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The following information will help you learn about your movement disorder. It is not intended to replace the information and advice from your doctor.
Only the most common movement disorders are listed here. Talk to your doctor if you don't see your disorder, they can help.
Overview: What is Parkinson's Disease?
Parkinson's is a neurodegenerative disorder, especially but not exclusively affecting dopamine cells. Symptoms affect multiple body systems including movement, cognition, emotion, sleep, and the autonomic system (blood pressure, bladder, and bowel).
Neurological disorders are the leading cause of disability in the world. Parkinson's is the fastest growing neurological disorder affecting 2-3% of the population over 65.
Getting a diagnosis of Parkinson's can be devastating. Give yourself time to adjust and let it sink in. We are here for you with information and resources to help. Over time, you will become a Parkinson's expert, take charge and manage your health.
The resources here are a starting point. Not every resource will be applicable to you. Some resources will be relevant now, later on, or not at all. Your doctor can help identify topic areas that will help you as you navigate your Parkinson's journey.
All resources are in PDF format unless otherwise indicated.
Motor symptoms can happen anytime in the course of the disease and usually respond well to medication. Motor symptoms differ from person to person. Not everyone with Parkinson's will experience all of these motor symptoms, but everyone with Parkinson's will experience slowness (bradykinesia).
Motor or "movement" symptoms can include:
Other motor symptoms include:
Non-motor (non-movement) symptoms are sometimes called
the "invisible" symptoms of Parkinson's. They are common and are different for each person. You may experience some and not others. Non-motor symptoms can occur any time in the course of the disease, even before motor symptoms or before a diagnosis.
Non-motor symptoms can impact the quality of life for Parkinson's and for their families and loved ones. Talk to your doctor, they are here to help.
Parkinson's disease can impact how you think and feel:
Parkinson's can also cause other difficulties:
Medication is used to improve your quality of life living with Parkinson's. It's important to take your medications at the prescribed dose and time. Your doctor will work closely with you to develop the best regimen for you.
Deep Brain Stimulation (DBS)
Physiotherapy is part of the multi-disciplinary approach to Parkinson's care. In early Parkinson's, physiotherapy provides education in physical activity and self management strategies. In the mid and later stages it can help minimize deterioration, improve gait, balance, daily activities, and reduce the risk of falls.
An Occupational Therapist can help you identify challenges, set realistic goals, and strategize solutions to help you continue doing the things you enjoy that are important to you. Strategies may be adapting your environment, adjusting the activity, and perhaps changing your mindset from "I think I can" to "I will".
A balanced and healthy diet is the foundation of good health. There are some dietary adjustments that can help your medications work more effectively or help with side effects.
Changes or difficulty chewing and eating, speaking or swallowing are common in Parkinson's. These changes can happen at any time, but usually increase as PD progresses. Sometimes these problems are not obvious and difficult to describe.
When it comes to mental health there is a large amount of variation between people with Parkinson's. Some people experience no mental health issues, and for some, their main difficulties are mental health related i.e., depression, anxiety, cognitive issues, or psychosis.
Sleep issues, fatigue and apathy can contribute to mental health difficulties, and sometimes Parkinson's mediations can contribute to impulsivity and psychosis.
Talk to your doctor if you have any concerns or questions about mental health.
Overview: What is Ataxia?
Ataxia is a symptom of incoordination usually due to diseases affecting the part of the brain known as the cerebellum.
Symptoms of Ataxia can include:
Overview: What is Lewy Body Dementia?
Lewy Body Dementia (LBD) is a common Atypical Parkinsonism. LBD is associated with abnormal deposits of the alpha-synuclein protein (Lewy bodies) in the brain resulting in one of the most common forms of dementia and problems with thinking, hallucinations (typically visual), movement, behaviour and mood. Sometimes it is called "Dementia with Lewy bodies". Lewy bodies are also seen in patients with Parkinson's disease, that is why some features are shared between the two diseases.
In LBD the Lewy bodies spread throughout the brain and the symptoms can be broad, affecting many functions of person affected.
The main symptoms are decision-making and problem-solving difficulties associated with memory decline.
Some of the common features include experiencing a shorter attention span, and issues with the sense of direction, which can result in getting lost easily.
Patients with LBD may have issues with movements similar to Parkinson's disease, like hand tremor, slowness of movement, and stiffness. LBD can affect the functions of the upper limbs and may cause trouble walking.
One of the frequent features associated with LBD are hallucinations, typically visual hallucinations. The affected individual usually reports seeing things that are not there, like seeing colours, shapes, people or animals, or seeing things in different forms.
Acting out dreams during sleep, which is called Rem Sleep Behaviour Disorder (RBD) is a prevalent feature of LBD.
Usually, to make the diagnosis of LBD you may need more than one visit to the specialist's office, going through a detailed medical history, physical examination, and may require a brain MRI and a sleep study.
Currently there are no treatments for LBD.
Manaagement of LBD is best with a multidisciplinary team, where the family doctor, Neurologist, Psychiatrist/Psychologist, Physiotherapist, and Social Worker all work together for the best patient care.
For some patients, the doctor may start Parkinson's disease medications, which can help with movement difficulty, but unfortunately, the response is usually limited.
For the cognitive part, a detailed neuropsychiatric evaluation should be taken, as some of the behavioural issues can be solved without the need for medication. Assessment for the need for dementia medication is often considered.
Physical therapy can help you maintain muscle strength and flexibility. It can also help with balance and mobility. A
Physiotherapist may be able to help you increase your stamina levels to help you cope with fatigue.
Occupational therapy teaches you strategies and modifications that can make day-to-day activities easier and help you continue to do the activities you like to do.
Speech therapy can help with vocal projection and clarity. A
Speech-Language Pathologist may suggest: changing your posture to improve the quality of your voice, exercises to strengthen the muscles used when speaking, speaking slower to emphasize each word, breathing techniques to improve your speech, and exercises to stimulate your swallowing reflex and strengthen the muscles used when swallowing.
Overview: What is Corticobasal Syndrome?
Corticobasal Syndrome (CBS) is a progressive neurodegenerative disorder included under the broad "umbrella" term of Atypical Parkinsonism. It usually starts in mid adulthood (40s – early 60s) with stiffness, difficulty performing dexterity tasks with one extremity, involuntary movements, or even affect mobility with poor balance and falls. Initially, a combination of these symptoms affects mostly one side of the body with relentless progression to the other side. The complaints of a patient with CBS can be similar to those of Parkinson's including slowness of movements, stiffness and tremor, however, additional symptoms not usually seen in Parkinson's appear in patients with CBS within 5 years of onset.
CBS is a rare disease, meaning that each year 5 people per 100,000 are living with the disease and an average of 1 person per 100,000 are newly diagnosed with CBS. Since CBS can start in varied forms and show a diverse combination of symptoms, it is a challenge to diagnose it during the first 2-3 years.
The inability to perform complex manual tasks or gestures, is first noticed when movements start to become clumsy. The actions affected are typically those that were learnt by practise throughout life. Common examples are loss of the ability to use eating utensils, do up buttons, or tie shoelaces. When apraxia is present in a leg, walking can become "frozen" for several seconds at a time and lead to balance problems and instability.
Contributing to the movement problems of CBS are sensory problems. It's not a simple loss of sense of touch, but an inability to interpret spatial complexity involving touch. This can take the form of an inability to recognize common objects by feel alone, or the inability to know the position of a finger or a limb in space.
Several of the above mentioned symptoms can contribute to an unsteady walk. The presence of uncoordinated leg movements can be aggravated by a decrease in the postural reflexes that help us maintain an up-right posture, and ultimately increase the risk of falls. The progression of these issues may lead to an inability to walk unassisted, requiring a walking aid.
In CBS, speech can be affected. Slurring (dysarthria) or stuttering is common. Additional difficulties can occur such as understanding or expressing language (aphasia), and difficulty saying what you want to say despite knowing the right words (apraxia of speech).
Overview: What is Progressive Supranuclear Palsy (PSP)?
PSP is a progressive neurodegenerative disorder that has no known cause or cure. It affects brain cells that control balance, walking, coordination, eye movements, speech, swallowing, and thinking. These symptoms begin, on average, when an individual is in their early 60's but may start as early as in their 40's, and is slightly more common in men than women.
Initially, someone with PSP can have similar complaints than someone with Parkinson's such as slowed movements, stiff posture, and in some cases, even tremor. However, additional symptoms which are not usually seen in Parkinson's appear less than 5 years later and include repeated falls, trouble with eye movement, swallowing and speech difficulties, and changes in behaviour and thinking.
The fact that PSP can start in varied forms and show a diverse combination of symptoms makes it very hard to diagnose during the first 2-3 years. PSP is a rare disease, meaning that each year five or six people per 100,000 are living with the disease and an average of 1.1 people per 100,000 are newly diagnosed with PSP.
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Loss of balance is usually the first symptom. It can be experienced as dizziness and during doctor visits be mistaken for inner ear problems. However, the balance difficulties of PSP progress, affecting the ability to maintain an up-right position during a turn or standing up/sitting down from a chair. It often causes backward or unexplained falls and eventually requires the use of a walking aid at some point in the disease. Prevention of falls is a critical measure in the management and an ultimate goal to maintain the quality of life of patients with PSP.
A region in the base of the brain, called the midbrain, contains cells that control eye movements. PSP affects the midbrain cells, causing a weakness of the supranuclear gaze (difficulty looking in a particular direction). Especially in PSP, there is a difficulty in the ability to move the eyes up or down. This can interfere with eating or with descending a flight of stairs, symptoms easily detected by a specialist doctor interview but that typically appear after a few years of initial symptoms. However, even months to years before a specialist is seen, family members and friends may notice subtle changes like the inability to maintain eye contact during conversation or a complaint of tunnel vision while driving a car.
The complex and coordinated movements that allow speech production are under the control of brain cells located in the vicinity of those that control eye movements. As these brain cells suffer from PSP, the movements of the mouth, tongue and throat also weaken resulting in different speech sounds. In most PSP patients after an average of three or four years, speech becomes slurred and slow. Additional features are an irregular, explosive or rubber-band quality (called spastic speech), a drunken quality (ataxic speech) or a soft speech similar as that of Parkinson's disease patients. A combination of at least two of these three features is often seen in the speech of patients with PSP.
PSP can have diverse cognitive symptoms. These are called executive dysfunction. Symptoms include difficulty synthesizing several different ideas into a new idea or plan, and slowing thoughts. Some patients with PSP may complain of forgetfulness, or difficulty finding words. Additionally, personality changes like the loss of interest in ordinary pleasurable activities or increased irritability, difficulty resisting impulses or even inappropriate social behaviour can be seen at some point in the disease. Important to note, these behavioural changes may cause a patient with PSP to have a decreased ability to make decisions about safe movements and predispose them to repeated falls.
Similar to how the muscles used in speech are affected, the first stage of the swallowing process (oral-pharyngeal phase) can be affected in PSP. Typically, patients will have to clear their throat after dinking liquids, cough or even choke. When this symptom progresses, choking with saliva can be a problem, and measures to prevent aspiration (inhaling liquid or food) will be needed. Repeated, or minor episodes of small amounts of food and drink dripping into the lungs can cause aspiration pneumonia, which is the most common cause of death in PSP.The risk of aspiration is aggravated by overloading the mouth or taking big gulps of beverages that PSP patients might do due to recklessness or impulsiveness (part of the cognitive symptoms). Speech-Language Pathologists are the most qualified health care professionals to assess this and give recommendations to help.
There is a lack of highly effective drugs for the treatment of PSP, and a cure has not yet been discovered. Drugs used in Parkinson's can occasionally help decrease the slowness and stiffness, and very rarely balance symptoms. The natural element Coenzyme Q10 has been studied, but no clear evidence of benefit was seen after 12 months in those patients who used a considerable high dose of it.
For significant drooling, several measures can be taken. Chewing gum can stimulate swallowing and reduce the amount of drooling. Medications applied to the inside of the mouth can decrease the activation of your salivary glands.
An increase in muscle contraction that causes awkward or abnormal postures or movements of the affected limb can also present in PSP. This is called dystonia. For dystonia either of the neck, limbs or the face, treatment with botulinum toxin injections can be used. This medication acts as a temporary relaxant of the muscle producing a decrease of the symptoms of dystonia. The effects last about 8-12 weeks, and can be repeated every few months to maintain the benefit.
Overview: What is Multiple System Atrophy (MSA)?
Multiple system atrophy (MSA) is a rare progressive neurodegenerative disorder that affects the brain and other areas of the nervous system. Some of these are involved in the control of movement, balance, coordination, while others are responsible for blood pressure, bladder, bowel and sexual function.
There are various types of MSA, although they all share the accumulation of a protein that leads to progressive loss of function and death of different types of cells in the nervous system. This protein is called alpha-synuclein and is also present in individuals with Parkinson's disease. However, MSA can be further distinguished from Parkinson's disease by the involvement of several other areas of the nervous system, including the cerebellum (responsible for coordination and balance), as well as the autonomic nervous system (involved in the control of involuntary actions such as blood pressure, heart rate and bladder control).
Symptoms of MSA usually start between the age of 50 and 60 and may include slowness of movements, muscle stiffness, and/or shaking or tremor. Other symptoms include difficulties with balance, and coordination.
Another symptom is the failure of the autonomic nervous system that controls involuntary actions such as blood pressure. Some patients may experience blood pressure drops when rising from a seated or lying down position with associated light-headedness or fainting spells. Additional signs of autonomic involvement also include problems with heart rate, erectile dysfunction, problems with urination and/or constipation.
To date, there is no cure or available treatment to delay the progression of MSA. However, there are several medications and nonpharmacologic (non-drug) treatments that may alleviate some of the underlying symptoms.
Specific drugs might be used in selected individuals to control urinary symptoms, constipation, light-headedness and fainting spells. Occasionally, some patients with MSA can also be prescribed medications to enhance motor (movement) function.
Additional treatments include strategies not related to medications or drugs. For instance, dietary changes might improve some of the constipation experienced by individuals with MSA. Gait training and mobility aids are also an essential part of the MSA management to avoid falls and injuries.
Other health care providers, such as physical, occupational and speech therapists assist doctors in the management of MSA and provide supportive care to patients.
Overview: What is Dystonia?
Dystonia is a movement disorder that involves involuntary muscle contractions that can result in continuous or repetitive movements (including tremor), twisting, or abnormal postures. It can affect your whole body (generalised), or just one part (focal). It can start at any age.
Clenched or curled toes or a cramped foot are signs of dystonia. These contractions are often painful and can make daily activities difficult.
Dystonia can be classified into three groups: idiopathic (cause unclear), genetic (usually confirmed on genetic testing) and acquired (such as damage to the brain, environmental factors or due to a medication). Dystonia therefore can be a symptom of another movement disorder, such as Parkinson's disease, or it can be a movement disorder on its own.
Symptoms of dystonia can be variable and may be continuous or intermittent. They can initially be mild and may not result in abnormal posturing until a later stage. Sometimes stress or significant life events can worsen dystonia.
Symptoms may include:
At present, there are no disease modifying treatment available for dystonia. Treatment is therefore based on symptom control and can include the following:
Overview: What are Functional Movement Disorders?
Functional Movement Disorders (FMD) are a group of disorders that fall under the umbrella term of Functional Neurological Disorder (FND). They may cause bothersome neurological symptoms that result in an inability to walk, speak, or control limb or facial movements the way you normally would. Although not widely talked about, FND is very common, accounting for the second most frequent reason why someone may be referred to a neurologist.
While symptoms of FMD can vary from person to person, they are united by common characteristics that can be detected by a neurologist trained in diagnosing FMD. These "positive signs" show that altered activity in certain brain circuits are disrupting a person's ability to move normally. This is why doctors sometimes say that FMD is a "software" problem of the brain, rather than a "hardware" one (as in a stroke or MS). People with FMD usually don't have brain damage that can be detected on MRI or other advanced tests. Instead, the brain circuits are structurally intact, but aren't working correctly.
FMD can have multiple risk factors. It is often triggered by injuries, illness, or emotional stress. It can also arise in the context of other neurological disorders, like Parkinson's Disease, which is sometimes called "functional overlay."
Studies have shown that FMD can be as disabling as other neurological disorders like Epilepsy and Multiple Sclerosis. While FMD is not fatal, it may result in severe disability and difficulties in many areas of life. Fortunately, FMD is often treatable.
Getting a diagnosis of FMD can be confusing. It can be hard to understand what it means, why you are experiencing the symptoms, and what you should do. Here are a few important things to know about FMD:
FMDs come in many forms. Some of the most common are uncontrollable, unwanted movements (tremor, dystonia, jerks), inability to move normally (weakness, paralysis), and disruptions of a person's ability to walk (gait). These symptoms may be episodic (come and go over time). They may be worse or better at different times (fluctuate).
FMDs are a type of Functional Neurological Disorder (FND). Because FND affects core, multi-purpose brain systems (including the Salience Network), you may have other symptoms as well. It is common for people with FMD to have other FND symptoms, such as seizure-like events, problems with swallowing or speech, visual symptoms, dizziness, and others. Pain, fatigue, cognitive fog, and headache are also common among people with FMD.
FMD is a "whole brain" disorder. It affects a person's physical ability, capacity to work, relationships, and emotional health. Recognizing this, most experts today believe the best care for FMDs is multi-disciplinary. Medications are typically not used for the treatment of FMD.
At the Integrated Movement Disorders Program, patients receive cutting-edge treatment for FMD. Our multi-disciplinary team works collaboratively with patients to stabilize symptoms and facilitate recovery. Sessions include aspects of physical therapy, cognitive behavioral techniques, pain management, and activity planning to help patients manage improvement across physical, social, and emotional domains of life. Recovery from FMD is a process, often with ups and downs, with the goal of our program to give you the tools to keep getting better.
There are a number of management strategies that you can implement:
Overview: What is Tremor?
Tremor is an involuntary rhythmic movement involving one or more parts of the body. It is one of the common movement disorders encountered in clinical practice. Tremor can involve any part of the body, and most commonly the hands are affected. When severe, tremor can be disabling and interfere with daily activities. It can also result in social embarrassment.
Tremor can develop spontaneously or it can result from another disorder, such as Parkinson's disease or dystonia. Tremor can sometimes run in families, or can result from certain medications, such as steroids, stimulants or inhalers. In many cases however, the cause is unknown.
Tremor can be present at rest (resting tremor) or more commonly when carrying out activities (action tremor). The most common cause for a resting tremor is Parkinson's disease. There are many causes for an action tremor.
The following are examples of the more common conditions movement disorder specialists see in their clinical practice:
Essential tremor (ET) is one of the most common movement disorders. The condition can affect the hands, head, legs, trunk, and/or voice. The tremor tends to affect both sides of the body and is predominantly present when carrying out activities, such as writing or eating and drinking (action tremor), and less so when resting. Essential tremor can start at any age, even at a young age, and often runs in families.
Dystonic tremor tends to occur in individuals who have dystonia. The tremor can affect both sides of the body, however most commonly one side is affected more than the other. Although the tremor can sometimes mimic a Parkinsonian tremor, there are usually no additional features, such as slowness of movements.
Cerebellar (intention) tremor
Cerebellar tremor can result from damage to the co-ordination centre of the brain (cerebellum). This type of tremor is characterised by slow irregular clumsy movements in the hands, which tend to worsen as you get closer to the target, such as picking up a small coin or pressing a button.
Parkinsonian tremor, is one of the hallmark features of Parkinson's disease. Unlike essential tremor, a Parkinsonian tremor tends to occur at rest and affects one side of the body initially. When severe, the tremor can also become present with action. This is also known as a re-emergent tremor.
Involuntary trembling or shaking that may happen at different times and in different situations. Tremors usually don't affect both sides of the body in the same way. They typically occur during movement, doing tasks such as writing, using tools or speaking and occur less when resting.
Treatment options can include the following:
The management of tremor is based on symptom control and the above treatment options should be individualised, allied with the following:
Overview: What is Wilson's Disease?
Wilson's disease is a rare hereditary disease in which excessive amounts of copper accumulate in the body, mainly in the liver. When its storage capacity is full, copper is released into the bloodstream and can damage the liver, brain and other vital organs. Wilson's disease is present at birth, but symptoms do not show up until copper builds up in the liver, brain and other organs.
You are at increased risk of Wilson's disease if your parents or siblings have the condition. Diagnosing the condition as early as possible dramatically increases the chances of successful treatment.
For more information on Wilson's Disease, the
Canadian Liver Foundation has information.
Symptoms of Wilson's disease can include:
* You may need to consult your ophthalmologist to evaluate for this.
Wilson's disease can have serious complications or even be fatal if left untreated.
Mental health, defined by the
World Health Organization (WHO), is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". According to WHO, mental health includes "subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others". From the perspectives of
positive psychology or of
holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve
psychological resilience. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health".
Wikipedia contributors. (2021, August 14). Mental health. In Wikipedia, The Free Encyclopedia.
Retrieved 19:19, August 24, 2021, from https://en.wikipedia.org/w/index.php?title=Mental_health&oldid=1038789135
Mental health is just as important as physical health. Learn about supports available to you, and how to get help when you need it. Find mental health support:
Here to HelpLearn about mental health – Wellness Module 1: Mental Health Matters
Mood Disorders Association of OntarioSupport programs for families and individuals affected by mood disorders.
The Centre for Addiction and Mental Health (CAMH)
Canadian Mental Health Association (CMHA)Resource list of Ontario mental health supports.
Ontario Psychological AssociationFinding a Psychologist
Rocket DoctorBook a virtual appointment and see an Ontario doctor for psychological and mental health concerns the same day, covered by OHIP.
Medical Psychotherapy Association CanadaFind a General Practitioner that provides psychotherapy.
Wellness Recovery Action Plan (WRAP)WRAP is an education and planning tool for mental health recovery, helping you discover your own simple and safe wellness tools and identify when you need to use them.
MindBeaconMind Beacon's Therapist Guided Program uses Cognitive Behavioural Therapy (CBT) in a skills-building approach, helping you develop resiliency and coping skills.
AbilitiCBTThe governments of Ontario and Manitoba are offering AbilitiCBT for free to residents age 16 or older for anxiety, depression, pain management and insomnia.
Connex OntarioInformation and referral service, focusing on mental health, addiction and problem gambling services.
Student - Senior Isolation Prevention Partnership (SSIPP)SSIPP helps mitigate social isolation of older adults by building a society that promotes their well-being, while enabling them to feel valued and remain socially connected.
AppsCalm | Headspace | Prana Breath
Depression, anxiety and apathy are common mental health concerns. Learn more and get help when you need to.
DepressionDepression Resource from Patient Education | Depression Resource from Integrated Movement Disorder Program
AnxietyAnxiety Canada | Anxiety Disorders Resource from Patient Education | Anxiety Resource from Integrated Movement Disorder Program
Motivation and Parkinson’s disease: A discussion on Apathy & Impulsivity
Mental health medications – CAMH
Non-pharmaceutical options (Resources are in PDF format) Mindfulness Exercises | Breathing Exercises | Grounding Exercises | Recommended websites, books and apps
Courtesy of IMDP Clinic, 2020
Physical Activity is defined as any bodily movement produced by skeletal muscles that result in energy expenditure1. There is no doubt that exercise is an essential treatment for any movement disorder.
Planned, structured and repetitive movement with the purpose of improving or maintaining physical fitness.1 Exercise is prescribed like medication and is essential in the treatment of movement disorders.
1 Caspersen, C. J., Powell, K. E., and Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.
Public Health Rep. 100, 126–131
There are many organizations that provide trustworthy information on movement disorders.
You will find links to reliable online information for the following diseases:
Progressive Supranuclear Palsy (PSP)
Multiple System Atrophy (MSA)
Lewy Body Dementia
Your health care provider may refer you to services or specific health care providers. You may also find public resources and private services below that you may be eligible for.
Contact the Local Health Integration Network (LHIN) (free) to inquire about an assessment and services that you may be eligible for under government-covered care.
To find a Dietitian:
To find an Occupational Therapist:
To find a Physiotherapist:
To find a Speech-Language Pathologist:
To find Mental Health support:
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