How Occupational Therapy Helps Parkinsons
Parkinsons disease is a degenerative disorder of the brain that impairs nerve cells that control movement. This leads to symptoms like shaking, stiffness and difficulty with walking and talking, that gradually worsen over time. Approximately 60,000 Americans are diagnosed with Parkinsons each year, with men being 1.5 times more likely to have the disease than women.
Healthy Outlook spoke with occupational therapist Lorinda Hagstrom from Overlakes Outpatient Rehabilitation Services to learn more about this treatment.
Data Sources And Search Strategy
This study was carried out according to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions . The systematic literature search was conducted using Pubmed , Excerpta Medica dataBASE , Cochrane Central Register of Controlled Trials , the Oriental Medicine Advanced Searching Integrated System , and Chinese medical databases . The articles reported until December 2016 were searched, and there was no language limitation. Various exercise terms and MeSH terms were used for searching. The search strategies used in each database are presented in Table 1.
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Living With Parkinsons And The Emerging Role Of Occupational Therapy
Jelka Jansa
1Neurologic Hospital, University Medical Centre Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
2Phoenix Cottage, New Buildings, Carlingcott, Bath, UK
Academic Editor:
Abstract
1. Introduction
This overview explores the philosophy and evolution of the OT role specifically in the management of people with Parkinsons from the unique perspective of the two authors, who have a combined 47 years professional experience of working with people living with Parkinsons . Recently published, robust and rigorous randomised controlled trials , along with earlier non-peer reviewed, published sources that synthesised and translated basic research evidence into clinical practice, and more recent evidence-based Parkinsons specific guidance for OTs are also presented. This emergent evidence base underpins and demonstrates the role of OT and its value, in terms of health related quality of life benefits of OT for people with Parkinsons and in some cases for their care givers as well.
2. Canadian Practice Process Framework
2.1. The Frame of Reference, Societal, and Practice Context
2.2. Eight Action Points
2.2.1. Enter/Initiate
2.2.2. Set the Stage
2.2.3. Assess/Evaluate
2.2.4. Agree Objectives and Plan
Occupational therapist and PD patients expectations should be focused towards the same achievable functional goals. It is important to negotiate goals that are specific and measurable and that can be achievable in the time frame available for intervention.
2.2.5. Implement Plan
What Other Services Does Physical Therapy Provide
Recommendations. A physical therapist can make recommendations for physical therapy at home, at an outpatient facility, or at a nursing or rehabilitation facility.
Work capacity evaluations. Many physical therapists can perform functional capacity evaluations to provide more information for disability claims based on physical performance. This functional capacity evaluation can be useful when the Social Security office denies disability to a person who is unable to work for an eight-hour day.
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Big Things Learned About Treating Patients With Parkinsons Through Lsvt Big
As three of the faculty for the LSVT BIG Training and Certification Course, we have had the incredible opportunity to learn from each other over the years. Although each of us has unique backgrounds and paths that led us to become Occupational Therapists, we share a common passion for helping people with Parkinson’s disease .
We have also realized there are common themes in the lessons we have each learned and in ways we have changed our approach to treating patients with PD since becoming LSVT BIG Certified.
What Are The Common Difficulties Associated With Parkinsons Disease
The symptoms of Parkinsons can be categorised under three main headings and below are some of the functional difficulties they may cause.
- Tremors such as a trembling or shaking in the hands. This can affect the ability to write, eat, drink, prepare meals or use door keys
- Slow movement due to muscle stiffness this can mean that carrying out daily tasks such as getting out of bed, on and off the toilet, washing, dressing or using the stairs all become challenging
- Difficulty walking this can mean an increased risk of falling and a decreased ability to carry out daily activities
If you would like to learn more about how we as occupational therapists can help people overcome common difficulties associated with Parkinsons Disease, you will find some useful links at the bottom of this page.
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Tips And Tricks From An Occupational Therapist That Can Help Increase Independence During Daily Activities
Lisa Carson, OTD, OTR/L is an occupational therapist at Washington University in St. Louis, Missouri, who works closely with our APDA Greater St. Louis Chapter. She has a lot of expertise in treating people with PD, helping them to achieve increased independence. If you are interested in working with an OT, be sure to speak to your neurologist about it and ask for a recommendation. Your local APDA Chapter may also be able to refer you to an Occupational Therapist in your area.
Recently, I was able to ask Dr. Carson about tips and tricks for people with PD who are having difficulty with some basic activities such as eating, preparing meals, writing, using a keyboard, and using a cell phone. Here are her suggestions:
Systematic Review Of The Effectiveness Of Occupational Therapyrelated Interventions For People With Parkinsons Disease
Erin R. Foster, OTD, MSCI, OTR/L,Mayuri Bedekar, MS, OTR/L,Linda Tickle-Degnen, PhD, OTR/L, FAOTA,
Erin R. Foster, Mayuri Bedekar, Linda Tickle-Degnen Systematic Review of the Effectiveness of Occupational TherapyRelated Interventions for People With Parkinsons Disease. Am J Occup Ther January/February 2014, Vol. 68, 3949. doi:
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How Ot Can Help Improve Your Quality Of Life Throughout The Stages Of Parkinsons:
In Stage I of Parkinsons, tremor and other movement symptoms are mild and typically affect one side of the body. OT during Stage I can address:
As Parkinsons progresses to Stage II, tremor, rigidity and other movement symptoms impact both sides of the body and posture and walking are also affected. OT during this stage can address:
- Stretch to warm up before dressing. Allow plenty of time to get ready before going out into your community. Use adaptive equipment to make dressing easier, such as a long handle shoe horn, elastic shoe laces, button hook, Velcro closures on shoes and clothes, etc.
- Toileting. Use a regular schedule to help prevent accidents. Use pads, briefs or panty liners to help with incontinence. Use plastic or washable pads for bed.
- Exercise Training. Continue large amplitude exercises as you are able.
In Stage III of Parkinsons, symptoms include loss of balance and slowness of movement, and falls are more common. Though the person living with Parkinsons is still fully independent, symptoms significantly impair activities of daily living such as dressing and eating. To help during this stage, OT can address:
In Stage IV of Parkinsons, symptoms are severe and very limiting. Tremor may be less, but rigidity and freezing can profoundly affect your quality of life. While its possible to stand without assistance, movement may require a walker. OT during Stage IV can address:
Use Your Personal Strengths
How can you build on your strengths and minimize your limitations? For example, if you have the strength of helping children enjoy reading, you could exercise that strength by reading to your grandchildren, by listening to them as they read, or by playing a reading game that stimulates both your imagination and theirs.
One of your strengths may be thinking skills. One thinking skill is imagining doing the activity before doing it. For example, imagining writing big can actually help you write big. Another thinking skill is speaking the steps out loud. When combing your hair, try saying hold and comb, to avoid dropping the comb.
Make sure you are exercising. Improving strength, balance and endurance through exercise supports your participation in all sorts of activities. Whether it is dancing or walking to a neighbors house, find an enjoyable way to exercise.
Lastly, be positive. Think, I will do rather than Ill try to and you may be more successful.
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How Does Physical Therapy Help Parkinson’s Disease
Physical therapy cannot cure Parkinson’s disease, because at this time, neurological damage cannot be reversed. But therapy can help you compensate for the changes brought about by the condition. These “compensatory treatments,” as they’re called, include learning about new movement techniques, strategies, and equipment. A physical therapist can teach you exercises to strengthen and loosen muscles. Many of these exercises can be performed at home. The goal of physical therapy is to improve your independence and quality of life by improving movement and function and relieving pain.
Physical therapy can help with:
- Balance problems
- Immobility
- Weakness
Important note: Some physical therapists may apply diathermy to relieve muscle aches and pains. This could be dangerous to patients who have deep brain stimulators.
How Can Occupational Therapy Help
OT intervention can assist the individual to function optimally in their activities of daily living and facilitate their engagement in occupations most meaningful to them. Four main areas targeted by OT intervention are:
- Activities of daily living: teaching the use of adaptive techniques and tools to reduce the impact of tremors, and provide strategies to assist with managing medication routines. This may also include gait and balance-based activities
- Sensorimotor: facilitating joint movement, maintaining range of motion and preventing contractures through impacted joints, and improving motor planning and task execution
- Psychosocial: providing group-based interventions to enhance overall functioning and social participation in a supportive environment, providing education in self-management skills , promoting engagement in productive activities and leisure, exploring and discussing roles within the family and home unit, and providing education to individuals, families, and carers
- Environment: assessing for and implementing appropriate assistive technologies and home modifications to enhance safety and accessibility within the home and community, assisting clients, families and caregivers to explore the community for support groups and resources
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How Can An Occupational Therapist Help
Occupational therapists are specialists who promote health and well-being. In PD, their primary objective is to enable patients to participate in the activities of everyday life by working with them to improve their ability to engage in tasks they want to, need to, or are expected to do. In many cases, this may require modifying an occupation or the environment to better support occupational engagement.
These therapists provide assessment, treatment, and recommendations in areas such as:
Occupational therapists may also help with changes in relationship dynamics by promoting the maintenance of normal roles, daily routines, and social habits as much as possible. They provide support to patients to continue working, and serve as a link between a patient and the workplace. Therapists also help with social, recreational, and leisure activities, and driving. .
Parkinsons News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
What Do Patients And Their Families Say About Lsvt
Patients are excited to see and feel the changes. Loved ones will often comment on their observation of the person’s improved movement or posture or daily activity participation. Most clients notice progress in their walking and movement within the first week, but the real change is at the end of four weeks when re-testing shows numbers that reinforce how he/she feels related to gains in walking speed, balance, managing buttons or fasteners, bed mobility and daily tasks.
LSVT BIG is improving the quality of life for our clients, but it is also very rewarding for the therapists. To see their expression and realization of what they can still do is a joy, and doing the movements alongside him/her reminds me of the effort that is put forth as they live with the disease day in and day out. It takes a lot of commitment from the client, their support system and us as therapists, but the outcomes are worth it.
LSVT programs require a physician referral. To learn more, talk to your healthcare provider or visit Overlakes Outpatient Rehabilitation Services.
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Help With Funding For Adaptations
Occupational therapists can advise and help arrange funding for minor home adaptations if you need them, such as fitting grab rails or hand rails by steps and stairs.
If you need advice about more expensive home adaptations, such as stairlifts, or accessible bathing facilities, you should speak to an occupational therapist based in a social services department, or the health and social care services of a local authority. They may advise you on any funding available. However, major home adaptations, such as installing a level-floor shower are often subject to means testing.
Parkinsons Disease And Occupational Therapy: Helping People To Live Better With Their Pd Symptoms
If youre living with Parkinsons Disease an Occupational Therapist may be able to help you achieve your goals so you can perform better to live better.
Whether youre frustrated by your ability to perform everyday tasks, had a fall or perhaps youve experienced a decline in confidence to manage at home?
Whatever your situation, these are all very real and all too common experiences many people affected by PD, maybe much like you, have on a regular basis.
We would like to help.
No intervention can reverse or cure Parkinsons disease. This has been real frustration for many people, maybe much like you as well as David Norris our Senior OT who is passionate about providing Parkinsons Disease occupational therapy services.
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Training Of Trial Therapists
Before the start of the trial, the participating occupational therapists follow a three-day training to inform them about the study procedures and to train them to treat the patients and caregivers according to the OTiP intervention protocol. Special attention is given to enhancing the therapists skills in coaching and motivational interviewing and in eliciting and collaboratively defining meaningful, individualized goals with the patient and caregiver. Ways to achieve sufficient treatment intensity in ten weeks are discussed. Halfway through the inclusion period a booster training session is planned. Therapists can use a secure online platform to share issues and experiences and can consult an expert OT to discuss the intervention.
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Parkinsons Disease Ot: Your Home Functional Programs
- LSVT BIG:
- We say, start as soon as possible- dont wait for increasing symptoms
Whilst everyone can benefit, the people who best respond to LSVT BIG are those people with mild to moderate symptoms and aged 56 to 86 years of age.
The whole point of this program is to make a persons life better. One of the first questions I ask people when I see them is what do you enjoy and what do you want to still be able to do? This is not a gym based program. Instead its personally relevant and focuses on every day tasks.
- Thrive For Life:
- Parkinsons Disease Pathfinder:
- Plus all the OT standard services are available to assist with home modifications or equipment needs.
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How Long Does The Lsvt Program Last
The LSVT BIG program is 16 sessions: four consecutive days per week for four weeks. Each session lasts one hour. There is daily homework practice as well. Once a person graduates from LSVT BIG with the skilled therapy sessions, the recommendation is to continue the exercises daily.
At our clinic, we have occupational therapy, physical therapy and speech-language pathology all under one roof. Occupational and physical therapy combine to provide the frequency of services each week, which allows us to address a vast number of a person’s concerns in that four-week period.
Ot Encompasses Several Different Areas:
- Activities of Daily Living . These are the basic self care skills of eating, dressing, grooming, bathing, toileting and toilet hygiene and personal care devices .
- Instrumental Activities of Daily Living . These include the care of others, care of pets, financial management, driving and community mobility, health and medication management, meal prep and clean up, religious and spiritual activities, shopping, safety and emergency maintenance, etc.
- Functional Mobility. This includes getting around your home and environment to perform your daily activities, transfers to bed, toilet, bathtub/shower, couch, recliner chair, wheelchair and car, etc.
- Adaptive Equipment. This includes long handle utensils to reach your feet or back, tremor management eating utensils, non skid mats, button hook, lidded cup with straw, scoop dish, adaptive pen, etc.
- Work Activities. This includes work station set-up/ergonomics, adaptive devices to make it easier to perform work tasks .
- Cognition. This includes activities to stimulate cognitive function to maximize performance .
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Occupational Therapy And Carers
Occupational therapists can advise your carer and family how to support you in staying independent. They can also advise on ways to look after their own health.
It is important that your family and carers are also involved in, and understand, any changes the occupational therapist recommends to your usual routines. Getting help and advice from an experienced therapist can reduce the amount of help you need from your family or carer and so alleviate any pressure they may feel.
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