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Occupational Therapy andParkinson’s DiseaseJessica Doane-Swanson MS, OTR/L

Objectives Define Occupational Therapy (OT) Domains of OT Hoehn and Yahr Staging of Parkinson’s Disease(PD) Role of OT in the stages of PD

What is OccupationalTherapy? The use of treatments to develop, recover, ormaintain the daily living and work skills of peoplewith a physical, mental or developmental condition. A client-centered practice that places a premiumon progress towards the client’s goals. Focus on adapting the environment, modifying thetask, teaching the skill, and educating theclient/family in order to increase participation inand performance of daily activities, particularlythose that are meaningful to the client.

Hoehn and Yahr Staging ofParkinson’s DiseaseStage OneSymptoms mildUsually presents with tremor of one limbStage TwoSymptoms are bilateralPosture and gait affectedStage ThreeSignificant slowing of body movementsEarly impairment of equilibrium while walking or standingStage FourRigidity and bradykinesiaTremor may be less than earlier stagesStage FiveCachectic stageRequires constant nursing care

Stage One HomeSafety Resources Exercise

Home Safety Bathroom Bedroom Kitchen Living Areas

Home Safety: Bathroom Nightlights Grab bars Non-skid mats Patch leaks Wipe up water immediately Positioning items in the shower

Home Safety: Bedroom Lamps Store eye glasses within reach of the bed Cords are a tripping hazard Remove clutter from walkways Portable commode

Home Safety: Kitchen Throw rugs If possible, rearrange cupboards and drawers Sturdy step stool Avoid using a chair as a step stool Sweep often and wipe up liquid

Home Safety: Living Areas Flat, sturdy walkway Throw rugs Higher chairs and armrests Phones Straight path, clear offurniture Longer cords for ceilingfans and lights

Resources: Home Modifications Chicago Mayor’s Office forPeople with Disabilities (312) 744-7054 ml http://lifecenter.ric.org/ Search – HomeModifications Click on – Homemodifications andfunding options Illinois State Division ofRehabilitation Services:Home AccessibilityModifications (800) 2524382 Home Repairs forAccessible andIndependent Living:Chicago Department ofHousing (312) 744-5000 Access Living – Center forIndependent Living –Chicago (312) 253-7000 Progress Center – Centerfor Independent LivingForest Park, IL (708) 2091500 Council on DisabilityRights Home ModificationResourceswww.disabilityrights.org

Resources: Financial Assistancefor Home Modifications City of Chicago Small Accessible Repairsfor Senoirs Direct: 312.744.5000 Illinois State Treasurer’sOffice Direct: 312-814-1700 Centers for Medicare andMedicaid Services (CMS) 800-MEDICARE (633-4227) Medicare does NOT coverhome modifications Medicaid programs varyby state. The Lawrence & DarleneGilford Foundation (847) 446-8718 U. S. Department of Housing& Urban Development(HUD) 312.353.5680 Extended Home LivingServices www.ehls.com - resources - fundingresources More information: ources/ http://lifecenter.ric.org/index.php?tray content&tid top9&cid 687

Resources: Lending Closets Lending closetslend durablemedicalequipment toindividuals. Elderwerks: Senior CareConsultants Northshore Lending Closets Seniors in Action: Usedequipment in the north andnorthwest suburbs 847.692.2509 http://www.seniorsinaction.org/ 708-444-8460 574797-9a85-846750490cb71.aspx

Exercise Random PracticeExercise Exercises to promotecardiopulmonaryfitness

Give me a challenge!! Exercises that do NOT challengemotor planning Riding a stationary bike Weight lifting Treadmill walking at a slow pace Lap swimming Don’t stop, just try to switch it up

Stage Two Activities ofDaily Living(ADLs) Toileting LargeAmplitudeExercises

ADLs Dressing Before dressing -- Allow plenty of Functional mobilitytime Stretch to warmup

Toileting Urinary Frequency andUrgency Regular Schedule Avoid caffeinated drinks Bladder control Pads, shields, briefs Plastic or washable padsfor bed **Please consult your healthcare provider before tryingany of these tips

Large Amplitude ExercisesPurpose:1. To increase the amplitude and speed of movement in both armsand legs during walking and other everyday tasks2. To reset perception of movement executionDaily Exercise Program: Sustained movements Repetitive Movements Functional MovementsEvidence: Potential to improve trunk rotation Increase stride length Long term benefits Improved dual tasking

Stage Three Safety duringtransfers Mobility Devices Car Transfer ADLs BathroomEquipment Toileting in themiddle of the night Travel Pack

Safety duringtransfers What type ofchair am Iabout to sitdown on?

Safety during transfers:Stand Sit Get close Back up until you canFEEL the chair with BOTHlegs Center and check Reach back with yourhands

Safety during transfers: Sit Stand SCOOT FORWARD Feet firmly on the ground, shoulderwidth apart, and a little back Look up with your eyes to keepyour upper body from leaning toofar forward Think ‘Nose over toes’ Stand with your legs NOT yourarms

Mobility Physical Therapy Mobility Devices ***See a physical therapistbefore purchasing anyassistive devices don’ts do’s Auditory cues

U-step walker withlaser cueIn-Step MobilityProducts Corp.1-800-558-7837walkers@ustep.com www.ustep.com

Car TransferGetting into the car1. Back up2. Both hands on solidsurfaces3. Don’t hold onto the door4. Sit down sit facing theoutside – Not balancing onone legGetting out of the car5.Move your body as a unit2.Feet firmly on the ground1.Move your body as a unit3.Scoot forward4.Both hands on two solidsurfaces5.Stand up

ADLshttp://www.imagiroo.com/ Feedinghttps://www.liftlabsdesign.com/ Writing

ADLs Lower body dressing: Safety Sit down Arm chair Avoid leaning over to feet Hygiene Hygiene

Bathroom Equipment and Bathing Tub transfer bench Standard showerchair Long handledsponge Grab bars

Toileting in the middle of thenight Auditory Cues Imagery Direct, simple verbal cues Urinals Bed risers

Travel Time! Travel Pack Contact the hotel Transport wheelchair Liftware spoon Exercise program For men- urinal Seat cushion

Stage Four Bathroomequipment Bedmobility Transfers

BathroomEquipmentToilet lift by Barry Phillips ofPhillips Lift System Website:http://www.toiletliftchair.com/ Email:sales@phillipsliftsystems.com (765) 969-0274

Bed Mobility

Sit to stand transfers

Stage 5 CaregiverEducation PassiveRange ofMotion LiftEquipment

Caregiver Education Proper Body Mechanics Plan the move Lift with your legs Communicate and Coordinate Turning in Bed Moving a Person Up in Bed Bed Making Bathing in Bed Using a Bedpan One-Person Transfer from Bed to Chair Sliding Board Transfer Transfers in the Bathroom

Passive Range of Motion

Lift Equipment

References Morris ME. Movement disorders in people with Parkinson disease: amodel for physical therapy. Phys Ther. Jun 2000;80(6):578-597. Occupational Therapy Practice Framework: Domain & Process 2ndEdition (2008). American Journal of Occupational Therapy, 62,625-683. doi:10.5014/ajot.62.6.625 Occupational Therapy. Retrieved from http://en.wikipedia.org/wiki/Occupational therapy Petzinger et al. (2007). Effects of treadmill exercises on dopminergictransmission in the 1-methyl-4-phenyl-1,2,3,6tetrahydropryidine- lesioned mouse model of basal ganglia Injury. The Journal of Neuroscience, 27 (20), 5291-5300 Lim et al. (2005). Effects of external rhythmical cueing on gait inpatients with Parkinson’s disease: A systemic review. ClinicalRehabilitation, 19, 695. doi: 10. 119/026921550cr906oa Foster et al. (2014). Systematic review of the effectiveness ofoccupational therapy-Related interventions for people withParkinson's disease. The American Journal of Occupational Therapy, 68 (1), 39-45.

References Hackney & Earhart. (2010). Effects of dance on gait andbalance in severe Parkinson disease: A comparison ofpartnered and nonpartnered dance movement,DisabilityRehabilitation, 24(4), 384-92. Fox C, Ebersbach G, Ramig L, Sapir S. LSVT LOUD and LSVTBIG: behavioral treatment programs for speech andbody movement in Parkinson disease. Parkinson'sDisease. 2012; 2012: 1-12. Ebersbach G et al. Comparing exercise in Parkinson's disease– the berlin LSVT BIG study. Movement Disorders. 2010;25(12): 1902-1908. Farley BG, Koshland GF. Training BIG to move faster: theapplication of the speed amplitude relation as arehabilitation strategy for people with Parkinson'sdisease.Exp Brain Res. 2005; 167: 462-467.

References Farley BG, Fox CM, Ramig LO, McFarland DH. Intensiveamplitude specific therapeutic approaches forparkinson’s disease. Topics in Geriatric Rehabilitation.2008; 24(2): 99-114. DeCant K. LSVT BIG. Clinical Skills IV Notes. 8 April 2013. Rao, A. (2014). Occupational Therapy in chronicprogressive disorders: Enhancing function andmodifying disease, 68 (3), 251-252. Atchison & Dirette (2007). Conditions in occupational therapyed.). Philadelphia: Lippincott, Williams, & Wilkins(3rd Ma, H., Trombley C., Tickle-Degnen, L., & Wagenaar, R. (2004)Effect of one single auditory cue on movementkinematics inpatients with Parkinson’s disease. AmericanJournal ofPhysical Medicine and Rehabilitation, 83, 503536. http://dx.doi/10.1097/01.PMH.0000130032.97113.E0

References Images: 2011/01/2041bedcane1.jpg Grabbars for bed http://www.livsolutions.com/images/superpole.gif Floor to ceiling grab bar erUsling.jpg Hoyer lift sling http://www.norco-inc.com/ norcoinc/files/u4/BHM Ceiling Track System Bathroom.jpgHoyer lift with ceiling track http://t2.gstatic.com/images?q p-gVEk4zGQw images/otdomain.jpg if utensil-strap-4.jpg C-lightweight-Transport-wheelchairhuge.jpg (transport wheelchair)

References Images cont: http://www.craftmatic.com/images/electrolift/chair head.jpg Lift recliner 20Chair-Portable-Uplift-Seat-Assist-.jpg Portable seat lift 1000/doknexpaof2.jpg door knobextender 1000/turknobop.jpg turning knob extender http://img.webmd.com/dtmcms/live/webmd/consumer assets/site images/articles/health tools/assistive devices oa slideshow/webmd photo of rubber faucet handle converters.jpg(kitchen or bathroom sink grippers) /07/yoga-for-old-people.png Flexibilitypicture / non skid mat hVTaWCm/ 35.JPG shower caddy http://www.picturesof.net/ images 300/Cartoon Man Tripping Over an Electrical Cord Royalty Free Clipart Picture 100112-052670-735042.jpg Tripping over a cord /2011/05/kitchen-step-stool.jpg step stool / (elastic shoe laces)

References Images cont: eng-US/walker medium.jpg (metal frame rolling walker) data:image/jpeg;base64,/9j/ (Dressing while seated) http://www.google.com/imgres?imgurl http%3A%2F (Nosy cup) data:image/jpeg;base64,/9j/ (Tub transfer bench) data:image/jpeg;base64,/9j/ (Shower chair) data:image/jpeg;base64,/9j/ (long handled sponge) NZUzt2PiBRBg.jpg 00/resources/product/701/picture.jpg (Toilet lift) phics/handicap-accessiblebathroom.jpg (After bathroom picture) http://img.medicalexpo.com/images 55.jpg (Hospital bed) ion hospital bed adjustable bed.jpg (Adjustable bed frame)

Disease. 2012; 2012: 1-12. Ebersbach G et al. Comparing exercise in Parkinson's disease - the berlin LSVT BIG study. Movement Disorders. 2010; 25(12): 1902-1908. Farley BG, Koshland GF. Training BIG to move faster: the application of the speed amplitude relation as a rehabilitation strategy for people with Parkinson's disease. Exp Brain Res.