Parkinson's Disease Explained: Symptoms, Treatments, and How Physiotherapy Can Help
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on November 22, 2024
Parkinson’s disease (PD) is a progressive neurodegenerative disorder that impacts millions worldwide. It primarily affects motor function but also has a wide array of non-motor symptoms, influencing nearly every aspect of life. With advancements in research and treatment, including the crucial role of physiotherapy, individuals with Parkinson’s can manage symptoms more effectively and maintain a better quality of life. This comprehensive guide explores the condition, from its causes and symptoms to treatment options and strategies for living well with Parkinson’s.
Definition of parkinson's disease
Parkinson’s disease is often misunderstood as solely a movement disorder. In reality, it is a multifaceted condition involving the central nervous system, with both motor and non-motor symptoms that evolve over time. Understanding its definition and underlying mechanisms is essential for effective management.
Parkinson's disease is a chronic and progressive disorder of the central nervous system. The primary pathological feature is the degeneration of dopamine-producing neurons in the substantia nigra, a brain region crucial for controlling movement. Dopamine, a neurotransmitter, enables smooth and coordinated muscle activity. As dopamine levels decrease, individuals experience difficulty with motor control and various other symptoms.
While commonly associated with tremors, rigidity, and slowed movement, Parkinson's also includes non-motor symptoms such as mood disturbances, cognitive decline, and autonomic dysfunction. These non-motor aspects are often under-recognized but can significantly impact daily life.
Parkinson’s is more than a movement disorder. Recognizing its diverse symptoms and chronic, progressive nature is the first step toward effective care and symptom management.
Types of parkinson's disease
Parkinson’s disease presents in various forms, each with unique characteristics. Identifying the type of Parkinson’s is vital for tailoring treatment strategies and understanding the disease's progression.
Idiopathic Parkinson’s Disease: This is the most common form, accounting for 85–90% of cases, with no identifiable cause. It typically develops after age 60 and progresses gradually.
Early-Onset Parkinson’s Disease: Diagnosed before age 50, this form often has a genetic component, such as mutations in the LRRK2 or SNCA genes. It progresses more slowly but poses unique challenges, such as balancing treatment with work and family responsibilities.
Vascular Parkinsonism: Caused by small strokes that disrupt blood flow to areas involved in movement control, this form mimics some symptoms of PD but is less responsive to dopamine-based treatments.
Drug-Induced Parkinsonism: Certain medications, particularly antipsychotics, can block dopamine receptors, leading to symptoms similar to PD. These symptoms are often reversible upon discontinuing the medication.
Atypical Parkinsonian Disorders: Conditions like Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) share features with Parkinson’s but involve distinct brain pathologies. They tend to progress more rapidly and have additional symptoms like severe autonomic dysfunction or impaired eye movement.
Understanding the type of Parkinson’s disease is essential for accurate diagnosis and effective management. Tailored treatments can address the specific challenges associated with each type.
Causes of parkinson's disease
The exact cause of Parkinson’s disease remains unknown, but research highlights a combination of genetic, environmental, and age-related factors. Investigating these causes sheds light on potential prevention and treatment strategies.
Genetic Factors: Mutations in genes such as LRRK2, PARK7, and SNCA are linked to Parkinson’s, particularly in familial cases. Genetic forms account for 10–15% of cases, and their study has provided critical insights into the disease's mechanisms (Kalia & Lang, 2015).
Environmental Factors: Exposure to pesticides, herbicides, and heavy metals increases the risk of developing PD. Conversely, caffeine consumption and smoking (surprisingly) appear to lower risk, suggesting protective mechanisms worth exploring (Ascherio & Schwarzschild, 2016).
Age: Aging is the most significant risk factor for Parkinson’s. As the brain ages, its ability to repair cellular damage diminishes, making it more vulnerable to neurodegeneration.
Gender: Parkinson’s is more common in men than women, possibly due to hormonal differences or genetic susceptibility.
Interplay of Factors: PD likely results from an interaction between genetic predisposition and environmental exposures, making it challenging to pinpoint a singular cause.
Parkinson’s disease arises from a complex interplay of genetic and environmental factors, with aging amplifying the risk. Further research is crucial to uncovering its root causes and developing preventive strategies.
Signs and symptoms of parkinson's disease
The symptoms of Parkinson’s disease vary widely among individuals and progress over time. These symptoms are broadly categorized into motor and non-motor aspects, both of which significantly affect quality of life.
Motor symptoms
Tremor: Often the first noticeable symptom, it typically begins in one hand with a characteristic "pill-rolling" motion.
Rigidity: Muscle stiffness can limit range of motion and cause discomfort, often described as "lead-pipe" rigidity.
Bradykinesia: Slowed movement affects daily tasks, such as buttoning a shirt or walking.
Postural Instability: Impaired balance increases fall risk, particularly in advanced stages.
Non-motor symptoms
Cognitive Impairment: Memory issues and difficulty with planning are common, with some cases progressing to Parkinson’s dementia.
Mood Disorders: Depression and anxiety often precede motor symptoms and impact overall well-being.
Sleep Disorders: REM sleep behavior disorder and insomnia are common and disrupt restorative rest.
Autonomic Dysfunction: Issues such as constipation, urinary problems, and low blood pressure complicate daily living.
Parkinson’s symptoms extend beyond motor dysfunction, encompassing cognitive, emotional, and autonomic challenges. Early recognition of these symptoms is key to managing the disease effectively.
Prevention strategies for parkinson's disease
Preventing Parkinson’s disease is challenging due to its complex and largely unknown causes. However, ongoing research suggests several lifestyle factors that may reduce the risk or delay onset. Understanding these protective strategies can empower individuals to take proactive steps toward brain health.
Protective Strategies
Regular Exercise: Physical activity has been consistently linked to a lower risk of Parkinson’s disease. Exercises like walking, swimming, or strength training improve brain health and may enhance dopamine utilization (Ahlskog, 2011).
Mediterranean Diet: A diet rich in fruits, vegetables, whole grains, and healthy fats provides antioxidants that combat neurodegeneration. Omega-3 fatty acids, found in fish, may offer additional neuroprotective effects.
Adequate Sleep: Poor sleep quality and sleep disorders are associated with increased Parkinson’s risk. Maintaining good sleep hygiene supports brain repair and detoxification.
Stress Management: Chronic stress can accelerate neurodegeneration. Practices like mindfulness, yoga, and meditation may reduce the brain’s susceptibility to damage.
Ongoing research for parkinson's disease
The fight against Parkinson’s disease (PD) is supported by an ever-growing body of research aimed at understanding its causes, improving symptom management, and finding a cure. Advances in neuroscience, genetics, and therapeutic approaches continue to offer hope for better treatments and improved quality of life for individuals with Parkinson’s. Below is a detailed exploration of current areas of research and their potential implications.
Research on the causes of parkinson’s disease
Genetic discoveries
Recent studies have identified specific genes associated with Parkinson’s, such as LRRK2, SNCA, and PARK7. Research is exploring how these genetic mutations lead to neuronal degeneration, particularly in dopamine-producing cells. Efforts are underway to develop therapies targeting these genetic pathways to slow disease progression or prevent its onset (Nalls et al., 2014).
Environmental risk factors
Environmental exposures, including pesticides, herbicides, and heavy metals, are strongly implicated in Parkinson’s. Ongoing research focuses on identifying specific toxins and their mechanisms of action, such as mitochondrial dysfunction or oxidative stress, which contribute to neurodegeneration (Ascherio & Schwarzschild, 2016).
Gut-brain connection
Emerging evidence suggests that Parkinson’s disease may begin in the gut, with abnormalities in gut microbiota potentially triggering alpha-synuclein aggregation, a hallmark of the disease. Current studies are examining how gut health influences Parkinson’s progression and whether probiotics or dietary interventions could serve as preventive or therapeutic measures (Sampson et al., 2016).
Advancements in symptom management
Improved medications
Levodopa Delivery Systems: Research is focused on developing more consistent and long-lasting formulations of levodopa, such as extended-release capsules or subcutaneous infusions, to reduce motor fluctuations (Stocchi et al., 2010).
Novel Drug Classes: Drugs targeting non-dopaminergic pathways, such as adenosine A2A receptor antagonists, are being explored to complement current therapies and address motor symptoms with fewer side effects (Hauser et al., 2014).
Neuroprotective Agents: Compounds like inosine, designed to elevate urate levels (a potential neuroprotective agent), are under investigation for their ability to slow neuronal loss (Schwarzschild et al., 2014).
Non-pharmacological therapies
Exercise and Neuroplasticity: Studies have shown that structured exercise programs, such as high-intensity interval training, can enhance brain plasticity and improve motor function. Ongoing trials are exploring the optimal types and intensities of exercise for maximum benefits in Parkinson’s (Schenkman et al., 2018).
Physiotherapy Innovations: Research into advanced physiotherapy techniques, including the LSVT BIG program and virtual reality-based therapies, is providing new insights into enhancing mobility and reducing falls.
Frontiers in surgical and technological approaches
Deep Brain Stimulation (DBS) Improvements
While DBS is an established treatment for advanced Parkinson’s, ongoing research aims to refine this technique. Adaptive DBS systems that automatically adjust stimulation based on brain signals are being developed to improve symptom control and reduce side effects (Little et al., 2013).Gene Therapy
Gene therapy trials are exploring ways to deliver genes directly into the brain to restore dopamine production or protect neurons. Promising approaches include using viral vectors to deliver the GDNF (glial cell-derived neurotrophic factor) gene to support neuron survival (Bartus et al., 2011). Stem Cell Therapy
Stem cell research is investigating the potential to replace lost dopamine-producing neurons. Early trials using induced pluripotent stem cells (iPSCs) show promise, though challenges such as cell survival and integration remain (Hallett et al., 2015).Focused Ultrasound
A non-invasive surgical option, focused ultrasound, is being studied for its ability to treat tremors and rigidity by targeting specific brain regions. Research is ongoing to expand its applications and refine its safety profile (Elias et al., 2016).Exploring Disease Modification
Alpha-Synuclein Aggregation Inhibitors
Alpha-synuclein clumping is a key pathological feature of Parkinson’s. Researchers are developing drugs that prevent or reduce these toxic aggregates. Early trials of monoclonal antibodies targeting alpha-synuclein show potential to slow disease progression (Lindstrom et al., 2014).Immunotherapy
Immunotherapy approaches aim to harness the immune system to remove harmful proteins or reduce inflammation in the brain. Ongoing studies are testing vaccines designed to stimulate the immune system to target alpha-synuclein (Volc et al., 2020).
Precision medicine and biomarker discovery
Biomarkers for Early Diagnosis
Identifying reliable biomarkers is a top priority for Parkinson’s research. Advances in imaging techniques, such as PET scans targeting dopamine transporter density, and blood or cerebrospinal fluid tests for alpha-synuclein or neurofilament light chain proteins, are being validated for early and accurate diagnosis (Postuma et al., 2015).
Personalized Treatment Plans
By combining genetic, environmental, and clinical data, researchers are working to develop individualized treatment strategies tailored to each patient’s specific disease profile. This precision medicine approach could lead to more effective symptom control and slowed disease progression.
Ongoing research into Parkinson’s disease is transforming our understanding of its causes, mechanisms, and treatment options. From genetic discoveries to advancements in surgical techniques and neuroprotective therapies, these efforts are paving the way for more effective interventions. At Keilor Road Physiotherapy, we stay abreast of these developments to provide the most up-to-date and evidence-based care for our patients.
Diagnosis of parkinson's disease
Diagnosing Parkinson’s disease requires careful evaluation, as no single test can confirm it. Early diagnosis is crucial for managing symptoms effectively and improving long-term outcomes.
Clinical Examination: Neurologists assess motor symptoms such as tremors, rigidity, and bradykinesia. Non-motor symptoms, like sleep disturbances or mood disorders, may also provide early clues.
Imaging Studies: MRI and CT scans help rule out other conditions, such as strokes or brain tumors, that mimic Parkinson’s symptoms.
DaTscan: This specialized imaging test evaluates dopamine transporter levels in the brain, aiding in differentiating Parkinson’s from other tremor disorders.
Genetic Testing: Recommended for individuals with early-onset PD or a strong family history, genetic testing can identify mutations linked to the disease.
Challenges in Diagnosis: Early symptoms, such as mild tremors or fatigue, can be subtle and mistaken for other conditions. A detailed medical history and expert evaluation are essential.
Accurate and early diagnosis of Parkinson’s disease relies on a combination of clinical expertise and advanced imaging tools. Identifying the condition early allows for timely intervention and better symptom management.
Treatment options for parkinson's disease
While there is no cure for Parkinson’s disease, various treatments can manage symptoms and improve quality of life. A combination of medication, surgical options, and complementary therapies offers a holistic approach to care.
Medications
Levodopa:
The gold standard treatment, levodopa converts to dopamine in the brain, alleviating motor symptoms. Long-term use may lead to motor fluctuations or dyskinesias.Dopamine Agonists:
These mimic dopamine's effects and are often used in early stages or alongside levodopa. Side effects include drowsiness or impulse control issues.MAO-B and COMT Inhibitors:
These medications slow dopamine breakdown, enhancing its availability in the brain.
Surgical Interventions
Deep Brain Stimulation (DBS):
Electrodes implanted in specific brain regions deliver electrical impulses to regulate abnormal signals, improving motor symptoms.Focused Ultrasound:
A newer, non-invasive option that targets and destroys specific brain tissue contributing to tremors.
Complementary Therapies
Physical Therapy: Improves mobility and reduces fall risk.
Occupational Therapy: Assists with daily activities and adaptive techniques.
Speech Therapy: Addresses speech and swallowing difficulties.
Nutritional Support: Optimizes overall health and symptom management.
Effective treatment for Parkinson’s disease often involves a multidisciplinary approach, combining medications, surgical options, and therapies tailored to the individual's needs.
Physiotherapy's role in treating parkinson's disease
At Keilor Road Physiotherapy, we understand the profound challenges faced by individuals living with Parkinson’s disease. Our physiotherapy approach is grounded in evidence-based techniques tailored to improve mobility, strength, and overall quality of life. By addressing both motor and non-motor symptoms, we empower our patients to manage the condition effectively and maintain independence in their daily lives.
Benefits of physiotherapy
Improving Mobility and Flexibility. Parkinson’s disease often causes stiffness and rigidity, leading to restricted movement. At Keilor Road Physiotherapy, we focus on gentle stretching and mobility exercises to alleviate muscle stiffness and improve joint flexibility. This helps patients move more freely and reduces discomfort during daily activities.
Enhancing Balance and Reducing Fall Risk. Postural instability and impaired balance are common in Parkinson’s, increasing the risk of falls. Our physiotherapists use targeted exercises to strengthen core stability and enhance coordination. Techniques like standing balance drills and dynamic stability exercises ensure that patients regain confidence in their movements and reduce the likelihood of falls.
Maintaining Independence in Daily Activities. We prioritize functional training that enables patients to perform essential daily tasks, such as dressing, walking, and climbing stairs. Through customized exercise programs, we aim to help patients preserve their autonomy and maintain an active lifestyle for as long as possible.
Specific physiotherapy techniques
LSVT BIG Program. The LSVT (Lee Silverman Voice Treatment) BIG program is a specialized exercise approach tailored for Parkinson’s disease. At Keilor Road Physiotherapy, we guide patients through large, exaggerated movements to counteract bradykinesia (slowness of movement). This program enhances the size, speed, and amplitude of movements, improving functional mobility. Whether reaching for an object or walking across a room, patients gain the confidence to perform everyday actions more effectively.
Gait Training. Walking challenges, such as shuffling steps and freezing episodes, are common in Parkinson’s. Our physiotherapists implement gait training strategies to address these issues. This includes:
Cueing techniques using verbal prompts, visual markers, or metronomes to initiate and sustain walking.
Heel-to-toe walking drills to improve stride length and fluidity.
Obstacle navigation training to enhance adaptability in real-world environments.
Resistance Training. Muscle weakness is a frequent consequence of Parkinson’s, contributing to reduced mobility and endurance. At our onsite rehabilitation studio, we incorporate resistance training tailored to each patient’s capabilities. Using equipment like resistance bands and light weights, we focus on building muscle strength, particularly in the lower limbs and core, to support posture, balance, and overall stability.
Balance Exercises. Postural instability is a leading cause of falls in Parkinson’s. Our balance exercises are designed to enhance proprioception (body awareness) and stability. These may include:
Static exercises, such as single-leg stands.
Dynamic drills, like stepping onto unstable surfaces.
Dual-task exercises, combining balance with cognitive tasks, to mimic real-life scenarios.
Evidence-based effectiveness
Impact on Quality of Life. Numerous studies have demonstrated the positive effects of physiotherapy on individuals with Parkinson’s disease. For instance, a systematic review by Tomlinson et al. (2012) highlighted that physiotherapy significantly improves gait, balance, and functional independence. At Keilor Road Physiotherapy, our patient-centered approach aligns with these findings, ensuring that each program is both evidence-based and personalized.
Slowing Disease Progression. While physiotherapy cannot halt the progression of Parkinson’s, regular sessions can delay the onset of severe disability. By maintaining muscle strength, flexibility, and cardiovascular fitness, physiotherapy supports neuroplasticity—the brain’s ability to adapt and rewire itself. This can help patients retain functional abilities longer and improve their overall quality of life.
Why choose Keilor Road Physiotherapy?
Our expertly trained physiotherapists are dedicated to providing individualized care tailored to each patient’s specific needs. With access to our onsite rehabilitation studio and state-of-the-art equipment, we deliver innovative treatment programs that maximize outcomes. From advanced techniques like the LSVT BIG program to hands-on therapy and education, we ensure a holistic approach to managing Parkinson’s disease.
If you or a loved one is living with Parkinson’s, we encourage you to book an appointment with Keilor Road Physiotherapy. Together, we can work toward improving your mobility, confidence, and independence.
Living with parkinson's disease
Living with Parkinson’s disease (PD) requires resilience, adaptability, and a strong support system. While the challenges of the condition are significant, many strategies can help individuals manage symptoms, maintain independence, and lead fulfilling lives. This section explores coping mechanisms, caregiver support, and the value of a multidisciplinary approach to care.
Coping strategies for patients with parkinson's disease
Parkinson’s disease affects not only physical movement but also emotional and mental well-being. Implementing practical strategies can help patients navigate their daily lives more effectively.
Establishing a Routine:
Regular schedules for medication, meals, and physical activity provide structure and reduce stress. A consistent routine also helps manage fluctuations in symptoms, such as "on" and "off" periods related to medication.Engaging in Regular Exercise:
Exercise is a cornerstone of Parkinson’s management. Activities like walking, yoga, tai chi, and swimming improve flexibility, strength, and balance. Programs tailored for Parkinson’s, such as those offered at Keilor Road Physiotherapy, are especially beneficial for maintaining mobility and reducing fall risks.Adapting the Home Environment:
Simple modifications can enhance safety and accessibility:Installing grab bars in bathrooms.
Removing tripping hazards like loose rugs or clutter.
Using chairs with armrests to make sitting and standing easier.
Using Assistive Devices:
Tools like walkers, canes, and weighted utensils can make everyday tasks more manageable. Voice amplifiers may assist with speech difficulties, while tremor-cancelling utensils simplify eating.Managing Stress and Mental Health:
Stress can worsen Parkinson’s symptoms, particularly tremors. Relaxation techniques like deep breathing, mindfulness, and meditation can help. Mental health support, including counseling or therapy, addresses common issues like depression and anxiety.
Support for caregivers
Caring for someone with Parkinson’s disease is rewarding but can also be physically and emotionally demanding. Caregivers play a critical role in ensuring the well-being of their loved ones, but they must also prioritize their own health.
Preventing Burnout:
Caregivers often experience burnout due to the constant demands of care. Taking regular breaks, seeking respite care, and practicing self-care are essential to maintaining their health.Accessing Education and Resources:
Learning about Parkinson’s disease empowers caregivers to provide better support. Organizations like Parkinson’s Foundation and Michael J. Fox Foundation offer resources, webinars, and training programs.Building a Support Network:
Joining caregiver support groups provides an opportunity to share experiences, gain advice, and feel less isolated. Online communities can also be valuable for connecting with others in similar situations.
Support groups and resources
Reputable Organizations:
Parkinson’s Foundation: Offers educational materials, support hotlines, and community programs.
Michael J. Fox Foundation: Focuses on research funding and patient advocacy.
Shake It Up Australia Foundation: Supports Parkinson’s research and awareness in Australia.
Local and Online Support Groups: These groups provide emotional support, practical advice, and a sense of community. Many groups are tailored to specific needs, such as young-onset Parkinson’s or caregiver support.
Educational Workshops and Seminars: Local hospitals and physiotherapy clinics like Keilor Road Physiotherapy often host workshops on managing Parkinson’s disease, focusing on exercise, nutrition, and mental health.
The role of a multidisciplinary approach
Parkinson’s disease management benefits greatly from a team of healthcare professionals working together to address the diverse challenges of the condition. Each professional brings a unique perspective and skill set:
Neurologists: Specialize in diagnosing and treating Parkinson’s, including optimizing medication regimens and monitoring disease progression.
Physiotherapists: Provide tailored exercise programs to improve mobility, strength, and balance. Clinics like Keilor Road Physiotherapy also offer advanced techniques, such as the LSVT BIG program and gait training.
Occupational Therapists: Help patients adapt to changes in abilities, suggesting tools and techniques to simplify daily activities.
Speech Therapists: Address issues with speech, swallowing, and communication. Techniques like voice exercises improve clarity and reduce risks of aspiration.
Dietitians: Offer guidance on nutrition, ensuring patients maintain a balanced diet to optimize energy levels and manage symptoms like constipation.
Mental Health Professionals: Provide counseling and strategies for managing depression, anxiety, and other emotional challenges associated with Parkinson’s.
Living with Parkinson’s disease is a journey that requires resilience, adaptability, and support. By implementing practical coping strategies, seeking caregiver resources, and utilizing a multidisciplinary care team, individuals with Parkinson’s can manage their symptoms effectively and continue to lead fulfilling lives. At Keilor Road Physiotherapy, we are committed to supporting patients and their families through every stage of this journey, offering tailored care and expert guidance to improve quality of life.
Conclusion
Living with Parkinson’s disease is undoubtedly a life-altering journey, but with the right strategies, support, and healthcare resources, it is possible to maintain a fulfilling and meaningful life. Understanding the condition—its symptoms, progression, and management options—empowers individuals and their families to make informed decisions and take proactive steps toward improving their quality of life.
A multidisciplinary approach is essential for managing Parkinson’s disease effectively. Neurologists, physiotherapists, occupational therapists, speech therapists, dietitians, and mental health professionals all play crucial roles in addressing the wide-ranging challenges of the condition. Together, this team provides comprehensive care that encompasses medication optimization, mobility enhancement, speech and swallowing support, and emotional well-being.
At Keilor Road Physiotherapy, we take pride in being an integral part of this team. Our expert physiotherapists offer evidence-based therapies tailored to the unique needs of Parkinson’s patients, such as the LSVT BIG program, gait training, and balance exercises. These interventions not only improve physical mobility but also empower patients to regain their independence and confidence in daily activities. We strive to support individuals at every stage of their journey, ensuring they feel seen, supported, and equipped to face the challenges of Parkinson’s.
For caregivers, the journey can be equally demanding, requiring resilience, patience, and support. By prioritizing self-care and seeking resources like support groups or respite care, caregivers can sustain their ability to provide the compassionate care their loved ones need.
Living well with Parkinson’s is about focusing on what is possible rather than what is lost. It’s about celebrating small victories, embracing new strategies, and connecting with a supportive community. Advances in research and therapies continue to provide hope for a brighter future, making it an exciting time for those affected by Parkinson’s to stay engaged with new developments.
If you or a loved one are navigating life with Parkinson’s disease, we encourage you to seek professional guidance, stay informed about the latest treatments, and reach out for support. At Keilor Road Physiotherapy, we are committed to walking alongside you every step of the way, providing expert care and compassionate support to help you live life to its fullest potential. Together, we can work toward greater mobility, independence, and an improved quality of life.
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.
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