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).

My Pop’s Journey

My Pop was diagnosed with Parkinson’s disease several years ago.  I wasn’t too sure what Parkinson’s disease was at the time. I knew it impacted on the ability to perform movements as I noticed that Pop shuffled a lot while walking. I have watched this progressive condition take over his body. He has remained active for as long as possible, accepting challenges such as tramping a 44km great NZ walk, riding his bike, to slowing his movements gradually.

Hesitation to begin walking was observed as he had difficulty taking the initial step to begin walking.    His balance was affected as it increased his risk of falling. I noticed when Pop was sitting in his chair his posture was ‘stooped’ and he had the tendency to lean to one side. I was pleased to see him given a high backed chair to sit on which supported his head. I often noticed Pop was messy and slow in eating and drinking and this demanded greater effort and has lead to losing interest in food because he had trouble swallowing. As Parkinson’s has increased his food now has to be moulied. Excess saliva building up in his mouth troubles him also often causing embarrassment. I noticed that a good sitting posture at meal time and as few distractions as possible allow him to concentrate and reduce the difficulties he has. My Pop was an accountant and over time I noticed his hand writing had become smaller and ‘spidery’. He was given a gel ink pen which flowed more smoothly and a pen grip which was more comfortable and easy for him to hold onto.  He also becomes emotional during family gatherings which had an impact on me. Because of Parkinson’s being a progressive condition, family members dealt with Pop’s changes as were necessary. I guess the defining moment for me and one that impacted on me the most was when I noticed the hand rails mounted in the toilet, bathroom, up the steps through the garden to the back door. It made me realise Pop’s condition had become more serious. Up until then I hadn’t been affected by the small changes that had been happening, but when I realised how easy this made my Pops life I had to accept this.  

My Reflection

I now have become more knowledgeable about the progression of PD. I have watched my precious Pop afflicted by PD and I can now identify the impact it has had on him and why he has had to adjust to the changes in his lifestyle. I learnt that daily routines can continue so that self esteem remains. Independence, safety and confidence in as many areas of daily life are encouraged as long as possible. I realised that it was obvious relatives are important members of the rehabilitation team as ADL’s become difficult. This is when adaptive and compensatory approaches become relevant. Gradually these appeared in my Pops home as his needs progressed- a large key phone, raised toilet seat, toilet grab bars, shower bench, a walker, the need to reduce furniture congestion, non-slip surfaces for plates while eating, a raised chair. I also had to adjust to watching my Pop withdraw from his active life and his numerous secretarial positions. As PD progresses Pop’s meals become smaller, his need for rest has increased, dressing himself is an issue, a wheelchair and hoist are necessary, communication is difficult and he is more emotional. It is important for me as an OT to relate these progressions to other people with PD and focus on methods that will help patients to perform meaningful occupations independently for as long as possible. I believe OT’s should effectively provide ongoing support and treatment for the patient with PD in order to help to sustain and/or regain physical, mental and social well-being.

By researching and learning about PD I feel that I now look at Pop differently. I think more about why Pop is the way he is. He is still the same person however the gradual effects Parkinson’s has had on him has affected his life and changes have been made as necessary. I now understand in depth what PD is and the interventions an OT will use with a person with PD. When talking with Pop I can clearly identify what effects PD has on his daily activities.

I found PD was a massive topic and I couldn’t cover everything I wanted to in this blog.  It has been important for me to research the OT interventions and how they can help prevent barriers to everyday occupations for individuals with PD.

Thank-you for reading my blog :)