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Occupational Therapy For Parkinsonian Patients: A Retrospective Study
Giuseppe Frazzitta
1Department of Parkinsons Disease, Movement Disorders and Brain Injury Rehabilitation, Moriggia Pelascini Hospital, Gravedona ed Uniti, Italy
2Istituti Clinici Scientifici Maugeri IRCCS, Department of Biomedical Engineering of the Montescano Institute, Italy
3MIRT ParkProject, Livorno, Italy
Abstract
1. Introduction
Hand dysfunction is a common symptom in Parkinsons disease and is characterized by poor manual dexterity, deficits in fine motor movements, inability to control grip force output, and difficulty in performing movements with normal amplitude, speed, and coordination .
Hand dysfunction leads to difficulties in activities of daily living , such as eating, dressing, washing, and writing , with loss of independency and poor quality of life .
These abilities are acquired through motor learning processes that are related to executive functions .
Despite the presence of deficits in hands functionality and the reduced autonomy in ADL , these disturbances are often ignored because the majority of rehabilitation programs are focused on gait and balance problems . Therefore, patients are usually referred to an occupational therapist in the later disease stages, when they are experiencing a significant level of disability .
OT aims at treating hand impairment to reduce dependency or recover the patients autonomy in ADL , and it should be considered as an important aspect of a multidisciplinary approach.
2. Materials and Methods
2.2. Outcome Measures
What Are The Common Difficulties Associated With Parkinson’s Disease
The symptoms of Parkinson’s 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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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
Occupational Therapy For Parkinsons
Occupational therapy is the only profession that helps people across the lifespan to do things they want to do through the use of therapeutic activities . Occupational therapists enable people of all ages to live life to its fullest by helping them promote health and prevent or live better with injury, illness or disability.
OT interventions focus on adapting the environment through modifications, modifying the task, teaching a skill and educating the person, care partner and family in order to increase participation and ability to perform daily activities. OT is practical and customizable, focusing especially on activities that are important and meaningful to each specific person.
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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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Risk Of Bias Within Studies
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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Occupational Therapy Benefits On Patient With Parkinsons Disease
This article was reviewed by Lindsey A, DPT.
What is Parkinsons Disease?
It is a chronic progressive neurological disease that is linked to decreased dopamine production in the substantia nigra and presents typically with symptoms of tremor of resting muscles, rigidity, slowness of movement, impaired balance, and a shuffling gait.
What are the Characteristics of Parkinsons Disease?
Movement related symptoms include flexed forward posture, shuffling steps, reduced arm swing while walking, impaired balance, tremor, and bradykinesia . In addition, Parkinsons disease can present with non-motor symptoms including apathy, depression, constipation, sleep behavior disorders, loss of sense of smell and cognitive impairment. All these symptoms can cause difficulty with ADLs i.e bathing, toileting, dressing, grooming, and eating in addition to other functional tasks. This decreased ability to participate in daily life tasks is therefore the reason for an OT referral.
How can Occupational Therapy help?
In addition to physical exercises that increase flexibility, motor coordination, and strength, occupational therapists often recommend interventions or modifications that can enable individuals to perform ADLs with increased independence and confidence .
OT Modifications/Interventions:
Adaptive Equipment Recommendations:
Suggest dressing aides including sock aides, reachers, and button aides:
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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Which Works For Me
After your evaluation, let your therapist decide which exercise program is best for you. It is never too early or too late to start an exercise program for Parkinsons. Research has demonstrated functional improvements at all stages of the disease. Your therapist will determine with you which treatment protocol best suits your needs. Contact us to schedule your evaluation.
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Find An Occupational Therapist
Are you looking for a more personalized plan? If so, request a referral for occupational therapy from your neurologist or movement disorder specialist. Ask them if they can recommend an occupational therapist with knowledge of PD. You can also contact your state OT association, or local rehabilitation facility or home care agency, to find an OT. You can find more information on the American Occupational Therapy Association website at www.aota.org.
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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.
Be Your Own Therapist
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
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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
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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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.
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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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.
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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What Is Parkinson’s Disease
Parkinson’s Disease is a progressive, neurological condition where nerve cells in the brain stop working over time, and therefore cannot produce the chemical dopamine. Dopamine sends signals to the brain triggering it to produce smooth, fluid and controlled movement. Without dopamine, movement can become slower and more difficult.
How Can Occupational Therapy Help People With Parkinsons Disease
Occupational therapists can work with people with Parkinsons 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 Is Occupational Therapy
Occupational therapy can help people with Parkinson’s disease stay active in daily life. By improving your skills, showing you different ways to complete tasks, or introducing you to handy equipment, an occupational therapist can help you perform everyday activities with greater ease and satisfaction. An occupational therapist may also recommend making changes to your home or workplace to promote your independence.