Dr. Jon Doan

May 2015


In our third installment of the series, we introduce you to Dr. Jon Doan.  Dr. Doan is currently an Associate Professor in the Department of Kinesiology and Physical Education at the University of Lethbridge.  Dr. Doan’s research combines mechanical and biological engineering with kinesiology and neuroscience to focus on measuring and interpreting the interaction of human perceptions and actions at work and at play.  His current research explores two main topics: 1) perceptual basis of occupational over-loading and soft tissue injury, and 2) exercise therapy and biomedical devices for neurorehabilitation amongst people living with Parkinson disease.


Parkinson Association of Alberta (PA):  Why did you choose to pursue research as it pertains to Parkinson's disease? How did you end up in this field?


Dr. Jon Doan (DJD):  I had always planned to go back to school and do my PhD and I had a really great opportunity at Lethbridge to work sort of at the intersection of Kinesiology, Phys Ed and Neuroscience with Dr. Lesley Brown from the kinesiology side and Dr. Ian Whishaw from the neuroscience side.  That pair of mentors really enthused me about research with Parkinson disease; they had a wonderful goal and underlying theory which was not to focus on the motor deficits that may exist with Parkinson disease.   Instead, we focused on researching the skills it persisted in, what those persistent skills look like, and what they could tell us about roots for neuroprotection, neurotherapy and neuromanagement of Parkinson disease.


PA:   What is the current research question you are trying to address and why?


DJD:   Our current research focus is in the neuroprotection area and looks at the benefits or the possibility for vigorous exercise as neuroprotection for people living with Parkinson's; with our specific form of exercise being ice skating.  Our interest there is in two parts.  There’s a big picture and there's a little bit of a smaller picture.  


The big picture is that ice skating has biological, psychological and social parts that we think could all benefit people living with Parkinson's.   Certainly, the biological part is just the exercise effect on the brain, neural networks and performance.  The psychological benefits for exercise we know about are increased emotion, the feelings of exuberance we get from exercise.  They are all interesting for us but the social part is the one that we think is uniquely Canadian.   


PA:   How so?


DJD:   So many small towns have an arena as their town center.   This is a great opportunity for us to get people living with Parkinson disease back to that town center, maybe with friends, maybe with family, and out for a skate.  That is great for a patient who lives in rural Canada who may not have equal access to neurologists or even an exercise therapist or some of the things that we may have in urban Canada.   So we thought that the social piece of skating is unique for Canadians and maybe quite beneficial.


PA:   That makes sense.   I'm going to ask what I’m sure some people will be thinking…isn’t ice skating dangerous for people with Parkinson’s?   While I now know that is not the case; it is what I thought the first time I had heard about the research you were doing with skating.  Can you talk to that a little bit?


DJD:   Yes, the skating idea started, or the interest in skating, started for us with the Oprah Winfrey show.  Several years ago, Michael J. Fox was on Oprah Winfrey talking about his life with Parkinson's and his many successes pre and post diagnosis.  As part of that, he went out for an ice skate with Dr. Oz and he dropped the line, "The amazing thing is that I skate better than I walk."


I'm not a regular Oprah watcher but my mom is and after that episode she called me up and said, "John, did you see Oprah today?"  I hadn't had a chance, but I tracked down the episode and agreed with Michael J. Fox, he really did skate better than he walked.


Not long after that we were at a Parkinson Association of Alberta support group in Lethbridge giving a talk about our research (that was taking place) at the time and I mentioned the ice skating piece  and said we were interested in seeing if anyone tried ice skating.  Two of the young onset patients in the group said that they felt that that would be something they would be interested in.   So I got them out in the ice along with a couple undergraduate students from the University of Lethbridge and it was true--they skated better than they walked!


PA:   Wow! Why do you think that is?


DJD:  There are some deficits in Parkinson disease that you just can't do in the ice -- the limited arm swing, the small and shuffling steps.  If you do those things on the ice, you don't move.   So skating and the fact that they are on the ice prompted bigger arm swings, bigger steps and greater locomotion velocity.


When we get participants out on the ice we look at their pre-skating walking, their skating and their post skating walking.   We've had people skating through and walking through a doorway to see how the skating affects their freezing.  We've done some stick handling as well as see how bringing in puck handling along with the skating could influence activity and it all looks pretty positive. The part about the skating that we like so much is that there is a lot of transfer to a lot of the activities of daily living. It is balance challenging and requires the arm swings and big big steps; and if we can get people exercising inside those models, we think we're re-networking, redeveloping and/or reinforcing those motor skills that can carry over to walking, improve balance and other activities on regular terrain as well.


We went from there and said, "Let's try this in multiple places," and since then we've worked with patients through BC, multiple areas in Alberta, in Saskatchewan and Ontario.


PA:   We hear from some of our clients that activities they used to when they were younger or actively pursued as an adult seem to be a little easier to accomplish even after living with Parkinson's. Does muscle memory have a play in that or not really?


DJD:   We're not teaching anyone to skate. We're only working with people who have experience in skating and people who have experienced skating. We're thinking about this as sort of a paradoxical persistence, almost like paradoxical kinesia where we see a patient who is frozen by the stimulation of often a negative event, a burning building or an emergency situation gets them out of a frozen state moving fluidly for a little while. We think in skating there is this positive paradox. Exposure to the ice and visual stimulation of skating seems to activate this persistent neural network, this ability for skating. It's been fascinating. We've worked with people all across the country now and have met a number of patients who continued to play high level hockey, organized hockey or skate. But, we also found a number of people who used to love skating or hockey at some level. Players, coaches, people who liked to skate with their kids but unfortunately, since the diagnosis had given up that activity.  We reminded them of how much they liked it and when we got them back on it we found skillful and smooth skating.


PA:   Incredible. So there is a renewed confidence once they realize that being able to do something they still love is still possible.  I'm sure there are a few adaptations that need to be made, but it's a confidence booster as well, which plays into social and psychological well being.


DJD:  Absolutely. We certainly insist everyone wears a CSA approved helmet.  We've had multiple participants who are amazed that we're doing this and they are often joined by a significant other, spouse or a care partner who is equally as amazed.  The stories from skating are endless. We've had people who 20 years ago played hockey at university. They show up with the same 20 year old equipment and they're skating around easily and ably. It really does remind them of what they loved to do.


PA:  How do you envision your research benefiting the Parkinson's community at large?


DJD:  We think skating in and of itself could be this vigorous exercise that has the biological, the psychological and the social benefits that could help patients who participate in skating.  We're also interested in what makes the skating this positive persistent paradox.  Currently our research suggests that maybe it's the visual flow, the sensation of the world moving by more rapidly. We're testing a grad student with inertia, working on the visual sensation of skating. Showing people a simulated first person perspective video of skating to see what that does to one's motor skills. Not actually skating, just standing but with the visual sensation of skating.


It could be quite powerful or useful for people who have experience skating.  Understanding that theoretical piece may also give us a virtual reality version or a version that we could use for people who don't feel comfortable getting on the actual ice. We said, "Well, let's give you this exercise program that takes place on regular terrain but that's supplemented by this visual sensation that gives you better pause or control activated motor system."


PA:   Interesting, then theoretically, even from a virtual perspective, there could be potential for people who physically couldn't get on the ice anymore either -- may be a little more advanced in their Parkinson's where they could still get some benefit?


DJD:   Absolutely.


PA:   Were there any unexpected challenges that you've come across while performing your research?


DJD:  There have been lots of challenges.  Certainly, when we mention ice skating and Parkinson's patients together in the same sentence, we get a lot of dubious looks.  Parkinson's is well known as having balance challenges, high frequency of falls and of course getting on the ice increases your risk of falls as well.  We frequently need to emphasize that Parkinson's isn't exclusively a disease of older people; it affects people across the age ranges.  Our research targets young onset patients, moderate patients and people with experience in ice skating.  When we think about exercise therapies we need to start developing things for young onset patients as well.  It's a problem if they fall through this gap of only having support mechanisms set up for an older patient population.


PA:   Do you think if people who had been diagnosed got into the habit of being active early on it could carry on and keep you motivated because it has always been a part of your Parkinson well-being?


DJD:   Absolutely we know some people love escape and there's no reason for that love of skating to stop when you are first diagnosed with Parkinson disease or when you are several or multiple years into the course of Parkinson's as well. It's a behavior that we think would be beneficial, could be safely done and seems to holds more promise for neuroprotection.


PA:   What are your thoughts on moving forward in the future with this research? How do you see it playing out?


DJD:  Our next step is to test it as a full intervention. We've sorted down single-visit testing right now; and in order to validate it with an accurate number subjects, we traveled to the subjects. We've travelled to many different sites to try this out. Now, we'd like to turn that into an intervention where we give interested participants basically a power skating for Parkinson's program to carry out at their local arena.  We'd "prescribe" a certain number of times per week for a certain number of weeks and we will test them pre-intervention, mid-intervention, and at the end of that intervention to see what is being done inside a longer term which would really be a goal.


Given that arenas and rinks exist in small and big communities, we would certainly be interested in looking at rural advantage here as well. For our people with Parkinson's in rural areas, is there a specific benefit there? Can we do remote work with them as well?  Maybe there's an activity monitoring that we could do when they're skating. We've actually done a little bit of preliminary work with Reebok and with an activity sensor company  about making some instrumented skates whereby we can get that information back to our lab that lets us know "Hey, whoever had these skates went out skating this number of times. Here's what the size of steps they were making, here's what they did."


This is also really parallel with the music and walking study that we're working on at the University of Lethbridge now. The Ambulosono project is where people walk a prescribed number of times per week and they receive a musical stimulus as long as they're walking at the prescribed rate. We'd like to do the same thing with the skating. Feed some music up through a helmet that comes from these sensors in the skates; and as long as you're skating at the right rate, you're going to get this musical stimulus that helps encourage your skating. The when we got the data back we could track how much skating they did and how much better it got.


PA:   I really like the rural concept, because we all know not everybody -- especially in a country as big as Canada, a province as massive as Alberta -- has access to the same sort of activities. Most Alberta communities have a rink, be it an outdoor one or an indoor one.  And, depending on your mood or personality, skating can be solitary or something that can be done in a group.


DJD:   In small town and big city Alberta, the rink is often the center of the community.  It is where many patient's kids or grandkids may go for hockey or figure skating.  It's where their friends may go for a leisurely skate and a coffee and it is where we can get patients back to making these social connections, interacting with friends and family and getting this vigorous exercise.


PA:   So a little more personal, what do you enjoy about your research and your job?


DJD:   Well, it's a great question. For the research, I really enjoy combining two of my passions. I have a passion for science and I have a passion for skating. University of Lethbridge has given me the authority to really research whatever I want and I happen to be interested in people living with Parkinson disease, the mechanics and the neuromechanics of the skills that persist and why those persist and how we can tap into them and make it useful and the skating piece as well. I really love tying these together professionally.


On the personal side, I have not been to a rink with participants yet where we haven't left with an amazing story of someone who haven't skated in years but used love it or who continues to play immensely. There are just so many personal connections for Canadians to skating that we get a chance to see those through the participants, through their care partners, significant others or their spouse who say, "I'm so glad that we're back to this. This is what I used to love to do. This is what I still love to do." It's just an amazing connection there.


PA:   Any parting words of advice for people affected by Parkinson disease?


DJD:   Find the vigorous exercise or the level and mode of exercise that's right for you and find a way to do it for yourself. I understand that skating is not for everyone but I do know that many Canadians enjoy it.  I think it's unfortunate when patients who have enjoyed an activity in the past find that a diagnosis of Parkinson's often squashes that activity or enjoyment for them.  Oftentimes there is no reason one can't still safely participate. For the most part, people just stop doing it.  If skating isn’t for you, maybe its bike riding or swimming, maybe it's jogging. Who knows?  But there are certainly lots of passions that could and should be pursued and keep people engaged and active.
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