Prairie Doc Perspective Week of May 25th, 2025
“Living with Parkinson’s Disease”
By Dr. Kelly Evans-Hullinger
“I am concerned your symptoms are due to Parkinson’s disease,” is something I have said to numerous patients over the years. This is a degenerative neurologic disease which is common enough that most patients have heard of it or even know someone living with it.
Most commonly, the patient or their family might have noticed classic symptoms: a tremor, difficulty with movement like walking, or balance problems. Importantly, not all tremor is Parkinson’s, though that is typically the biggest concern my patients have. 
Parkinson’s disease is typically a diagnosis made by findings on history and physical exam; it is uncommon that further testing is used. Often, we will refer to our experts in neurology to confirm a suspected diagnosis. As a progressive neurological disease, we don’t currently have any tools to stop or slow the progression of Parkinson’s, but we have many tools to improve symptoms and quality of life.
First and foremost, regular exercise is paramount for patients with Parkinson’s. Quality of life and functional status is better in patients exercising with moderate intensity 150 minutes per week. The type of exercise doesn’t necessarily matter, so find something that is enjoyable enough to stick with.
Beyond independent exercise, specialized therapies administered by a qualified physical therapist and speech therapist can reduce symptoms. Physical therapists will help with walking, movement, and balance; speech therapists can improve patients’ speech and communication and, if needed, help with swallowing problems.
Medications are commonly used to help with tremor and rigidity in Parkinson’s disease. Most often, the first line treatment is a medication called carbidopa-levodopa, and most patients see immediate gratification with the effect of the medication on their movement symptoms. If needed, other medication options can be added.
Finally, options such as deep brain stimulation (DBS) can be used in more severe disease in which medications are not adequate to control motor symptoms. This involves insertion of a device into the affected area of the brain; electrical stimulation there alleviates those symptoms. Other interventions are sometimes used as well with the help of a specialty-trained neurologist.
In summary, Parkinson’s disease is fairly common as people age, and most patients live for many years with the disease. It is important to be educated on the disease and all the options that might improve symptoms and quality of life while one lives with Parkinson’s disease, and a qualified physician can help tailor those treatments to each individual patient.
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm on SDPB Radio.

Prairie Doc Perspective Week of May 11th, 2025
“Have you pre-habilitated today?”
By Joanie Holm, RN


On a recent morning, the first story I heard on the radio was about Pre-habilitation prior to surgery.  We have all heard of rehabilitation, but have you considered pre-habilitation, or increasing your exercise before surgery?  


Recent studies by Durrand, Singh and Danjoux of the National Institutes of Health (NIH) have documented what was inherently known- that building up a reserve of strength before surgery pays off. Makes sense, right!


The physiological challenge of a major surgery has been linked to running a marathon. In both cases, preparation is critical. Surgery involving a major body cavity has an estimated mortality of 4%. Post- operative complications of a major surgery affect 15-40% and may increase the hospital length 2-4 fold as well as increasing readmissions.


The NIH study demonstrated that increasing preoperative functional capacity promotes recovery, reduces complications and reduces healthcare cost.


Later in the day, as I walked the track, my brain took a leap. Isn’t life our chance to pre-habilitate? Wouldn’t pre-habilitation help us if we caught COVID or Influenza? What if you or I suddenly need to have our appendix or gallbladder removed? What if we are in a car crash and have broken bones? What if we have a stroke or heart attack? Pre-habilitation through daily exercise, eating a balanced diet and moderate intake of harmful substances would increase our chances of survival and recovery without complications.


Today and all of the tomorrows are our chance to prepare for the possibility of poor health. We are the key member of the prehab team. Take advantage of your health today to prepare for unexpected complications. Get up and get moving!


 Joanie Holm, RN is a one of the original founders of Healing Words Foundation/Prairie Doc Programming and is the current Board President. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm
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Prairie Doc Perspective Week of May 4th, 2025
SD BAND: Bridging Rural Behavioral Healthcare Needs in South Dakota 
By Ryan Groeneweg, Ed.S., BCBA
As a school psychologist working for a small public school, I remember a teacher asking me to observe a student in her classroom. She expressed concerns about an elementary student’s unusual behavior, lack of playing with classmates, lack of communication and even some unusual motor movements, including flapping her hands. This was in 2001, and I was experiencing my first referral for a student who would eventually receive an educational diagnosis of autism. 
 At that time, autism was considered rare, and providing educational support to meet their needs was challenging. I began to see a growing number of referrals, increasing communication and behavioral challenges, and came to realize that my training and experience as a school psychologist weren’t enough. In 2010, after completing the required coursework and supervision, and passing the National Behavior Analyst Certification Board examination, I began a career as a Board-Certified Behavior Analyst (BCBA) in South Dakota. At that time, fewer than 10 BCBA professionals were in South Dakota. 
Today, there are 88 active BCBAs registered in South Dakota, far below Minnesota (517), Iowa (282), and Nebraska (300). Even when compared to states with similar rural and frontier characteristics, South Dakota lags behind North Dakota (97), Montana (92), and Alaska (89). Currently, nationwide demand for behavior analysts is higher than ever. Annual nationwide demand for individuals holding BCBA certification has increased each year since 2010, with a striking 58% increase from 2023 to 2024. 
One major reason South Dakota has fallen behind was the absence of an in-state training program until 2021. Recognizing this critical gap, a partnership between the Public Health and Health Sciences programs in the University of South Dakota’s School of Health Sciences, the University of South Dakota’s Center for Disabilities, and LifeScape -a Sioux Falls-based non-profit organization- launched the Applied Behavior Analyst (ABA) two-year graduate program. This program aims to expand South Dakota’s behavioral health workforce and contribute essential public health services across the state.
Students who complete the USD ABA graduate program must independently complete 2,000 hours of ABA supervised fieldwork experience. When you consider that most BCBAs in South Dakota live near the state’s larger population centers, Sioux Falls and Rapid City, it’s apparent that those supervised fieldwork experience hours are mostly completed where supervision is available. This barrier creates limited access to BCBAs in rural communities but highlights a great opportunity: addressing disparities in access to specialists in rural areas. South Dakota continues to experience critical shortages of professionals trained to support individuals with autism and other developmental disabilities. 
The South Dakota Behavior Analyst Network Development (SD BAND) was formed to address the critical need for enhanced behavioral health services and the greater integration of BCBAs throughout the state, especially in underserved rural communities. This network of state partners includes the University of South Dakota (USD), Community Healthcare Association of the Dakotas (CHAD), South Dakota Department of Social Services (SD DSS), South Dakota Department of Human Services (SD DHS), and the Community Support Providers of South Dakota (CSPSD). SD BAND is tasked with expanding the presence and collaboration of BCBAs within community health centers and other health care settings across South Dakota, to raise awareness among health care providers, adult service providers, and the broader community about the crucial role of BCBAs, and to facilitate their integration into existing service delivery options. 
Ryan Groeneweg, Ed.S., BCBA, Mr. Groeneweg has been the Director of Community Education at the USD Center for Disabilities since January 2019. In this role, he is the principal investigator (PI) for the South Dakota Department of Education Training and Technical Assistance Grant (2019 to present), and the South Dakota State Autism Grant (2019 to present). He is also an assistant professor at the USD School of Medicine and the program director for the USD School of Health Science Master in Health Science, with a Specialization in Applied Behavior Analysis (ABA) and the USD ABA Certificate Graduate program. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.