingPong Parkinson. On 02.02.2020/XNUMX/XNUMX1 then became “PingPongParkinson Deutschland e. V." in
Nordhorn officially founded. It is the nationwide association of individuals and self-help groups who volunteer to take care of people with Parkinson's and their families using table tennis.

The focus of PPP's activities is to offer those affected and their families information and mutual exchange. Table tennis has proven to be ideal for this.

The concept of PingPongParkinson is based on the fact that it wants to offer table tennis for everyone with Parkinson's, regardless of their personal abilities, i.e. from beginners to world champions.

what you should know

Ping Pong Parkinson is now available virtually. Anyone who has the appropriate technical requirements can play virtual table tennis with or against another PPP player at any time and place.

 The simulation is extremely realistic and is particularly suitable for those who have not yet found a connection to a club, who want additional training units or newcomers to table tennis who would like to develop a few skills themselves first.  

You can find out more about this at parkinson-journal.de/ppp-vr

This is a guide that has been created to the best of our knowledge. However, it does not claim to be completely correct and complete. Any liability is excluded.

WHAT WE SHOULD KNOW ABOUT PARKINSON'S

Legal aspects 1: Severe disability

According to the Federal Statistical Office, there are around 7,9 million severely disabled people in Germany, which is 9,5% of the population.[1]

I. Legal bases

The term "severe disability" is defined in Section 2, Paragraph 1, Clause 1 of the

Social Code Book IX legally defined: 

“People with disabilities are people who have physical, mental, intellectual or sensory impairments that affect them Interaction with attitudinal and environmental barriers to equal participation in society with high probability for more than six months.

Section 2, paragraph 2 of Social Security Code IX defines when a severe disability is present: 

"People are severely disabled within the meaning of Part 3 (SGB IX) if they have a degree of disability of at least 50 and their place of residence, their habitual residence or their employment at a workplace within the meaning of Section 156 is lawful within the scope of this code to have."

And § 2 para. 2 of the Social Security Code IX stipulates for equality:

“Severely disabled people are to be given equal status to people with disabilities with a degree of disability of less than 50 but at least 30, for whom the other requirements of paragraph 2 are met, if they cannot find a suitable job within the meaning of Section 156 as a result of their disability without equality obtain or not retain (equivalent disabled people).”

II. Disability

What does all this mean for people with Parkinson's?

The provision in Section 2, Paragraph 1, Sentence 1 of Social Code Book IX means that not only obvious disabilities are subject to the definition, but also those with a non-visible disability, such as a serious chronic illness such as Parkinson's. People with Parkinson's are considered long-term patients or seriously chronically ill within the meaning of the law.

III. severe disability

Determining whether a person with Parkinson's also has a severe disability depends on the extent of the disease.

To determine this, the person concerned submits a corresponding application to the pension office responsible for them. This decides in each individual case whether the criteria of a severe disability are met and issues a so-called assessment notice, which contains the determined degree of disability (GdB) and a mark, if applicable. The authority issues the notice even if the GdB is found to be less than 50.[2]

The GdB varies, in increments of ten, between 20 and 100 and quantifies the severity of the disability. It is therefore the measure of the physical, mental, psychological and social effects of a functional impairment due to damage to health.

a. standards of determination

When determining the extent of the disability, it is about the existing functional deficit, a duration of more than six months and the impact of the disability on participation in life in society.

The competent authority follows the so-called "supply medical principles". These contain reference values ​​for the level of the degree of disability. The principles of medical care can be found in the "Medical Care Ordinance" at the Federal Ministry of Labor and Social Affairs.[3]

For Parkinson's syndrome is defined:

  • GdB 30 – 40: one or both sides, minor movement disorders, no balance disorders, minor deceleration
  • GdB 50 – 70: clear disturbance of the movement sequences, disturbances of balance, unsteadiness when turning, stronger slowing down 
  • GdB 80 - 100: severe disturbance of movement processes up to immobility

These standards are only a guide. Ultimately, an individual overall view of all impairments is crucial.

b. duration of the determination

The degree of disability can be checked and, if necessary, reassessed if there are any changes in health. Since people with Parkinson's disease are usually found to be worse, it can only be recommended to have the GdB checked regularly! This review here is more opportunity than risk. 

c. consequences of the determination

People with (determined) disabilities are entitled to certain disadvantage compensations. 

These depend on the type and degree of disability.

  • Free public transport
    Severely disabled people with the mark “impairment of the
    Mobility", "deafness", "extraordinary walking impairment" or "helplessness" meet the requirements for being able to use free public transport.
  • Disabled parking spaces
    Severely disabled people with the mark "extraordinary walking disability" are entitled to be issued with the blue parking permit for the use of disabled parking spaces. For people with Parkinson's, this means that there is usually no entitlement, since the effects of the walking disability are not determined to be exceptional
    .
  • Protection against dismissal from a GdB of 50:
    To § 168 Social Code Book IX requires the ordinary and about § 174 para. 1 Social Code Book IX also the extraordinary termination of an employment relationship of a severely disabled person, which has existed for at least 6 months, by the employer with the prior consent of the responsible integration office and is ineffective without this consent, § 134 Civil Code.    

    If the integration office has given its consent to the termination, the employer can § 171 para. 3 Social Code Book IX only give notice of termination within 1 month after delivery of the consent.

Furthermore, the Participation Rechte of the works councils to  § 102  Works Constitution Act andand the Disabled representative to § 178 Abs 2 Social Code Book IX to protect.

  • Increased holiday entitlement from a GdB of 50:
    People with severe disabilities who work a 5-day week are entitled to five additional vacation days per year.
  • Tax Relief

The tax office grants an additional allowance for income tax. The amount of the allowance depends on the GdB. It is currently:

GdB of 20      0,00 € from 2021: €384,00
GdB of 30  310,00 € from 2021: €620,00
GdB of 40  430,00 € from 2021: €860,00
GdB of 50  570,00 € from 2021: €1.140,00
GdB of 60  720,00 € from 2021: €1.440,00
GdB of 70  890,00 € from 2021: €1.780,00
GdB of 80 1.600,00 € from 2021: €2.120,00
GdB of 90 1.230,00 € from 2021: €2.460,00
GdB of 100 1.420,00 € from 2021: €2.840,00
mark "blind"  3.700,00 € from 2021: €7.400,00
mark "helpless" 3.700,00 € from 2021: €7.400,00

The allowances are always annual amounts, which means that there is no monthly accrual. If the GdB only existed for part of the year or if it changes in the course of the year, the higher allowance applies to the whole year.

For people with a GdB under 50, the tax exemption applies until

2020 tax year only if they are legally entitled to a pension or other ongoing benefits as a result of the disability[4] OR if the disability has resulted in a permanent loss of physical mobility or through a typical Occupational disease originated.

  • Broadcasting license fee reductions People who have been awarded the “radio/television” mark and whose GdB is not just temporarily at least 80 can apply for a broadcasting license fee reduction and who are constantly unable to attend public events because of their illness.
  • who are blind or have significant visual impairments that are not only temporary, if they have a GdB of at least 60.
  • who are deaf or who cannot communicate adequately by hearing, even with hearing aids.

IV. Equality

Employees who have a GdB of at least 30 may be able to equal to severely disabled people become. 

Upon application, the employment agency grants equality if the person due to their disability finds a suitable job i. s.d. § 156 Social Code Book IX cannot obtain or retain. Equal rights, like severely disabled people, have special protection against dismissal. However, you are not entitled to additional leave. 

Equality, if granted, takes effect on the day the application is submitted. It can be limited. The employment agency does not inform the employer about equality.

[1] As of June 24, 2020

[2] Note: The degree of disability is not given as a percentage!

[3] www.bmas.de

[4] A pension from the statutory pension insurance does not count.

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This is a guide that has been created to the best of our knowledge. However, it does not claim to be completely correct and complete. Any liability is excluded.

WHAT WE SHOULD KNOW ABOUT PARKINSON'S

Legal aspects 2: statutory health insurance and Parkinson's disease

Health insurance is compulsory in Germany, ie it is required by law. It insures against the risk of illness and its consequences and is offered by statutory (GKV) and private health insurance companies (PKV).

The following will only deal with the GKV.

News[1] there is in Germany 113 statutory health insurance companies with approximately. 71,4 million insured and family members.

I.ICD

Worth knowing in advance: 

The WHO[2] published International Statistical Classification of Diseases and Related Health Problems (ICD) is the recognized one classification system for medical diagnoses.

The valid edition is ICD-10-WHO Version 2019.[3] 

The primary parkinsonian syndrome is found in Chapter VI, notation G

Name: Diseases of Nervous system G20.2 primary parkinsonian syndrome

II. Statutory Obligations

In Germany, everyone with statutory health insurance is entitled to extensive insurance benefits, the so-called mandatory statutory benefits, in the event of illness. This also includes the medical services required to treat Parkinson's disease, specifically:

III. doctor visits

Reimbursement of the costs for regular doctor visits, e.g. B. as a check-up, are statutory compulsory services of the GKV. In principle, the free choice of general practitioners and specialists applies, provided they work together with the statutory health insurance companies.

IV. Hospitalizations

Inpatient treatment in the hospital is also a compulsory service of the statutory health insurance, but the patient has to pay a share of the costs.

V. Medicines

This applies when the costs of drug treatment are covered by statutory health insurance Benefits in kind principle. Insured persons must therefore, with the exception of co-payments, for treatment including the prescribed

Medicinal, medicinal and aids generally not pay if the regulation is made within the framework of the statutory catalog of services. 

According to the Social code V, insured persons are entitled to adequate, needs-based medical treatment that corresponds to the generally recognized state of the art in medical science. What exactly this includes is not determined by the law, but by the Federal Joint Committee (G-BA), the supreme decision-making body of the joint self-government. The G-BA also decides what is known as the Drugs Directive.

         a. co-payments            

(see the separate elaboration "Co-payments in statutory health insurance")

b. generics

By means of so-called discount agreements, health insurance companies can negotiate better conditions with drug manufacturers. They usually pass on some of the savings they make to the insured, for example by waiving the co-payment. The pharmacists are accordingly obliged to give preference to medicines within the framework of this discount agreement and to exchange a medicine prescribed by a doctor for a preparation from a manufacturer with whom the health insurance company has a discount agreement. To do this, however, the active ingredient and potency must be identical and the dosage form and package size must be comparable. 

The doctor can exclude this exchange of drugs if he deems it necessary. To do this, he must tick the box "aut idem" Mark with a cross.

VI. remedy

Remedies or healing measures are also part of the statutory mandatory benefits.

Depending on the symptoms and the stage of the disease occupational therapy, physical therapy or speech therapy as Remedies in question, all of which are often an integral part of the treatment of chronic degenerative diseases such as Parkinson's.

The provision of medicinal products for members of the statutory health insurance funds is regulated in the medicinal product guidelines of the Federal Joint Committee. The so-called remedy catalog provides information about which remedy can usually be prescribed for which diagnosis / diagnostic group and in what quantity. Before prescribing medicines, the doctor must convince himself of the patient's condition, including appropriate diagnostics, and document it. This also applies to subsequent regulations.

The principle of economy must be observed. It is therefore important to consider before the regulation whether e.g. B. by aids, drugs or self-responsible measures of the patient, the therapy goals can be achieved qualitatively equivalent and more cost-effectively. If this is not the case, remedies can be prescribed.

The catalog of remedies contains the following definitions for the REGULAR CASE of Parkinson's:

  priority

Remedies

Optionals

Remedies

supplementary

Remedies

prescription amount
Physical therapy General

physiotherapy

Specific

Physiotherapy for

Treatment of diseases of the central

nervous system using the

neurophysiological techniques

Bobath, Vojta or

PNF (Proprioceptive

neuromuscular

facilitation)

 None Cold therapy

heat therapy

 First prescription:

<= 10 units Subsequent prescription: <= 10 units total prescription quantity of the normal case <= 30 units at least once a week
occupational therapy sensorimotorperceptive

Treatment

Motor-functional

Treatment

Brain performance training / neuropsychologically oriented treatment

 

 Psychological treatment Thermal

Applications

 First prescription:

<= 10 units Subsequent prescription: <= 10 units Total prescription quantity of the normal case <= 40 units
        At least weekly 1x
  priority

Remedies

Optionals

Remedies

supplementary

Remedies

prescription amount  
speech therapy The

Difficulties swallowing:

Vocal, Speech and

Speech therapy

30, 45 or 60

Minutes with the patient, depending on the specific disorder and

community-led approach 

 None None First prescription:

<= 10 units Subsequent prescription: <= 10 units total prescription quantity of the normal case <= 60 units at least once a week

a. long-term prescription

The Therapeutic Products Directive enables prescriptions to be made outside the norm. If therapy goals can only be achieved through additional prescriptions in individual cases, longer-term prescriptions are possible.

In people with Parkinson's with the most severe impairment (stage 5 according to Hoehn and Yahr), there is a so-called "long-term need for medicinal products" according to the diagnosis list (Annex 2 HeilM-RL[4]) went out. Here, the permanently necessary remedies can be prescribed as "prescriptions outside the normal case" without the normal case having been run through beforehand. 

In people with Parkinson's with moderate to severe impairments (stages 3 or 4 according to Hoehn and Yahr), there is a so-called "special need for prescription" according to the agreement on practice specifics for medicinal products[5] went out. Here, however, after the normal case has been run through, the permanently necessary remedies can also be prescribed as “prescriptions outside the normal case”. 

For individuals with Parkinson's disease below Hoehn and Yahr Stage 3, the insured person must submit an application for approval if they believe that their level of functional/structural impairment is comparable in severity and duration to the higher stages.

b. Medicines that cannot be prescribed

Below are a few highlights from the catalog of medicinal products that are expressly non-prescribable according to Appendix 2 of the Therapeutic Products Directive:

  • hippotherapy
  • cave therapy
  • music and dance therapy
  • Magnetic therapy without using implanted coils
  • Reflexology
  • Acupuncture massage
  • Whole body massage
  • Partial and tub bathrooms, insofar as they are not in accordance with the specifications of the

catalog of medicinal products are prescribable

  • Sauna
  • Swimming and bathing, also in thermal and warm water baths
  • Measures that are intended exclusively to stimulate, strengthen and satisfy the sex drive

VII. Travel expenses

The GKV covers the costs for journeys if they are absolutely necessary from a medical point of view in connection with a service provided by the health insurance company in the case of:

  • Services that are provided on an inpatient basis
  • rescue trips to the hospital
  • Ambulance transport with the necessary specialist care.
  • Trips to outpatient treatment if one of the exceptional cases listed below applies: The trip is necessary for compelling medical reasons,
    • because you have a medical condition that requires very regular treatment. This is the case, for example, when driving for dialysis or for radiation or chemotherapy. The list is not final. Sick people who have a comparable illness can therefore apply for approval and examination of their case by the health insurance company.
    • and there is a permanent restriction of mobility, so that the use of a car or public transport is not possible.
  • Trips to pre- or post-hospital treatment or an outpatient operation in the hospital if this avoids or shortens the required inpatient or semi-stationary hospital treatment.

Insured persons must have their health insurance company approve trips to outpatient treatment beforehand. Approval by the health insurance company is deemed to have been granted to all insured persons who have a severely handicapped ID card with the mark o exceptional walking disability o blindness o helplessness

or have the need for care of care grades 3, 4 or 5. For people with care level 3, additional medical certificates are required.

Patients who are permanently restricted in their mobility but do not have a severely disabled person's pass have the option of equal treatment after the individual case has been checked by the health insurance company.

VIII. Outpatient treatment

Outpatient treatment for about 4 weeks can be approved every 3 years if it is necessary to prevent an impending disability, to eliminate or improve a disability or to prevent it from getting worse. The medical and treatment costs are fully covered; Subsidies can be granted for board and lodging.

IX. Inpatient cure

If an outpatient treatment is not sufficient, an inpatient treatment can be approved.

In this case, the fund also covers the costs of accommodation and meals. 

X. Psychotherapy

Psychotherapy is reimbursed by all licensed therapists within the framework of the cost-effectiveness requirement.

XI. Alternative treatment methods

Alternative treatment methods are generally not reimbursed in the GKV.

However, some health insurance companies voluntarily pay for special therapies. The reimbursement must be requested from the health insurance company.

However, there is a ban on services for alternative practitioner treatments.

XII. protection abroad

In the other EU countries, there is basic insurance protection, so that services can be claimed without the prior consent of the health insurance company. But: 

  • A permit is required for hospital treatment.
  • The costs are only reimbursed up to the rates that the health insurance company would have to pay in Germany.
  • The scope of services depends on the legal regulations of the individual countries, which do not necessarily correspond to the German standard.
  • A return transport from abroad will not be reimbursed.

It is therefore highly recommended to take out health insurance for travel abroad!

XIII. sick pay

(see the separate elaboration "Financial benefits in the event of incapacity for work")

 

[1] Stand: 26. August 2020

[2] World Health Organization

[3] ICD-11 comes into force on January 1, 2022

[4] Annex 2 to the Medicines Directive: List of diagnoses for the long-term need for medicines according to § 32 Para. 1a SGB V

[5] Agreed between the National Association of Statutory Health Insurance Funds and the National Association of Statutory Health Insurance Physicians (§ 84 Para. 8 SGB

  1. V)

 

WHAT WE SHOULD KNOW ABOUT PARKINSON'S

Gait disorders caused by Parkinson's

What image does the term "severely disabled" generate? A person in a wheelchair. What about Parkinson's? An old gentleman, bent over with tapping steps, who trembles even in summer.

Contrary to my goddaughter's definition: "People are old over 30, very old over 40", I don't feel old, walk halfway upright and don't tremble. I'm also not in a wheelchair and I'm trying to keep it that way. 

However, when I am without effective medication and/or under emotional stress, I am "severely disabled". Imagine you are standing at the bakery counter in the supermarket foyer on Saturday morning, or 10

meters away, in a line with horizontal stripes every 1,5m. All the

City dwellers who spend their relaxed weekends on Saturdays after a close

Initiate a schedule and show great understanding if a movement of the snake in front of you leads to a gap in the dimensions of the Gobi desert, i.e. more than 1 meter, not being filled by you immediately.

Why? Because you're frozen to the ground in this very desert. At the latest when the person behind you drives the shopping trolley into your heels and indicates to you that you should listen to his insults and not shout so much and then push your car out of the row into the middle, where you appear to be on display even without a pedestal, everyone feels with you... …..whether your alcoholism, dementia or other frailty.

Luckily, they cheer you up with constructive solutions: Less drink, stay at home, or simply disappear. This emotional experience stays with you until you find a way to leave the place after the longest 30 minutes of your day. This can only be topped by combining it with one

Urge incontinence at a time when you still thought of TENA as a Greek goddess. Nice weekend. 

Sure, that's an extreme scenario, but far from unrealistic.

This requires a pronounced gait disturbance, which occurs in the ON area (under sufficient medication), since more levodopa does not bring any change. This is referred to as levodopa resistance.

I.FOG—Freezing of Gait

The freezing of the passage (FOG – freezing of Gait) was defined as

“short-term, episodic absence or significant reduction in

Forward movement of the feet despite the intention to walk". Individuals with Parkinson's/pwp suddenly feel as if their feet are stuck to the ground when attempting to move forward. This usually takes a few seconds, but can occasionally exceed several minutes or longer. 

The understanding of the mechanisms of FOG is incomplete and the treatment is considered a very difficult task by clinicians. Hypotheses for the explanation according to Nieuwboer are:

a) threshold model

Compared to other pwp, those with FOG show significant gait disturbances, such as decreased step reinforcement, impaired gait coordination, and increased step time variability. This model assumes that when these motor deficits accumulate to the point of motor collapse, FOG occurs.

b) interference model

The relationship of motor, cognitive and limbic processes is both competitive and complementary. Since dopamine neurons are usually exhausted in pwp, the simultaneous processing of cognitive and/or limbic information during the motor task leads to an overload of the information processing capacity within the basal ganglia. The interference between neural processes would explain the phenomenon that increasing cognitive load while solving a dual task breaks down locomotion.

c) Cognitive model

This model emphasizes the conflict resolution deficit. Under normal

Conditions will prevent people from taking hasty action and delaying the choice of response until the conflict is resolved. In contrast, pwp with FOG fail to process the reaction conflict. They force a faster reaction decision but with less agreement, triggering FOG.

d) decoupling model

This model viewed FOG as a decoupling between the preplanned motor program and the motor response.  

These models and hypotheses explained FOG from different perspectives. Even though they are incomplete and can only partially describe FOG, it is worth noting that these models are helpful for a better understanding and characterization of FOG and provide clues for further research. More importantly, based on these models, therapies for the treatment of FOG can be developed and applied. 

II. Non-pharmacological therapy 

In addition to important and established treatment approaches, newer therapeutic strategies also seem to be effective and are being further tested with FOG.

  • Good medication adjustment is definitely helpful. For me, a holistic approach, within the framework of an inpatient stay in a recognized Parkinson's center, has proven to be useful. It is helpful that the experts in the so-called

Parkinson's complex therapy are on site and spare time for you. Furthermore, a certain basic knowledge of one's own illness helps to get the attention of the experts or to get it if it doesn't want to come by itself.

  • Positive attitude is free and at the same time priceless.

Just as we are in an area where chemical

Processes in the brain and feelings can no longer be separated with precision, the placebo effect plays a prominent role.

  • Sport and a positive body feeling are extremely effective remedies, not only for freezing. The positive attitude is automatically generated here. I recommend asking your local self-help group about Parkinson's sport. In particular, the offer of the PING PONG PARKINSON Deutschland eV (pingpongparkinson.de), makes it possible for all pwp to experience the outstanding possibilities of table tennis. Even the inexperienced player has a lot of fun.
  • According to the definition of the Dolders Institute at the Radboud UMC in Nijmegen, there are 55 types of cues, which are documented here and superbly illustrated by a subject in the Netherlands, under the pseudonym SPARKS. This means methods and tools that help the brain to initiate the gait process when it doesn't feel like it, as with FOG.
  • Physical therapy is a very important pillar in the treatment of Parkinson's. For doctors, therapists, pwp and relatives, it is worth taking a look at the "European Physiotherapy Guidelines for Idiopathic Parkinson's Syndrome". Professional organizations from 19 European countries collaborated to develop this guideline. This is an example of how highly regarded physiotherapy is in this clinical area of ​​neurological practice. 
  • Craniosacral Therapy: The handles of this emphasizes manual

Process in which the therapist uses the finest liquid streams in the

Body – they extend from the skull (cranium) to the sacrum (os

sacrum). A session usually lasts an hour and addresses the organism in a gentle way. After the application you feel more relaxed, more energetic, more alive. Since the regular

I have neither neck tension nor dizziness.

  • Deep Transcranial Magnetic Stimulation: dTMS induces electric current generated by a magnetic field altered at rest and activates cortical neurons located up to 2-3 cm below the scalp. Various studies show a positive effect, especially in Parkinson's with clear freezing in an advanced stage. A

Hospitalization or anesthesia is not required.

dTMS is a treatment option when standard drug therapy is not an option or has not worked sufficiently. A big advantage of treatment with dTMS are the very rare side effects. I will make my experiences in the next few months.

  • Vagus nerve stimulation (VNS) via TMS: In an open label pilot observational study, the effect of a non-invasive single-dose VNS on gait and FOG in 12 patients with FOG was evaluated. Video analysis showed that VNS significantly improved the number of steps taken during turning. The mechanism is still unknown. Further studies on non-invasive VNS are required.  

III. Pharmacological therapy 

There are several pharmacological treatments available that

Effective in reducing the number and duration of freezing episodes. Currently, dopamine replacement therapy with levodopa remains the first choice for FOG treatment in Parkinson's disease. 

  • In an open-label study, it was found that a 3-month pramipexole treatment as add-on therapy to levodopa or when given as a single dose, FOG significantly improved. Pramipexole as an agonist has many beneficial properties but a high potential for impulse control disorders. Switching to cabergoline was necessary for me but not helpful in terms of FOG.
  • Rotigotaine is from the group of non-ergoline dopamine agonists.

An open-label, uncontrolled study evaluated the transdermal patch rotigotine as monotherapy in untreated pwp over a 6-month period and found that the patch improved all aspects of gait, including walking straight, gait initiation and gait, compared to baseline

Rotation. Unfortunately, this effect did not occur for me. studies with

Dopamine agonists added to levodopa also found beneficial effects on gait speed with adjunctive therapy with apomorphine and pramipexole compared to levodopa alone. 

  • amantadine: A retrospective study examined pwp who received amantadine specifically for FOG and found that 10 out of 11 patients reported a subjective improvement in FOG after starting treatment with amantadine. However, two double-blind, randomized, placebo-controlled studies in 42 PD and 10 PD patients with FOG found that intravenous amantadine had no beneficial effect on FOG.

I can personally confirm this new assessment.

  • The cholinesterase inhibitor rivastigmine, which is approved for the treatment of dementia, improved pwp's gait stability and the

Number of falls reduced. Although dementia occurs in the final stages of Parkinson's disease, the disease is primarily a motor disorder. I started two intensive treatment approaches, both of which were ineffective after the initial placebo effect.

  • Opicapone is a COMT inhibitor that treats the levodopa fluctuations better and easier than the well-known entacapone, especially in end-off-dose patients. My medication includes

Opicapon, but I find it difficult to judge the effectiveness. 

  • Levodopa Carbidopa Intestinal Gel LCIG: The suspension form of carbidopa and levodopa can be continuously introduced into the intestine and the plasma levodopa concentration can be kept stable. LCIG has shown a beneficial effect on FOG with consistent findings, but it is an invasive approach that limits its clinical application to some extent.
  • CBD: Studies show that cannabinoids have a negative effect on some

movement disorders one therapeutic value own. Various cannabinoids can reduce dyskinesia and some forms of tremor and dystonia caused by levodopa in Parkinson's disease. In addition, they can Decrease in tics in the Tourette-syndrome and contribute to hypokinetic parkinsonian syndromes: My personal attempts with highly concentrated, freely available CBD oil were, however, without effect. Other pwp report good results, eg a reduction in stress levels and thus better sleep and less escalation of motor problems.

  • dronabinol is the medicinal variant of tetrahydrocannabinol

/ THC, the main ingredient of Cannabis. For Parkinson's disease, dronabinol is only available as a so-called "off-label" treatment, medically indicated and with special approval. I stopped the treatment because it was ineffective. Coincidentally, at the same time there was a survey of PwP worldwide by the well-known American Michael J. Fox Foundation, which also showed a rather weak average effect. Since we are in an area with a very relevant placebo effect when it comes to freezing, there is also an opportunity to support good faith with equally good marketing.

I have tried many of these therapeutic approaches myself, together with my very dedicated neurologist. I would like to say explicitly that these approaches all had their justification and also showed good success with other FOG-stricken pwp.

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WHAT WE SHOULD KNOW ABOUT PARKINSON'S

Mobile on all skins – assistance dog for pwp part 1 – what is that?

I. An assistance dog for people with Parkinson's / pwp

"An assistance dog for Parkinson's - what should it do for you?"

"Isn't that expensive, does the health insurance company pay for it?"

Questions that reach me immediately when I walk my dog ​​with "Assistance dog for people with Parkinson's - AZUBI" on the identification blanket. 

LEIA is still an adolescent Labradoodle with many ideas of her own, which she implements with great energy. It is therefore still a long way from being a reliable helper in my freezing phases. But one

We could both pass the assistance dog test without any problems: LEIA as the dog and I as her assistant. 

In Germany, the “assistance dog” often causes frowns, even among dog people. In the USA and even in some neighboring European countries, assistance dogs have long been thought beyond guide dogs for the blind. An assistance dog is legally defined there and has the necessary access privileges to support the partner anywhere, such as to grocery stores or hospitals.

A loving fur nose recently found its way to me through a search by an experienced assistance dog trainer in order to support me as a team partner with my gait disorders in the future. The team of pwp (person with Parkinson's disease) and assistance dog (in training) briefly introduced. Ladies first:

LEIA, 9 months, born on a farm in

Gelsenkirchen, almost with a view of Schalke, daughter of a

Labrador lady from the working line and the king poodle Bergmann. Currently 54 cm shoulder height and 22 kg and abysmal dark eyes, wrapped in the pitch-black coat of a poodle lady who played with my goddaughter's straightening iron.

Karsten, 50+, was born not far from the table tennis stronghold of Borussia Düsseldorf. Diagnosed with Idiopathic Parkinson's Syndrome for 10+ years. Despite excellent medical care, with regard to "freezing of gait" out of therapy and therefore turned to the dogs.

      

A hint, if I may be allowed here: A dog is cute, especially when

puppy and it is impressive what such an animal can and wants to achieve.

But what a dog means in everyday life, to look after it, to train it and to do justice to the animal, should be aware of before making a decision.

II. Fur nose helps 

Depending on the severity, Freezing of Gait (FOG) is a challenge even for a positive thinker like me. On some days my performance can drop by more than 90% for the whole day. Freezing is not only not being able to walk, it is also difficult to stand. Activities that you normally take for granted suddenly become indomitable. I often don't know what's worse: the helplessness I feel, the people who don't stop helping me even though it's hard enough without them, or those who look at you sadly or angrily because I supposedly looked too deep into the glass again. 

My first self-help, at the suggestion of my wife, was to use an m-scooter. This was later replaced by an e-scooter, at a time when these did not yet have a bad reputation. A very important value of this device was that I went from a drunk to a slightly whimsical person, and that pitying or disparaging looks turned into a smile. This different assessment of my fellow human beings in freezing situations decides about the hours afterwards. Will I get out again, or do I really slip into the feeling of helplessness. That this is not only of great importance for FOG, but everywhere where disability is not visible or behavior is not consistent with the external impression, I later realized when I was looking for solutions for my freezing. I came across two little girls with walking problems. On the Irish "Late Late Show" they were asked by the moderator what makes their assistance dog important to them. They named, in their words, exactly this transformation of their environment

When I searched YouTube for current Parkinson's trends, I happened to see a report on the laying out of the late US President George W. Bush Sr. There was a dog lying in front of the coffin. A so-called "service dog" who supported the ex-president with the consequences of his Parkinson's disease and had now survived his partner.

A dog that can help me walk and is happy to do so, that's it! A dog can also be used much more universally than an eScooter, has 4Motion and not just rear-wheel drive, and is much more popular. That's how I got the dog.

Many partnerships between assistance dogs and pwp show that the dog is the key to independent participation in community life.

Especially in the case of pwp who suffer from a severe form of the "freezing of gait" symptom in the advanced stage of their disease, an assistance dog, enabled through appropriate training, can make progress in an acute freezing situation possible.

Assistance dogs can also help with a range of symptoms of Parkinson's disease, from physical challenges such as unbalance with a risk of falling, to social and

emotional problems.                                                 

III. Important questions BEFORE deciding on an assistance dog

  • Can I get one despite my own illness / limitation?

assistance dog, both physically and mentally? 

  • With all the help that a dog provides, it is a living being that wants and needs to be cared for, cared for and occupied! What if I'm not at home (hospital stay, cure, vacation, etc.)? Do I have someone who can spontaneously take care of my dog? 
  • Can I afford an assistance dog? Not only is the purchase and training often very expensive, the running costs must also be taken into account (food, toys, veterinarian, etc.).
  • Do I take a "ready-made" assistance dog (external training) or do I want to train the dog myself with the support of a trainer?
  • Puppy, young dog and adult dog?
  • Where can I find a suitable and competent trainer?
  • How do I finance the training? Do I have enough financial resources myself or do I have to take out a loan? Can you find any sponsors?
  • What if my dog ​​turns out to be unsuitable during the training? Can I afford a second dog and try again with it?
  • What happens to my assistance dog if it can no longer/should no longer perform its duties due to age or illness? Can he spend his retirement with me or do I have to look for another home for him because I have a new one

need an assistance dog and can only keep one dog? 

  • Are there allergies or fears towards dogs in the immediate living environment?
  • Does the P##mP medical team approve of the dog?
  • Is the dog manageable in the long run, eg if the pwp's comprehensibility decreases or the living conditions change significantly due to the need for care?
  • Is the dog, in addition to its assistance function, also physically and intellectually sufficiently challenged?

IV. Possible assistance dog tasks

  • Pull walker/wheelchair and help with ramps and sidewalks
  • Assistance with getting in and out of the wheelchair
  • reduction of anxiety
  • Picking up dropped items and retrieving items from other rooms, a vital service to someone who is finding it difficult and/or painful to move around.
  • Pick up, hold, and carry any item shown to them until told to place it in their partner's hands. fetching items
  • Blood pressure and heart rate decrease from petting or sitting next to a dog. The calming effects of their body heat can also help relieve pain.
  • Improved balance helps with balance issues and can support their owners in place to prevent falls.
  • Good distraction from caring for a service dog gives people something to focus on other than just their illness. He helps patients develop positive routines and forces them to get up and go out. Like everyone

Dogs need service dogs exercise, so one is encouraged

Service dog requires owners to get some exercise every day.

  • Attract attention when help is needed. He can bark loudly to attract the attention of passers-by.
  • Help around the house with simple tasks such as ringing the doorbell, getting medicine, opening and closing doors and turning lights on and off.
  • Mental disorders or low self-esteem can

trigger depression. Interacting with a puppy can change these feelings. A dog can make people smile and make them feel better and others feel more comfortable around you.

My first summary, before training as an assistance dog: Labradoodles are cute, especially as puppies. Behind a languorous look that makes you forget everything, you combine all the good qualities of Poodles and Labradors. The poodle's high level of intelligence enables it to learn all sorts of stupid things very quickly and to see through the master's tricks before it even thinks of them. A first "Is he cute!", Follows the landing approach of 20+ kg cute young dog on the, only slowed down by the leash

Admirer, one: "But if he has energy - that certainly makes a lot

Work…I have to keep going.”

"She's still young." / "It will grow out of it." / "With the right one

Training," / "It's puberty." / "She just wants to play."

I believe all this to report and benefit from a fully trained assistance dog in a year's time, like the pwp from Dublin in the example below.

"It'll be fine!"

V. Example assistance dog for pwp from Dublin

A father of two with Parkinson's disease says his life has been transformed by having a dog that helps him with mobility and stability.

The Dublin Neurological Institute (DNI) pilot at Mater Hospital is a first for Ireland at least. While dogs have previously been trained as companions for pwp, this is the first specifically for the

mobility, stability and gait support.

Result: “This is the best treatment to improve my quality of life of all the treatments I have received for Parkinson's in the last 17 years.” He added: “When I used to go, people always thought I was drunk or on drugs. Now they just smile. We both walk more than six kilometers every day.”

Parkinson's is a long-term neurological disease that occurs in Ireland around

8.000 people are suffering. It affects the way the brain coordinates body movements, including walking, speaking and writing. While there are a number of treatment options available to manage the disease, there is currently no cure. Consultant neurologist Professor Tim Lynch from the DNI wanted to try something different to help the sufferer. “While HE has coped well with his Parkinson's disease over the years, he has

Problems with his feet getting stuck on the ground and freezing. So we had the idea that an assistance dog would be a support to avoid falling. Secondly, it could give a nudge to the leg that is frozen and act as a starting signal for the foot.” The consultant neurology professor from the DNI, who is leading the pilot, contacted the Cork-based charity Dogs for the Disabled. This trains dogs to support a variety of people with disabilities.

The charity's CEO said: “It's the first time we've worked with a Parkinson's patient. We selected and trained a dog based on an assessment of the PwP's needs, wants and personality type.

“It is a strong dog, a great worker, with real drive and determination. He's really developed well and it's just amazing to see how happy they are together." This is the first dog in Ireland to be specifically trained to support mobility, stability and gait.

Technical researchers have performed a gait analysis by

Have sensors attached to both. “Through these scientific measurements and using psychological tools, we are trying to prove whether there is a difference in gait.

“As far as we know, this is the first long-term study of a Parkinson's patient with a dog trained specifically for him. It would be very exciting if we could scientifically prove that this is beneficial for them,” said the supervising doctor from the DNI. The data collected during the project will eventually be published so that more stability dogs can be trained. “My dog ​​is like a part of me at this stage. I don't go anywhere without him. He takes care of me and I take care of him,” he said.

Originally by Philip Bromwell

         

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 WHAT WE SHOULD KNOW ABOUT PARKINSON'S

Mobile on all skins - assistance dog for pwp part 2 - training

  1. How do I get an assistance dog?

At the beginning there is the search for a suitable puppy. Not every dog ​​is suitable for training as an assistance dog. Factors such as the dog's confident nature and individual talents play a major role here. Ultimately, the dog can turn his hobby into a job. the

Ideally, an assistance dog school will search for the dog. 

For example, Leia is a Labradoodle, a cross between an intelligent standard poodle with little shedding and a will-to-please Labrador who just loves to serve his partner. In addition, with a shoulder height of approx. 55 - 65 cm and a weight of approx. 25 - 30 kg, she will be strong enough to support me or help me up.

When on duty, an assistance dog should present itself as follows:

  • Calm demeanor and not easily frightened
  • All four paws on the ground at all times
  • Good with toddlers, adults and other pets
  • Good behavior in public i.e. no jumping, barking, snapping, licking, begging and being aggressive

Have people or other dogs retrieved without confrontation

  • Has mastered basic training (sit, stay, come, heel, etc.).
  • Knows public places and means of transport
  • Commands are executed quickly and quietly
  • Always makes a neat and clean impression
  • Recognized as an assistance dog by an identification blanket
  • Good leash handling
  • Appropriate size and strength for the intended tasks
  • Enjoy working with your partner
  • No musculoskeletal restrictions
  • No organic diseases
  • Complete health examination of the dog (at the age of approx. 12 months after completion of the main growth phase) by a competent veterinarian.

For the assistance dog handler this means: 

  • dealing with other people in the most friendly way possible, informing ignorant people as factually as possible
  • understanding and as accommodating as possible in dealing with people who are afraid of dogs or who need / want distance from animal companions for other reasons (e.g. allergies)
  • People who treat you with great respect or even dislike

assistance dog should react with understanding and friendliness. This person may have a pronounced fear of dogs, has even been bitten before, or they suffer from a dog allergy. Perhaps you are facing a service dog team for the first time and have no idea how important the dog is to its owner. 

An assistance dog also has the express right to take care of its puppies and dogs

to enjoy young dog time. After the first year of life, in which essentially basic general behavior is trained, the special training begins. The dog is slowly introduced to its later tasks.

II. Alternative 1: self-education with training support

In the so-called self-training, the training goals are defined together with the dog school and trained in weekly training sessions. This prevents errors from creeping into the training. When the dog moves in with its partner early on, the bond between the team is built up and strengthened in a targeted manner right from the start. Another aspect of self-education is that the dog does not have to change homes. He grows into his later task right from the start. For the pwp, the training means intensive work and a lot of discipline on the one hand. On the other hand, it is a lot of fun to experience the progress of the training directly. The cost of training is about 30% of the cost of one

foreign training. The risk for character and health

Suitability and the correct way of working of the dog are the responsibility of the owner. Above all, it should be noted that especially when training puppies, the health suitability can usually only be tested at an age of about 12 months. Should the dog then prove to be unsuitable, the owner is left with the previous expenses and costs. Furthermore, it is then necessary to consider whether the dog

family dog ​​can stay with its owner and a second dog starts training, or whether another home has to be found for the first dog, since the owner can only keep and care for one dog.  

III. Alternative 2: external training

External training describes the complete training of the dog by a trainer. During his 2-year training, the dog has no contact with his future partner. After completing the training, there is an extensive induction phase with the pwp, for whom the

dog is intended. The young team then completes the team test after the induction period. A longer waiting time of at least 2-3 years must be planned for this training variant. It takes time for the dog to be found and trained. Due to the high expenditure of time, the medical care and care of the dog on the part of the training facility, the costs for this form of training are significantly higher than the costs of self-training.

IV. Cost example (self-education)

Unfortunately, the costs of training an assistance dog are not covered by health insurance (exception: guide dogs for the blind). So you have to see for yourself whether you can pay for it out of your own pocket or whether you can get donations or financial aid.

position education alimony 

Buy Puppy                   1.150 €
Veterinary costs before delivery   320 €
Early education with the coach                                        1.600 €  320 €
Basic equipment                      500 €
Dog food, chews, games…                      1.500 €
Liability insurance                        90 €
surgical insurance                      400 €
Vet expenses holder                      800 €
Dog tax                      220 €
Basic training assistance dog                                4.900 €     
group school                                                              1.600 €     
Assessment of fitness for service                      250 €
Specialist training as an assistance dog                                  5.500 €     
final exam                                                             500 €   
Training period (1,5 years)                                       14.100 €                5.550 €
Dog food, chews, games…                      1.400 €
Liability insurance                        60 €
surgical insurance                      300 €
species costs                      500 €
Dog tax                      140 €
retraining                                                                1.100 €     
Term of Service (per year)                                                     1.100 €               2.400 €

Education + maintenance for 10 years: €49.400                             

V. Exemplary examination requirements for an assistance dog

 

  • Control: The assistance dog should respond 90% of the time to every command at the first request, with and without a leash. This includes the basic commands (“sit,” “stay,” “come,” “down,” “heel,” and recall from the leash in a store in response to commands or hand signals) and the tasks learned. Not loosening yourself inappropriately in public: When on duty in public, an assistance dog should only be released on command and, if possible, on green spaces.
  • Don't sniff: On duty, assistance dogs are not allowed to pass by others

Sniff people, bags, goods in the store, shelves, counters, lanterns, fences, grass, bushes, trees or the ground. In his free time, he can sniff as much as he likes to compensate.

  • Stay close when freewheeling: A service dog should remain close by and controllable at all times, so when roaming freely it should not stray more than ten meters from its partner and stay on sidewalks.
  • Loose leash: If a task z. B. with PTSD assistance dogs, does not require the opposite, the assistance dog should always walk on a loose leash and not run ahead. He should focus on his partner, ignoring other customers, clerks, or people trying to entice, whistle, or snap his tongue. He also has to ignore flying leaves, balls and children playing.
  • Ignore edibles: In public encountered the

Assistance dog often eats on the floor. Whether a piece

Sausage rolls on the footpath or someone at the table next to you in the restaurant drops something, he must ignore this.

  • Gelassenheit: The assistance dog must tolerate acoustic and visual stimuli and strange smells.
  • Don't beg: No matter whether in the supermarket at the sausage counter, when walking past on the footpath or when queuing at the checkout. The service dog should not beg for pets, attention, treats or food from its partner or other people.
  • leashed: When the service dog enters public places, it should always be leashed.
  • Bus, train, elevator: Every assistance dog should be without fear

Use the elevator and behave appropriately while in the elevator. This includes checking and only getting on and off on command, not bothering other passengers and not sniffing at passengers.

  • stairs: When climbing stairs, service dogs should step up and down in step with their partner and should neither lead nor lag behind.
  • Seating & Standing places: When on duty, the assistance dog may only lie in front of or next to chairs, benches or seats and may not lie or sit on them.
  • substrates: The assistance dog should willingly walk over any surface that it encounters on duty, even reflective or smooth tiles.
  • Cars: Getting in and out should always be controlled and only on command.
  • Public toilets: In public, the assistance dog should be able to be taken to the toilet and behave calmly there. In particular, he should not attempt to look under the wall in the booth, run away, or make vocalizations from

give yourself While washing his hands, he should remain seated or remain seated until his partner picks up the leash again. To ignore: If the assistance dog encounters other dogs or people on duty, it must not pull them towards them, but must walk past them on a loose leash and ignore them. On command, if the partner so desires, individual dogs or people may be greeted.

  • Doors: The assistance dog must not storm through doors in public, but must pass through them in a controlled manner on command.
  • Buildings: The service dog should be with its partner at all times and should enter and exit every building together with the partner.
  • Restaurant: In the restaurant, the assistance dog should behave calmly and either lie down under the table or next to its partner in a stay-place position. He is not allowed to put his head or paws on the table. If crumbs or food fall down, don't pick it up and ignore it.
  • Airplane: On the plane, the assistance dog should not attract attention, make no vocalizations, do not block paths in the cabin and should not occupy the foot space or the seat of other passengers.
  • Strong distraction: Even in hectic, busy and noisy places where there is a lot of distraction, the service dog must be able to work and carry out commands.
  • Unforeseen: At all times, the assistance dog must remain friendly, controllable and follow commands. In everyday life, the assistance dog must be non-aggressive.

VI. Collection of tasks for assistance dogs

On call

  • Pick up fallen objects such as coins, keys, etc
  • Lay out underwear, shoes or slippers anywhere to help with dressing
  • Get towels and other items out of the dryer
  • Get your wallet out of the hallway, dresser or trunk
  • Clean-up help: Pick up, carry, put down certain items
  • fetch a basket with medication and/or drinks from the cupboard search & find teamwork - the dog with hand signals or

Guide vocal signs to retrieve within partner's reach

  • Retrieve items targeted with laser pointers
  • Pick up or fetch walking aids
  • Get a walker or wheelchair

Wear

  • Moving buckets from one place to another, indoors and out
  • Carrying buckets of items around the house
  • Carry objects down or up the stairs
  • Bringing items from the partner to a caregiver or family member in another room
  • Send dog to get food or other item from caregiver and return with it.
  • Dog carries a previously agreed object to the caregiver as a signal that help is needed
  • Carrying items behind a partner using a walker
  • Paying for purchases at high counters

Bringing goods in a bag from the seller to the wheelchair user 

Carrying mail or newspapers into the house 

Putting rubbish, direct mail in wastebasket or dustbin

  • Throw empty cans or plastic bottles in the recycling bin
  • Help your partner fill the washing machine
  • Dirty [dog's] food bowl - put in the sink
  • Put cutlery, unbreakable dishes, plastic glasses in the sink
  • Put items in the “Closet”.
  • Place dog toys in the designated container
  • Place prescriptions, mail, and other items on the work surface

Pull

  • Opening cabinet doors, drawers, refrigerator door or interior door with a strap or suction cup device
  • Assistance in removing shoes, slippers, sandals
  • Take off socks without biting your foot
  • Take off pants, sweater, coat
  • Heavy coat, lugging other things in the closet
  • Drag the laundry basket around the house with a strap  
  • Drag bedclothes to the washing machine
  • Pull curtain cord to open or close curtains

nose poke

  • Close the cupboard door or drawers
  • Close the dryer door firmly
  • Close the stove drawer  
  • Dishwasher Door - Place snout under door to close
  • Close the refrigerator and freezer doors by pushing them

pressing a doorbell

Operate the light switch

Operating a foot switch for lamps

  • Switching metal lamps with a touch lamp device
  • Helping the wheelchair user to get back into a sitting position if they have slumped
  • Place the paralyzed arm back on the wheelchair armrest
  • Placing the paralyzed foot on the wheelchair footboard if it has shifted
  • Press the floor pedal to turn on devices or lights
  • Operate elevator buttons with one paw, or on electric doors
  • Close heavy front door and other doors - jump up, use both front paws

mobility aids

  • Transfer Aid from Wheelchair to Bed, Toilet, Bathtub or Van Seat - Holding the standing aid to allow partner to maintain balance during transfer
  • Step walking assistance, standing assistance between steps, from wheelchair to nearby seat
  • Assistance with moving the wheelchair in the apartment
  • Open heavy door by pulling the door handle with a leash attached to the harness
  • Help able-bodied partner on inclines or when climbing stairs
  • Pull partner out of airplane aisle seat, then brace until partner finds balance.
  • Help partner walk with a rigid grip, like a stick

emergency situation

Bark for help on command

Find and fetch supervisors on command

Place front paws on the wheelchair user's lap to maintain an upright position so that the partner can get the mobile phone or a backpack, for example

  • Wake your partner up if there is a smoke alarm and accompany them to the exit

medical duties

  • Pressing the emergency call button to alert an emergency service
  • Guide emergency personnel to the home of the partner's location
  • Get an insulin set or emergency medication from your usual place
  • Resting your head on your partner's chest to provoke a cough or stimulate breathing

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WHAT WE SHOULD KNOW ABOUT PARKINSON'S

 On all skins mobile - assistance dog for pwp part 3 - legal

I. EU law

The European Parliament changed (March 06.03.2009th, XNUMX) the guidelines for the application of the principle of equal treatment, so that guide dogs and assistance dogs are treated equally.

"(12b) Effective non-discriminatory access can be ensured in a number of ways, including through the concept of 'design for all' and by facilitating the use of assistive devices for people with disabilities, including mobility and access aids, such as recognized guide or assistance dogs.”

II. German law

The guidelines of the European Parliament also found their way into German politics in 2017 and so the Bundesrat on February 10th

2017 (at its 953rd session) determined that by amending § 33

SBG V the possibility should be created to include assistance dogs in the list of aids (according to § 139 SGB V).

In addition, legal requirements are to be created so that assistance dogs can be entered in the severely disabled ID card. And the need for nationwide uniform quality standards for assistance dogs was also identified.

III. And what about other EU countries?

As a direct neighboring country, Austria has in § 39 of the

The Federal Disability Act (BBG) regulates what is meant by assistance dogs, but also what requirements must be met in order for a dog to be called an assistance dog.

To specify the law and criteria and requirements

The Federal Ministry of Labor has to clarify assistance dog teams,

Social, health and consumer protection guidelines for assistance dogs, which came into force on January 1st, 2015.

However, this system also has its flaws, mainly due to the rigid ones

Examination criteria clearly not related to the individual needs of the

concerned. In addition, this law does not clarify the question of financing Austrian assistance dogs.

IV. Examination/proof of an assistance dog in Germany 

Since 2013, §11 of the Animal Welfare Act has stipulated that institutions that train dogs with or for third parties must be officially approved and require proof of expertise. Any institution

(Training center, dog school, trainer), who has the required trainer license/expertise according to §11 of the Animal Welfare Act, can and may train assistance dogs, examine them and issue accompanying documents for the dog. 

Uniform legal regulations/minimum standards for the

However, there is currently no training/testing of assistance dogs in Germany. However, according to the Federal Government, these are in the works, which is why it is all the more important to look for a reputable and competent trainer who can train a prospective assistance dog team so well that they can also pass an “official” examination that will be introduced later in accordance with the then valid legal Specifications can pass without problems. 

In addition to the accompanying document/proof of training, other helpful documents for taking an assistance dog with you can also be a severely disabled person’s pass and a medical certificate confirming the need for the assistance dog. 

Can an assistance dog go everywhere (supermarket, cinema, doctor, etc.)? 

Theoretically yes, according to various paragraphs from the social code books

(SGB), the General Equal Treatment Act (AGG), the

Disability Equality Act (BGG) and the UN

Convention on the Rights of Persons with Disabilities (UN-BRK) and according to the

The Federal Government Commissioner for the interests of people with disabilities must be provided with barrier-free social services (this also includes help from animal assistance). This means that assistance dogs can accompany their human anywhere. 

Practice shows, however, that this is difficult even with a guide dog and even more so for other assistance dogs.

V. Other rights of service dog handlers

The leash obligation, for example, is not based on federal but on

decided at state level. For this reason everyone should

Assistance dog handlers take a look at the state dog law applicable in their own state. 

Example LHundG NRW: § 17 exceptions from the scope 

With the exception of Section 2 Paragraph 1, this law does not apply to service dogs

Authorities, rescue service or civil protection dogs and guide dogs for the blind. For Disability Assistance Dogs, herding dogs and useful hunting dogs are not subject to the statutory leash requirements when used. 

Download document as pdf

The following players have signed up so far:

Maria Kolbinger, Sven Trautner, Juergen Zender, Rodrigo Antunes, Ruth Eisinger, Catherine, Ruediger Ott, Reinhard Kaltenegger Ulli Heydt, Ernst Hillenkamp, ​​Armin Galsterer, Franco di Lena, Katharina Schmidbaur and 3 more people. The course is fully booked.

Latecomers can theoretically decide up to one day before the start of training, provided there are still places available. The registration then takes place directly via the website of the provider. There you can also see whether there are still spaces available.

Active training takes place for 2 hours in the morning and 2 hours in the afternoon. In between, the tables are available for free play. 

Further information from the organizer:

We have been organizing our weekend courses in Munich for over 20 years. Milbertshofen is a district in the north of Munich and is easy to reach by public transport.

Dates 2 days = 8 hours 1 day = 4 hours
12.11.22-13.11.22 80,00 € 50,00 €
10.12.22-11.12.22 80,00 € 50,00 €
  • Participation also possible on a daily basis
  • Please book accommodation yourself
  • You will be informed of the start of the course by e-mail in the week before the start
  • Payment is made on site
  • Venue: TSV Milbertshofen, Hans-Denzinger-Str. 2, 80807 Munich

We offer:

  • System training – you practice in a group adapted to your skill level. Each trainer is responsible for a maximum of 6 tables and can therefore effectively supervise all group members
  • “Ball bucket training” (individual training with lots of balls) – intensive and targeted individual training with lots of balls
  • robot training
  • Sparring partner (for larger courses)
  • Play with and against pimples and anti top
  • A great atmosphere, both in training and outside of training
  • Stretching
  • material advice

The breakdown of the focus by days:

In the course of a course, all hitting techniques are basically demonstrated and practiced systematically. Since everything is not possible in just one day, we divide the priorities as follows:

Course 2 days

  1. Tag: counter hits, topspin, block, footwork
  2. Tag: serve, return, flip, shot, balloon save 

Overview of the availability of free places

Registration Form

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