Parkinson's Disease And Occupational Therapy

Living With Parkinsons And The Emerging Role Of Occupational Therapy

Occupational Therapy & Parkinsons Disease

Jelka JansaAcademic Editor: Received

Abstract

Parkinsons disease is a chronic and increasingly complex condition, demanding multidisciplinary management. Over the last twenty years or so, alongside the growth of specialist services and healthcare teams specifically developed for people with Parkinsons, occupational therapy has grown in recognition as a treatment option, especially since evidence of its efficacy is now slowly emerging. The purpose of this work is to outline the role of occupational therapy clinical practice in the management of people living with Parkinsons disease and its emergent evidence base, combined with details of current occupational therapy philosophy and process, as applicable to occupational therapy practice for people with Parkinsons. The Canadian Practice Process Framework is used to structure this overview and was selected because it is a well-recognized, evidence-based tool used by occupational therapists and encompasses the core concepts of human occupation and person-centred practice. The framework employed allows the flexibility to reflect the pragmatic occupational therapy intervention process and so enables the illustration of the individually tailored approach required to accommodate to the complex pathology and personal, domestic, and social impacts, affecting the functioning of Parkinsons disease patients on a daily basis.

1. Introduction

2. Canadian Practice Process Framework

2.2. Eight Action Points

2.2.1. Enter/Initiate

How Does Physical Therapy Help Parkinsons Disease

Physical therapy cannot cure Parkinsons 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 theyre 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

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.

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.

Occupational Therapy Modifications For People With Parkinsons

Along with physical exercises, occupational therapists often recommend modifications to help people living with PD maintain function and continue participating in daily activities. Modifications may include:1

Changing the nature, time, and duration of an activity
Simplifying activities by breaking complex actions into simple tasks
Arranging items to reduce situations that involve time pressure, like moving the telephone to an accessible location

Recommended Reading: Caring For Someone With Parkinsonâs

Using An Adaptive Keyboard

Occupational Therapy and Parkinsons Disease

There are adaptive keyboards and specific software programs that can help to decrease typing mistakes and make the process of typing on a computer easier. There are also speech-to-text options which allow you to dictate what you want to write and eliminate the need for typing altogether. An OT consultation can help set you up with these options.

One trick that I recommend frequently which helps people use their computer is changing the cursor setting so that it tracks more slowly across the screen when you use your mouse. Slowing down the cursor can help make it easier to see and control. In addition, you can change the sensitivity of your mouse to make it easier to control.

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

Parkinsons Disease Treatments Covered

Parkinsons disease can come with a wide range of motor and nonmotor symptoms. The symptoms of this condition can be different for different people.

Since it is a progressive disease, symptoms can change over time. Medicare covers a range of different treatments, medications, and services that you may need to manage Parkinsons disease throughout your life.

You May Like: What Toxins Cause Parkinson’s Disease

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

Recommended Reading: What Is Treatment For Parkinsons Disease

Big Things Learned About Treating Patients With Parkinsons Through Lsvt Big

Parkinson’s Disease Thinking Changes: Engaging Occupational Therapy

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 Parkinsons 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.

Recommended Reading: Is Parkinsons An Autoimmune

Recommended Reading: How Long Can You Survive With Parkinson’s

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.

To Learn Techniques For Improving Sleep

The American Sleep Association reports 50-70 million people in the U.S. report sleep difficulty. People with Parkinsons are no exception and may experience sleep difficulty in greater numbers that those without Parkinsons. Sleep related issues are reported in 75% of people with Parkinsons. When we dont sleep well, we dont function well. Parkinsons symptoms are worsened by emotional and physical stressors. Fatigue is a physical stressor that can cause difficulty with movement and cognition. Balance, tremor, and thinking difficulties are likely to be exacerbated from poor sleep. Poor sleep causes daytime fatigue. Occupational therapists use a non-medication approach to improve sleep for people with Parkinsons. Your therapists will analyze your day and night time habits and make recommendations to improve your ability to get restorative sleep at night. Your therapist will also make recommendations for daytime rest, when needed. When you rest, how you rest and how long you rest will be a part of your treatment plan.

Some of the recommendations made by your Parkinsons OT , to improve your sleep, may include:

Avoid caffeine late in the day

Maintaining a consistent bedtime routine

Stop using electronic devices, phones, tablets, computers or tvs, 30-60 minutes prior to bedtime

Do not watch tv in bed.

Sleep in a cool dark room

Utilize the bed for sleep and sexual activity only

Exercise early in the day

A healthy balance of exercise, activity and sleep

How To Exercise With Parkinsons

Whether youre a first-time exerciser or a lifelong athlete, the key to working out with Parkinsons is to safely and regularly move your body in a variety of ways. Your fitness regimen should include these four main categories of exercise:

Aerobic activity
Balance, agility, and multi-task exercises

People with Parkinsons should strive to perform aerobic activity at least three times weekly and to complete exercises from the other categories two to three times each week.

In total, the Parkinsons Foundation suggests performing 150 minutes of moderate tovigorous exercise weekly.

To help you achieve this goal, try these helpful tips:

Invest in a treadmill, elliptical, or exercise bike. This will make it convenient to perform aerobic exercise from your home, regardless of the weather.
Obtain a set of light hand weights from a local exercise shop or thrift store. These can be used for a wide variety of strength training exercises.
Follow along with one of the many online exercise classes on YouTube that are tailored to people with Parkinsons disease. The Parkinsons Foundation and the Davis Phinney Foundation offer many great online exercise videos.
Connect with a workout buddy by finding a local Parkinsons support group associated with the American Parkinson Disease Association

Study Design And Participants

Occupational Therapy Exercises For Parkinsons Disease

We retrospectively identified PD patients, hospitalized at the Department of Parkinsons disease and Movement Disorder Rehabilitation of Moriggia-Pelascini Hospital in Gravedona ed Uniti , from January 2015 to June 2018, to undergo a 4-week Multidisciplinary Intensive Rehabilitation Treatment .

Eligibility criteria were as follows: diagnosis of idiopathic PD according to the UK Brain Bank criteria Hoehn and Yahr stage 2 to 4 ability to perform both the OConnor finger dexterity test and the Minnesota manual dexterity test .
Exclusion criteria were as follows: diagnosis of atypical parkinsonisms, psychosis, auditory and visual dysfunctions, and comorbidities impairing autonomy in ADL.

The study design and protocol were approved by the local Ethics Committee and were in accordance with the code of Ethics of the World Medical Association . All patients signed an informed written consent form for the use of their clinical data for scientific purposes. This trial was registered on ClinicalTrials.gov website }NCT03763955.

Also Check: Lion’s Mane Parkinson’s

Physical Therapy For Parkinsons

Physical therapy is a program that helps you build strength, flexibility, balance, and coordination. It starts with an evaluation of your current abilities to locate the areas of movement causing you problems.

The therapist will teach you exercises and other techniques to improve your strength, coordination, balance, and movement. During physical therapy sessions, you might learn to:

get in and out of bed or a chair more easily
stretch your muscles to improve your range of motion
walk more smoothly, without shuffling
go up and down stairs
use a cane or a walker to help you get around

To get the most out of your physical therapy sessions, find a therapist with experience treating Parkinsons or similar disorders. Therapists who are board-certified neurologic specialists should have this type of training. Ask your neurologist to recommend someone.

Certain types of physical therapy can help with movement issues caused by Parkinsons disease. Here are a few of them.

Treating Parkinsons Disease With Aquatic Therapy

Physical therapy and exercise regimens, like hydrotherapy, are quickly becoming prominent methods for treating a variety of illnesses, including neurodegenerative disorders like Parkinsons. Hydrotherapy adds specific advantages for many Parkinsons patients. As someone who owns or manages a physical therapy clinic, you can introduce aquatics for your existing Parkinsons patients. It may even help you attract new Parkinsons patients to your facility.

After Alzheimers disease, Parkinsons disease is the second most common neurological condition American adults face. Physicians often treat the disorder with heavy medications, which potentially yield unintended or unwanted side effects.

You may be wondering, Is aquatic therapy effective for Parkinsons? Hydrotherapy offers an alternative form of treatment which can be used in combination with drug therapies to produce improved results.

Aquatic therapy has been used to help people like Virginia Bishop, who suffered from Parkinsons disease as well as multiple sclerosis. She used aquatic sessions to increase her activity levels, improve core strength and build stamina. Her results included regaining the ability to tend to daily tasks, as well as play the piano.

Don’t Miss: Occupational Therapy Exercises For Parkinson’s Disease

Voting On The Recommendations

Parkinson’s Motor Symptoms Co-Management: Occupational Therapy and Neurology

GDG members agreed on the strength of every recommendation. Recommendations were approved and adopted when a majority of 60% of the GDG voted to approve. All recommendations received 100% agreement among the quorum of the voting GDG. No disagreements were recorded during recommendation voting. When changes were made to the strength of a recommendation based on the magnitude of benefit or potential risk, harm, or cost, the GDG voted and provided an explanation in the rationale.

Recommended Reading: Parkinsons Disease Family Support

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.

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!

About our guest bloggers:

Read Also: Patch For Parkinson’s Disease

Add Aqua Therapy To Your Parkinsons Patients Treatment

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.

Be Your Own Therapist

Occupational Therapys Role in Parkinsons

Which activities are most important to you? Once you answer, try the strategies below to see which ones work for you for each activity.

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.

Change the environment.

Adapt the activity.

Which activities do you enjoy and how can you adapt that activity to make sure you can still do it? For example, if you love baking, perhaps substitute complex recipes with simpler ones.

Find an Occupational Therapist

Recommended Reading: Last Stages Of Parkinson’s Disease

Parkinson’s Disease And Occupational Therapy