OTA II

2. OTA II Parkinson’s Disease

3. Parkinson’s Disease (PD) • Parkinson’s Disease is a chronic neurological condition • Named after Dr. James Parkinson, a London physician who was the first to describe the syndrome in 1817. • PD is a slowly progressive disease that affects a small area of cells in the midbrain known as the substantianigra. • Gradual degeneration of these cells causes a reduction in a vital chemical known as “dopamine.” • This decrease in dopamine is what causes the symptoms of the disease. • Cause: Unknown.

4. Problems/Signs/Symptoms: • Cardinal Problems: • Resting tremor • Slowness of movement (bradykinesia) • Rigidity in muscles • Eg: Cogwheel rigidity (jerky/ratchet like resistance to passive movement) • Impaired balance • Postural instability

5. Problems/Signs/Symptoms: • Additional Problems: • Lack of coordination • Micrographia (small, crowded writing) • Masked face (lack of facial expression) • Dysarthria (slurred speech) • Dysphagia (difficulty swallowing) • Stooped posture • Changes in gait (shuffling of feet, short steps and difficulty turning, freezing episodes, decreased arm swing) • Impaired ability to effectively use proprioceptive feedback to either initiate or to monitor movement • Cognitive impairment (memory impairment, deficits)

6. Motor Skills/Prevention of Deformities • Problem: • Increased rigidity and tendency toward immobility • Increasing risk for contracture and de-conditioning • Interventions: • Daily home exercise program for AROM and stretching. (may be done in individual or group setting). • Passive stretching of the upper extremities and the neck and trunk muscles may be required if the patient is unable to achieve full active range. • In the later stages of the disease, splinting may be indicated to maintain joint range of motion.

7. Motor Skills/Prevention of Deformities • Intervention continued • Use of visual tactile, and auditory cues to help patients initiate movement. Auditory cues should be short, firmly spoken such as “Stop”, “Step up” • Rhythmic movement (music and counting can initiate movement). • Auditory commands couple with counting are helpful in transfer techniques • Fine motor tasks such as stringing beads, removing nuts from bolts and picking up coins increases hand strength and coordination. • Other hand strengthening modalities: handwriting exercises to reduce micrographia. • Hand grippers and putty exercises

8. ADL’s Limitations and Interventions • Increase self feeding skills with adaptive feeding devices such as weighted utensils, scoop dishes, and cups with lids. Wrist weights (1lb) can also be used to minimize tremors. • Because of balancing deficits, patients should be discouraged from bending down to don shoes and socks. Use of long handled show horns, reachers, sock aids and dressing sticks, and be seated when dressing. • Patients with a shuffling gait should not wear rubber or crepe soled shoes because they may cause tripping • Grooming tasks are simplified with electric toothbrushes and razors • Long handled brushed, “soap-on-a-rope” and terry cloth mitts are recommended for the shower.

9. Communication Limitations and Interventions • PD patients frequently develop monotone, low volume speech. Speech therapy and teaching of proper breathing and posture exercises can benefit the patient • Diminished blinking responses and disturbances of ocular muscles impair the patients ability to read. Large print and audio books are useful with these patients. Computers and word processors offer an alternative for patients who have difficulty writing. • Felt tip markers are easier to use than regular pens. • Signature stamps in workplace. • Cordless and automatic dialing phones increase communication.

10. Home Evaluation Limitation and Interventions • Eliminate hazardous conditions that can trigger a fall • Patients with a shuffling gait have difficulty with uneven floors. Remove and throw out scatter rugs. Bathroom mats should be removed • Doorway thresholds should be even with floors • Outside the home: gravel or cobblestone walkways represent safety hazards • Bathroom: • Raised toilet seat with safety frame • Grab bars • Shower chair or tub transfer bench

11. Home Evaluation Limitation and Interventions • Bedroom: • Sturdy chair with arm rests used for dressing • Bed mobility: a firm mattress and a trapeze over bed • Bedside commode or urinal for frequent nighttime trips • Patient advised not to sit in deep, low chairs. Preferred chair has firm cushions, a straight back and padded arm rests • In Kitchen: • Frequently used items should be places so that excessive bending and reaching are not required. • Patients with severe tremors should not be handling sharp or hot objects • A patient’s walker can be fitted with a bicycle basket to make it easier to carry objects.

12. Mobility Limitations and Interventions • Use of visual and verbal cues to remind patient to stand erect, lift feet etc… • Patient may need wheelchair: lightweight with a pressure relieving cushion, elevating swing away leg rests and reclining back

13. Leisure Skills Limitations and Interventions • Adaptive devices for activities such as: • Card playing • Gardening • Board games • crafts

14. Psychosocial Issues • Tendency to withdraw from society becausee of embarrassment, difficulty in mobility and depression • The patient needs a daily schedule that encourages exercise outside activity and social contact. • Group activities that minimize social isolation and help the patient’s cognitive level are also recommended.

15. Lab Activity • Spend some time on the internet and research programs, support systems, etc… available for Parkinson’s patients in the Kingston area. • Pick one and give a general description of what the program is and how it’s supposed to help those with PD or their families. • Hand this in for your lab mark.