Hello and Welcome to the Blog I have created. My name is Lucy Anderson I am a 3rd
Year Occupational Therapy Student who attends Otago Polytechnic in Dunedin, New
Zealand. I have developed this blog as per requirements of a course called
‘Transition to Practise’. Within this blog I am going to talk about the role of
an Occupational Therapist (OT) and identify the interventions in detail.
Please don't hesitate to comment on any of the content loaded to the blog
or share your own experiences with Parkinson’s Disease. I would love to
hear about it
Happy reading :)
Introduction
Parkinson’s Disease (PD) affects many aspects of both motor and
non-motor performance; it is influenced by environmental conditions, often
fluctuates throughout the day, as well as over the course of the disease, and
is manifested in a highly individualised manner (Gaudet, 2002). As Parkinson’s is
a progressive condition, it can often take many years to develop and has little
effect on life expectancy. Different people will experience a different number
and combination of symptoms (Parkinson’s New Zealand, 2002).
Retrieved June, 10, 2013 from: http://www.athomeprc.com/services/parkinsons-care.html
Role of an Occupational Therapist
The role of an OT working with people with
Parkinson’s is to enable meaningful occupational performance within context. This
entails the selecting, organising and performing of activities and roles in a
particular environment and with a particular meaning for the individual. Occupational performance comes about through
a dynamic interaction of the person, occupation and environment (American
Occupational Therapy Association, 2002).
There is optimal occupational performance when there is a good fit
between the individuals desires and skills and the demands of the occupation
and the environment. (Sturkenboom et al, 2008). The
OT’s have four main roles-problem solver, educator, networker, and supporter (Aragon
& Kings, 2010).
Occupational Therapy Interventions:
The OT intervention process follows a
structured approach. The OT first identifies the patient’s issues with regard
to occupational performance, performance possibilities or performance
competencies. The OT discusses roles and activities with the individual, the
problems experienced in occupational performance and the impact the social and
physical environment means to the individual (Sturkenboom et al, 2008). Occupational issues faced by the caregiver are
also discussed at this stage. The OT then analyses which aspect of the person,
occupation and environments inhibit or support occupational performance.
Identifying the factors for occupational performance is highly important
because they will be used extensively in the interventions. Based on an
analysis of assessment data, the therapist can determine if the individual
requires intervention or not. If the individual with Parkinson’s requires
intervention, an intervention plan with goals and an action plan is drawn up in
consultation with the client and caregiver. The opportunities for change differ for each
person and situation. The emphasis of the general aims and interventions can
shift as the disease progresses.
There are several occupational therapy interventions which can be used for individuals with Parkinson’s. First, general recommendations are made on the subject of guiding the individual in learning new skills and changing behaviour. After that, key questions are answered about the value of specific interventions. The recommendations indicate to what extent these interventions should be used by OT’s in the rehabilitation of the individual and/or their caregiver.
Changing occupational performance can involve interventions directed at:
- Improving and maintaining skills during the performance of activities.
- Applying compensatory skills or strategies during the performance of activities.
- Increasing insight and knowledge in order to adequately deal with current and future limitations in daily activities (self-management).
There are several occupational therapy interventions which can be used for individuals with Parkinson’s. First, general recommendations are made on the subject of guiding the individual in learning new skills and changing behaviour. After that, key questions are answered about the value of specific interventions. The recommendations indicate to what extent these interventions should be used by OT’s in the rehabilitation of the individual and/or their caregiver.
1. Encouraging
self management
Self-management is encouraged by guiding people in setting their own personal goals and action plan following a problem solving approach (Lyons, 2004). The individuals insight into problems in meaningful occupational performance is increased by providing them information and feedback and by encouraging self reflection.
I think it is important that the individual with Parkinson’s has an insight into their disease, learn to anticipate problems in activities and participation, and learn how they can deal with problems in meaningful occupation performance.
2. Optimising
daily structure and activities
To help the individual the OT will focus on setting priorities in activities and changing them so that they best suit the individual. It is important to balance the demands of activities with the abilities and energy levels of the person. Priorities need to be set and previous standards and values reconsidered with respect to activities. Time pressures often have a negative effect on the individual’s performance. The OT makes sure the individual chooses an appropriate meaningful activity, which will match the individual’s interest, motivations and capabilities.
Reviewing a person’s daily routine, prioritising tasks, restructuring activities according to energy levels, and introducing regular rest periods, including good sleep hygiene, will all contribute to fatigue management (Jahanshahi & Marsden, 1998). For example, on placement using a fatigued dairy.
Self-management is encouraged by guiding people in setting their own personal goals and action plan following a problem solving approach (Lyons, 2004). The individuals insight into problems in meaningful occupational performance is increased by providing them information and feedback and by encouraging self reflection.
I think it is important that the individual with Parkinson’s has an insight into their disease, learn to anticipate problems in activities and participation, and learn how they can deal with problems in meaningful occupation performance.
To help the individual the OT will focus on setting priorities in activities and changing them so that they best suit the individual. It is important to balance the demands of activities with the abilities and energy levels of the person. Priorities need to be set and previous standards and values reconsidered with respect to activities. Time pressures often have a negative effect on the individual’s performance. The OT makes sure the individual chooses an appropriate meaningful activity, which will match the individual’s interest, motivations and capabilities.
Reviewing a person’s daily routine, prioritising tasks, restructuring activities according to energy levels, and introducing regular rest periods, including good sleep hygiene, will all contribute to fatigue management (Jahanshahi & Marsden, 1998). For example, on placement using a fatigued dairy.
3. Dealing with stress and time pressure
Stress and time pressure influence
the severity of the symptoms of Parkinson’s. This affects the performance in
activities. During assessment stage, I think it is important to identify which
factors contribute to stress and in which daily situations this stress occurs.
Individuals with Parkinson’s often have problems of slowed information
processing and slowed motor performance.
The OT can assist by educating the
individual how to deal with stress and time pressure in daily situations.
Consideration could be given to modifying the nature of the task, for example,
for meal preparation by buying pre-prepared meals which removes the need for
that person to undertake the task altogether.
4. Practicing arm/hand motor skills
Problems with reaching, gripping
and manipulating frequently occur in Parkinson’s disease and hinder the
performance of many daily activities.
Therapy can focus on maintaining or improving the motor skills of the
arm and hand in order to maintain or improve the performance of activities.
Compensatory strategies may also be needed to facilitate motor skills, for
example, I noticed a client being very frustrated whilst doing up his buttons
on his shirt while the individual beside him had his clothing adapted by
replacing the buttons with Velcro and was managing well.
5. Occupational performance with focused attention
5. Occupational performance with focused attention
During placement I could see that individuals
with Parkinson’s found some ADL’s difficult to perform, such as, handwriting,
cutting, eating and dressing.
Individuals with Parkinson’s find they have to think more when
performing these actions. Therefore, full attention and concentration on the
task is essential for success.
When working with the individual I would
focus on an ADL that the individual does daily which requires attention, for
example, having to do up the buttons when dressing.
6. Applying cognitive movement strategies
Individuals with Parkinson’s find it
difficult performing complex tasks that require the use of both hands (eating
with utensils) or performing a simple movement. As an OT I would choose a task
that challenges the individual, and break the activity down in to step-by-step
actions that focus on attention (cognitive movement strategies) such as,
reaching for a cup (Kamsma et al, 1995).
7. Minimizing dual tasks
A ‘dual’ task is when attention may have been
divided between two things, such as, transporting objects while walking
(walking and carrying). I noticed that people who have Parkinson’s find it
difficult dividing their attention and switching from one thing to another
(alternating attention) and the ability to maintain their balance.
The OT will discuss with the individual the
effect simultaneous performance of several sub-tasks has on the quality of the
occupational performance (O’Shea et al, 2002). The individual will learn to avoid distracting factors when
possible and will be able to recognise the activity so that they can focus on
performing one sub-task at a time.
8. Using Cues
Cues are classified according to the type of
stimulation and the frequency of repetition (Sturkenboom et al, 2008). By
observing an individual with Parkinson’s participating in activities, it is
obvious whether the individual already consciously or subconsciously uses cues,
what these cues are, and how the person responds to them. The individual needs
to practise using cues in relevant situations or activities, for example, I saw
a cue card like this being used on placement (below) (Aragon & Kings, 2010).
9. Optimising the physical environment
The OT can provide advice to the individual
with Parkinson’s and the caregiver about the physical environment. Aids,
adaptations and other modifications to the individual’s physical environment
are used to further enhance occupational performance or making the environment
safer or easier to live in (Aragon & Kings, 2010). I think it is critical
to the individual that the changes made to the physical environment will
contribute to greater independence and safety in occupational performance. I
found using equipment such as, a perching stool for the client useful to reduce
the risk of falling during performance of a task while in a standing position.
10. Advising and supervising caregivers
Caregivers usually experience a heavy burden
and need recognition and understanding of their situation. Often the caregiver
needs emotional support as well as information and advice on how to deal with
specific problems (Davey et al, 2004).
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