Parkinson Disease Occupational Therapy Interventions

How Occupational Therapy Helps Parkinsons

Occupational Therapy & Parkinsons Disease

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.

How Aquatic Therapy Helps Manage Parkinsons Symptoms

Hydrotherapy treats a wide range of illnesses and orthopedic or chronic disorders. Among them are many conditions related to strength and balance. While aquatic exercise for Parkinsons disease does not reduce all risks of falls which is a key concern among many Parkinsons patients it can be beneficial by strengthening the core and improving muscle memory.

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.

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What Is Occupational Therapy

In life with PD, you may have encountered speech or physical therapists. Where does occupational therapy fit in and how is it different? First, note that the word occupation in OT means activity. Our job in OT is to identify strategies that will allow you to continue doing activities that are important to you. Each person with PD will have different goals based on his or her symptoms and disease progression, as well as individual lifestyles, interests and priorities. Whether you have been living with PD for one month, five years or 20 years, and whether your goal is playing tennis or spending time with family, our approach is the same: to find ways to match your personal strengths with activities and an environment that will help you reach your goal.

To Learn Strategies That Combine Activities And Parkinsons Medication Timing For Success

Establishing a routine that aligns your Parkinsons medication timing with activities can significantly improve your success with the things you do daily. The medication prescribed for your Parkinsons symptoms can improve your ability to move and function. These medications can reduce muscle stiffness, decrease muscle cramping, decrease tremor and improve overall ease of movement. Taking your medication before certain tasks like exercising, bathing, dressing, etc may help you complete these with less effort. However, if you are getting too much movement after taking your Parkinsons medication then certain tasks that require refined movement, like shaving, may be better performed before the medication is fully on. Your occupational therapist will help you establish a routine of daily activities that works in conjunction with your Parkinsons medication schedule that was prescribed by your neurologist.

Key points:

Take your medication on time. Make every effort possible to take your Parkinsons medication on the schedule your neurologist prescribed. This is how the medication works best to help you function at your best. Phone alarms can be helpful in reminding us when it is medication time.

Your Parkinsons trained OT will help you lay out a daily plan connecting your medication regime with your activity and exercise routine.

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How Do I Find An Occupational Therapist

Referral procedures depend on where you live and treatment may or may not be accessible through your countrys national health system.

In some countries occupational therapy is prescribed by medical doctors but in others people with Parkinsons can contact an occupational therapist direct without going through their doctor.

Training and accreditation varies throughout Europe so it is best to check the experience of anyone you consult. It is helpful to be seen by someone who has experience of Parkinsons, and always ask for references and the likely costs before treatment commences.

Best Practice Guidelines are available online for occupational therapists working with people who have Parkinsons. ParkinsonNet also provides evidence based guidelines in English.

Your national Parkinsons organisation may be able to provide information based on members experiences. See also, Other Parkinsons organisations.

Preparing Meals And Navigating The Kitchen

Consider where things are located in your kitchen. You might want to reorganize or rearrange things in your kitchen so that frequently needed items are the easiest to access. Plan ahead and break down the steps of your meal prep so that it is more manageable.

There are lots of tricks and tips that OTs have to help in the kitchen such as sliding heavy pots of water along the countertop instead of carrying them or sitting at the kitchen table to chop vegetables instead of standing. If you enjoy cooking, there are likely lots of suggestions an OT can make to help you be safer and more independent in the kitchen.

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Tip: Enhancing Hand Coordination

We use our hands throughout the day in all activities. People with PD may notice changes in the ease in which they perform hand and finger motions. An occupational therapist can help evaluate and make recommendations to improve hand coordination:

Exercise hands and fingers regularly
Engage in enjoyable and stimulating hand exercises, such as gardening or knitting
Use toothbrushes, hairbrushes, silverware and writing tools with larger handles
Use both hands in tasks – dont favor one hand over the other
Schedule tasks that require greater hand control for times when you are well rested and medications are working well

How Can Occupational Therapy Help Parkinson’s Disease

Parkinson Disease: Treatment by a Physical Therapist

For Parkinson’s disease, occupational therapy generally provides assessment, treatment, and recommendations in the following areas:

Arm and hand therapy
Driver evaluation and vehicle modification information
Cooking and homemaking adaptations
Ways to make the most of your energy
Computer modifications
Workplace or work equipment modifications
Leisure skill development

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Implications For Occupational Therapy Practice

The findings of this systematic review have the following implications for occupational therapy practice with people with PD:

Assessments should include measures of IADL performance and IADL participation.
Occupational therapy practitioners can promote engagement in physical activity by using health behavior change techniques.
Social physical activity may stimulate increased participation in IADLs.
Occupational therapy practitioners should consider task-specific training for problematic IADLs. Handwriting can be addressed through upper extremity strengthening, writing activities, and external cues. Medication management interventions should incorporate a cognitivebehavioral approach and care partner participation.

Differences Between Physical Therapy And Occupational Therapy

While physical therapy and occupational therapy may be seen as interchangeable, there are some differences between the 2 practices. PT focuses on the physical rehabilitation of people recovering from injuries or disease. The goal of PT is to restore mobility. Physical therapists also educate people on managing their condition to maintain long-term benefits.3

OT also deals with rehabilitation and motion. However, it is focused more on enabling the person to engage in daily activities as seamlessly as possible. Occupational therapists also suggest adaptations and modifications to the persons environment.3

Physical therapists focus primarily on anatomy and the persons strength, functional capacity, and motor development. Occupational therapists combine physical aspects with mental health. They design exercises that teach people coping and management skills within their limits.3

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Risk Of Bias Within Studies

Occupational therapy for people with Parkinson

In most studies, the risk of bias was not high. Among the risk of bias domains, blinding of the participants and personnel and selective reporting revealed methodological concerns. Nine articles were classified as âunclear risk of bias in the random sequence generation because there was no specific description of the randomization method. Eight studies were classified as âunclear risk of biasâ in the allocation concealment. Another study that did not conceal the assignment order was classified as âhigh risk of bias.â Most studies were classified as âhigh risk of biasâ in the blinding of participants . In the incomplete outcome data , one study was evaluated as âhigh risk of biasâ and all the remaining studies were evaluated as âlow risk of biasâ. In the selective reporting , one study was rated as âhigh risk of biasâ and the rest of the studies were evaluated as âunclear risk of bias.â A summary of the risk of bias is shown in Figure 2.

The graph of risk of bias the summary of risk of bias: â+â=low risk of bias, âââ=high risk of bias, and â?â=unclear risk of bias.

S5: S3 OR S4

S6: S1 AND S2 AND S5

Citation: Foster, E. R., Carson, L. G., Archer, J., & Hunter, E. G. . Occupational therapy interventions for instrumental activities of daily living for adults with Parkinsons disease: A systematic review . American Journal of Occupational Therapy, 75, 7503190030.

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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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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:

How To Treat Parkinsons Disease Symptoms With Occupational Therapy

Parkinsons disease can introduce all types of challenges into your daily life, including those that interfere with simple activities that you used to take for granted such as eating, writing, and using a cell phone. Sometimes medication changes can help you move more easily, but sometimes that is not enough.

Add Aqua Therapy To Your Parkinsons Patients Treatment

Physical Therapy and Parkinson’s Disease

HydroWorx offers a variety of products specifically designed to help facilities, just like yours, bring the benefits of aqua therapy to Parkinsons patients and many others. We can work with you to identify your patients needs to determine the ideal hydrotherapy solution from our versatile family of products.

Not only can we help you identify the best possible equipment for your facility needs, but also unique and creative ways to integrate aquatics into your Parkinsons patients current treatment routines. When you have the equipment onsite, it becomes simpler to make adjustments, especially when you take advantage of features enhancing the experience like adjustable-floor therapy pools and variable-speed underwater treadmills.

The use of aquatic therapy, underwater treadmills and resistance jet technology for Parkinsons patients can do the following and more:

Help regain trunk balance
Improve ambulation
Encourage confidence

All of the above are critical when encouraging Parkinsons patients to exercise for their health and to reduce the severity of their symptoms.

Aquatics offers a full range of exercises patients can do without a fear of falling to hold them back. Whether youre working with Parkinsons patients, Alzheimers patients or patients with a host of other physical and neurological conditions, hydrotherapy can be an effective tool for promoting overall physical fitness and good health.

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What Is Occupational Therapy And How Can It Help With Parkinsons Disease

Occupational therapy is a branch of rehabilitative medicine that focuses on the performance of the activities required for independent daily living. like those mentioned above and others.

Occupational therapists who specialize in PD are experts in devising ways to help you maximize your movement and quality of life. In the past, we interviewed PD occupational therapists who specialized in:

Driving cessation

Unlike physical therapists who help with improving body movements, as well as strengthening balance, body alignment and range of motion, occupational therapists focus on the activities and tasks of daily life to promote independence and productivity. Plenty of people with PD will work with both types of therapists as part of their treatment plan.

How Can Occupational Therapy Help People With Parkinson’s Disease

Occupational therapists can work with people with Parkinson’s Disease and their families to provide advice, support and guidance during their journey. For some they may require advice on a specific item of equipment whilst for other clients we are involved in more substantial home modifications and support as their needs change with the progressing condition. Below are some ways that an occupational therapist can help:

How we can help

We aim to solve the difficulties associated with Parkinsons Disease. Some of the common ones we treat are listed below.

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What Should I Expect At An Appointment

You may meet your occupational therapist in a variety of places, including in your own home, a hospital, a Parkinsonâs clinic, a rehabilitation unit, an outpatient clinic, or in a residential or nursing home. In some countries it is possible to meet an occupational therapist at a Parkinsonâs support association office.

Appointments usually last between 30 and 60 minutes, and therapists may recommend a short course of occupational therapy usually once a week, for a month or two.

At the first appointment, an occupational therapist will ask about your daily activities, in particular how you look after yourself, your work and your leisure interests. For example, you may have problems preparing meals, dressing, shopping, walking in crowded places, doing a leisure activity, using a computer, or reading.

Collaboration is essential to successful treatment. Therefore, you need to tell your occupational therapist about your situation, how you cope on a daily basis and problems you experience. Then together you will be able to discuss goals for both you and your family and how you achieve them.

Never Underestimate Your Patients Potential

When you evaluate a person who has had PD for a long time, one of the first things you might notice is a flat affect, followed by a bit of difficulty in getting up from a chair, a slow, shuffling gait and flexed posture. It would be easy to make a quick judgment about that patients potential , but time and time again, we are surprised at what can be magically unlocked with therapy.

I remember a gentleman who arrived for his first OT appointment with a less than enthusiastic facial expression says Erica. He was walking very slowly with a quad cane and had a propulsive, shuffling gait pattern. After evaluating him, it was apparent to me that he was able to move bigger and better when cued, so I knew hed be a good candidate for LSVT BIG.”

Over the course of the of intensive LSVT BIG treatment, four times a week for four weeks, his attention to amplitude greatly improved his safety with functional mobility to the point where was able to walk again with complete confidence and without a cane. I was shocked not only by his potential to improve his mobility, but also by the profound effects it had on his mood and facial expression. I realized that I had initially misjudged his ability and motivation based upon his facial masking, but was glad I decided to give him the benefit of the doubt!

Video – Gait in a man with PD before and after LSVT BIG

2. Dont Be Afraid to Push Your Patient

Why?

3. Keep it simple

4. Functional carryover is key!

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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: