Batman Brian

I have spent the last week in Altea in Spain attending a Table Tennis coaching camp for People with Parkinson’s (PWP). This was the first European camp of this type that I know of and it is the intention of the organisers to make this a regular event. In this blog I have tried to describe this event in an accurate and informative way, with particular emphasis on the Parkinson’s aspects.

Note: I describe some aspects of medication adjustments I made during the week and why this was necessary. These changes were a personal decision for me and should not be read as typical, although they may be similar to what other PWP have been doing this week.

Travel

I consider myself a seasoned traveller after many years travelling while I was working and taking regular holidays abroad, notwithstanding the limitations recently due to the pandemic. However travelling alone, particularly as I have Parkinson’s introduced a level of anxiety, and self doubt I have not previously experienced.

What if I have the wrong documents, or have completed them incorrectly, or lose them? What if I press the wrong buttons at the baggage check in machine? Do I have enough medication, what if it is wearing off when I get to the passport check on arrival, will I be able to find my transfer point at Alicante Airport? Should I have asked for airport assistance when booking my flights? Will I get through the flight without any permanent scars from having to watch, listen to and suffer the impact of the many stag and hen groups surrounding me, some of who would not feel out of place in a zoo!

Thankfully everything went smoothly but these are some of the challenges I faced and now when I think back I intend to ask for assistance for future travels. This was probably a pride issue for me personally but I need to get over that and be able to ask for and accept the help available, and not just when travelling.

Wearing Off- what does this mean?

Motor fluctuations usually happen when levodopa (medications used to manage Parkinson’s symptoms) is wearing off, but they can happen at other times too.

In ‘wearing off’, symptoms may re-emerge when medication is due to be taken. This usually occurs near the end of a medication dose, or near the beginning of the next dose. It indicates that medication is not working as well, and needs to be reviewed.

Sometimes the effects of wearing off happen quickly – this is called ‘switching off’ or ‘on/off’.

Being ‘on’ is when a person’s symptoms are controlled and when they feel at their most capable. Being ‘off’ is when Parkinson’s symptoms come back and affect them the most.

In the early stages of Parkinson’s, you may not notice when a dose of levodopa begins to wear off. But as Parkinson’s progresses, some people find that a dose doesn’t last as long as it used to, so fluctuations can become more unpredictable.

In my case I experience wearing off for around an hour before each dose. Currently my doses are 4 hours apart. I have discussed this with my neurologist and told him I am content to “manage” these wearing off periods and that I do not want to increase my medication dose to reduce wearing off periods at this time. My reasoning is that I want to keep some “headroom” for increasing my dose of medication when my condition worsens. He is in agreement with this but we will increase my dose if my wearing off becomes unmanageable.

Altea

Accommodation

All the participants in the training camp stayed in the same hotel, or Athletes Village as I called it. This was ideal as we all had breakfast, lunch and dinner together and travelled mostly together back and forward to the sport centre used for the sessions. This meant we were not only playing TT together but also eating our meals together, and in some cases having drinks together immediately after retuning from a playing session or after dinner, sometimes both. This made for a relaxing atmosphere and allowed us to bond as a group and get to know each other. I have many new friends as a result and have learned so much about how others are managing this condition.

TT Venue

The camp was based in a local sports complex the Union Deportiva Altea Sports Club. This is a massive municipal arena with seating for hundreds of spectators. Only part of the facility was needed for the TT camp and there were 12 TT tables set up for our use. The centre is located 800 metres from the hotel and most players walked back and forward each day.

The Table Tennis

Coaches

The coaches Marcus Sjolberg, Anton Åkesson and Pelle Hagelland were also in the same hotel, Sara Ramirez lives locally but did join us each day for lunch and all four were a key part in the success of this camp. Individual sessions were mostly with Marcus, Anton or Sara, and Pelle did a superb job of walking the floor making sure everyone had someone to play with, offering advice and encouragement and stepping in when one player needed to rest to ensure no one was left out.

Schedule

The agreed schedule was that we would play from 10:00 to 12:00, return to the hotel for lunch and then play again from 14:00 to 16:00 each day. On day 2 because of the enthusiasm of the participants we started turning up at 09:15 and in some cases playing until 17:00. Therefore on some days we were playing for six hours.

Throughout the week every player had numerous one to one sessions with coaches where got the opportunity to work on specific aspects of their game. At the start of these sessions the player was asked to state what particular aspect of their game they would like to work on and this was then “coached” to help them improve, mainly using the multi ball technique (non TT players may need to google this).

During my sessions I worked on forehand top spin when receiving top spin and back spin balls, backhand, blocking, serving, receiving serve to name but a few. We also played many games with opponents of similar abilities where we got the opportunity to use what we had learned in the coaching sessions. The objective was not to win the games but to practice what we had learned in a match scenario.

Repetition is often used in TT coaching as a way of refining particular shots and improving consistency. As you can imagine this was a great opportunity to use this method having so much table time over 5 days with a variety of practice partners. Repetition is also used in other Parkinson’s focussed exercise types as a method of assisting with Neuroplasticity . Neuroplasticity refers to the brain’s ability to reorganise itself both in its structure and how it functions. The brain continuously creates new cells (neurogenesis). New findings suggest that intensive, challenging, repetitive and cognitively demanding exercises could induce neuroplasticity in PD. TT fits into this group of exercises.

On Thursday we had an afternoon off to relax and explore Altea. As I had explored in my two days of “acclimatising” before the camp started I decided to relax by the pool in the sunshine, where I was joined at various times by different members of the group. This break was well received as an opportunity to relax and rest weary our bodies.

Participants

Although there were many levels of TT ability across the group I think I played with every single player at some point during the week, some more than others and during these sessions if there was a “stronger” player then they would tend to provide advice to their opponent. Special thanks from me to Jesper Jerslund who spent to time helping me to read spin from opponents serve, and almost managed to hide his frustration well when I got it wrong. 😂

Dealing with our condition

As you can imagine playing sport for six hours a day for a week would be a challenge for most, but factor in that everyone playing has Parkinson’s then a whole new set of issues become part of the equation. Players got fatigued and had some minor aches and pains, more so as we progressed through the week. The biggest challenge though, certainly for me was managing my medication and fatigue to get the maximum benefit from the week. I needed to be flexible in both the timing of taking my medication and in some cases in the dose taken.

The timing adjustments were made to ensure I minimised my off times to prevent these from excluding me from sessions, or from reducing my flexibility and coordination while playing. Level of dose is a different issue. While exercise is recognised as part of the Parkinson’s treatment regime to help movement and is quoted in some areas as helping to slow progression of the disease, this is more of a long term strategy. In the very short term, certainly in my case and in those of others I have discussed this with, vigorous exercise can accelerate wearing off and cause severity of symptoms to increase. This is very short term, mainly in the period when the exercise is being undertaken and immediately after, and to combat this my doseage levels were adjusted upwards at certain times each day. On completion of the camp I have reverted to my previously agreed dose.

Summary

This has been a great experience that I would not hesitate to repeat. It has been challenging at times but everyone involved accepted this head on. A week in the Spanish sunshine (well mostly sunshine), playing TT with a group of people who have a degenerative disease but refuse to let it define them and who have found an activity they love. What’s not to like about that. I have made many new friends, got to know some who were already friends better (Joy and Stephen) and will see most if not all of them again as we continue our Parkinson’s TT activities in Germany, Portugal, Croatia and the UK this year.

Has my game improved as a result of this week’s activities? I hope so, but time will tell as I get back to playing in my regular clubs in Scotland when I get home.

However, the answer to that question is not what is important. What is important is the experience I have had this week, what I have learned and shared, the friends I have made and this fantastic Table Tennis movement we are all a part of.

Brian Carson