Study Design And Participants
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 .
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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 .
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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.
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.
Using An Adaptive Keyboard
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.
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How Can Occupational Therapy Help Me
As Parkinsons progresses you may find tasks or hobbies become more difficult or take more time and energy, for example turning in bed, eating and drinking, doing up buttons, using a computer and writing. Your occupational therapist will first assess your daily routines and often your home, work and leisure activities. He or she will then recommend different ways of doing difficult tasks, or advise on the use of appropriate gadgets or technical aids to assist you.
An occupational therapist can also advise how to adapt your home or workplace to improve easy movement or safety, for example by arranging the installation of extra hand rails by steps, stairs and perhaps in bathrooms. He or she may also advise on how to prevent some potential problems before they arise.
It is important to stress that the success of occupational therapy is dependent on your collaboration with your therapist. The advice and recommendations you are given should be a catalyst for you to develop your own routines that enhance quality of life and preserve independence. Occupational therapy cannot overcome daily challenges without your active engagement and cooperation!
Ideally, you should ask to be referred to, or contact directly, an occupational therapy service as soon as you start to find everyday tasks difficult. Because your symptoms will gradually change, you will probably need to contact an experienced therapist from time to time so that you can learn new strategies.
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 persons 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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Who Is Lisa Warren
Lisa Warren graduated from the University of Texas Medical Branch with a B.S. in occupational therapy. She received a Masters of Health Science from the University of Florida. She has more than 30 years of experience as an occupational therapist. Lisa is the rehabilitation site manager for the UF Health Norman Fixel Institute for Neurological Diseases. She has been a member of this team since 2010. This rehab clinic provides occupational therapy, physical therapy and speech therapy evaluations and treatment for persons with neurological disorders. Lisa has lectured healthcare providers locally, nationally and internationally on therapy for Parkinsons Disease, Huntingtons Disease, dystonia, essential tremor and other neurological disorders. She frequently speaks to support groups, teaches therapy students and provides community workshops.
Lisa has lectured locally and nationally on therapy for Parkinsons Disease, Huntingtons Disease, dystonia, essential tremor and other neurological disorders. She frequently speaks to support groups and at community workshops. She has established a quarterly meeting of therapists across the US and Canada for information sharing on the treatment of patients with neurological disorders. She is considered a world expert on OT for Parkinsons disease.
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Parkinsons Disease Ot: Your Home Functional Programs
- 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:
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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.
Defining The Strength Of The Recommendations
Judging the quality of evidence is only a steppingstone toward arriving at the strength of a CPG recommendation. The operational definitions for the quality of evidence are listed in , and rating of magnitude of benefits versus risk, harms, and cost is provided in . The strength of recommendation also considers the quality, quantity, and trade-off between the benefits and harms of a treatment, the magnitude of a treatmentâs effect, and whether there are data on critical outcomes. addresses how to link the assigned grade with the language of obligation of each recommendation.
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Physical Therapy Strategies For Parkinsons Disease
PT can improve daily functioning for people living with PD by:4
- Improving gait, or the way a person walks
- Improving transfers, like going from stillness to activity
- Improving balance
- Strengthening joints and muscles to improve physical capacity
One of the ways physical therapists help improve gait is through the use of cues. Cues are stimuli from the environment or generated by the person that they can use to facilitate repetitive movements, like walking. Cues can be:4
- Auditory, like using a metronome or music
- Visual, such as stepping over stripes on the floor
- Tactile, like tapping on the hip or leg
- Cognitive, like using a mental image of the length of a step
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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 persons concerns in that four-week period.
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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.
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
- Immobility
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.
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Occupational Therapy For People With Early Parkinsons Disease: A Retrospective Program Evaluation
Miriam Rafferty
1Shirley Ryan AbilityLab, Chicago, IL, USA
2Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA
3Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
4Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Academic Editor:
Abstract
1. Introduction
Occupational performance, or engagement in life activities, is impacted by Parkinsons disease symptoms, including tremor, bradykinesia, weakness, poor dexterity, fatigue, gait impairment, apathy, depression, and cognitive deficit . An integrated team approach is needed to address these deficits, including contributions from occupational therapists. Clinical practice guidelines recommend occupational therapy services for people with PD in all stages of the disease . Yet, data reveals that people with PD rarely use OT .
2. Materials and Methods
2.1. Setting
2.2. Participants
2.3. Implemented Intervention
2.4. Data Sources
Retrospective data were collected from all PwEP who came through the proactive rehabilitation program in 2018. Data were extracted from the referring providers note and OT documentation in the electronic medical record and managed using a tool created in Research Electronic Data Capture software hosted at the University Clinical and Translational Sciences Institute . Program evaluation phone interviews were completed in 2019 for PwEP seen in 2018.
Note
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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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 Can Occupational Therapy Help Parkinson’s Disease
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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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.
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 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.
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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.
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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:
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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.
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:
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