NAJMA ADAM DOW UNIVERSITY OF HEALTH SCIENCES/ LECTURER OCCUPATIONAL THERAPY DOW UNIVERSITY OF HEALTH SCIENCES/ PINE GROOVE REHABILITATION CENTER HILAL-E-AHMER

Help for people with Parkinson’s Occupational Therapy Help for people with Parkinson’s

Now imagine this... Have you had a shower, Had breakfast with family, Take a moment to think of some of the things (occupations) you have done today to attend this lecture…. Have you had a shower, Had breakfast with family, Driven a car? Before we start talking about Occupational Therapy I want to give you guys something to think about… Now imagine this...

HOW WOULD YOU… HAVE A SHOWER IF… You have rigidity in your muscles? You had poor balance? You couldn’t reach your arms up to your hair? Maybe an OT would… Recommend a seat for you to sit on. Work on activities to work on your balance. Install grab bars etc. to ensure safety. Standing vs. sitting Imagine not being able to wash your hair. Maybe an OT would help you.. work on strengthening your arms Look at other ways to wash your hair (resting arms on counter)

HOW WOULD YOU… HAVE BREAKFAST WITH FAMILY IF… You couldn’t hold a spoon/fork? You take a long time to finish your meal? You just couldn’t cope with getting out of bed? Maybe an OT would… Help you to regain movement and strength Recommend a special fork One handed-how will you use a knife? Memory strategies for events. Practice trials in community. Write out directions checklist to follow. One to one or group to focus on coping skills

HOW WOULD YOU… DRIVE A CAR IF… You were paralyzed from the waist down? You were fearful leaving the garage? You lost the use of your right hand? Maybe an OT would… Hand controls Work on transferring into car and then placing wheelchair in car Work on breaking down tasks to accomplish smaller goals Splint? Improve function in that hand Adapt steering wheel Moving switches to where they can be moved Some function? Built up key, adapted knobs

HOW WOULD YOU… HAVE COME TO ATTEND THIS LECTURE IF… You had pain in your back? You heard voices in your head? You had tremors in your hands? May do a GRTW Modify duties New ways to lift things Ergonomic assessment Can they return to work? Strategies to overcome _____________ Pain management Adapting to a bigger grasp Modify the work area Splint for pain relief

OCCUPATIONAL THERAPISTS …have the knowledge and the skills to help people overcome these and other barriers they may face in doing their everyday occupations!

What is an Occupational Therapist? Health Care Professionals who enable people to lead a more productive, satisfying, and independent life.

Who do Occupational Therapists work with? Children Adolescents Seniors Adults

Where do Occupational Therapists work? Hospitals Schools/Special schools Mental Health Facilities Armed forces Old Homes Private Clinics Rehabilitation Centers Community Health Centers Insurance Companies Client Homes Client Work Places

THE ROLE OF OCCUPATIONAL THERAPIST FOR PEOPLE WITH PARKINSON’S INCREASE AND MAINTAIN INDEPENDENCE IN ACTIVITIES OF DAILY LIVING (ADL’s) INCREASE MOBILITY & CO-ORDINATION

Activities of Daily Living(ADL’s) Basic ADL’s Instrumental ADL’s Self care Feeding Grooming Dressing Bathing Personal hygiene Toileting Interaction with physical environment Putting things away & getting things out of the closet Telephoning Written communication Using paper money, checks or coins Using books, newspapers & entertainment equipments Using public/private transportation Leisure activities

Firm seat with both feet on the floor with back supported. Clothing: Dressing: Warm & light room. Firm seat with both feet on the floor with back supported. Clothing: Easy to handle. Light weight warm /stretchy fabrics Easily laundered Cotton – or cotton – polyester Wide openings Aids: Elastic laces Shoe horn Slipper – socks

Eating : Begin meal slightly ahead of the rest of his family Eat little and often One course of main meal at midday 2nd course on the evening Half filled mug(tremor) Aids: Padded /light weight cutlery Plate guards Non slip mats Weighted bracelets (not too heavy) Mugs & cups with two enlarged handles

Correct positioning. It may be useful to reduce the distance between the hands and mouth e.g. raising the table or plate, or by positioning the patient so that his elbows can be used as a pivot in order to assist hand movement

Home Safety and Management Even floor. Non-slip polishes Grab rails e.g. bath, toilet, steps. Plan but flexible routine will help to conserve energy. Non-iron and dip-dry fabrics. Carrying aids: Net bag clipped to the walking frame. Trolley or an apron with large pockets all reduce the danger of tripping Alarm system Telephone

Bathing: Shower chair Non-slip bath mat Beds: Firm mattress Grab rail by the bed Night light luminous Alarm clock Light left on in the hallway

Mobility & Co-ordination Aim Gait Balance Transfers

1. Gait: Rx Aim: To improve size & rhythm of the walking pattern Large; rhythmical bilateral non-resisted movements Walking Practice using foot outlines lines marked on the floor at paced intervals are all suitable. Activities which encourage walking should be under supervision.

2. Balance:- Initially Work at a balance table. Mirror Later Encourage side flexion and rotation. Encouraged to bend and stoop, such as gardening and skittles. Wedged shoes Leather soled shoes Weighted clothing. Raised chairs /beds. Inclined seats reduces the risk of over balancing when rising.

Initiating Movement Rocking motion with verbal stimulus “one, two, three go!” Counting, Marching, Music, or rhythmic encouragement ‘step and step and ….’ One step backward before attempting to walk forward. Auditory & visual stimuli (received when climbing up stairs often makes this activity easier than walking on level ground).

3.Transfers: Stable & firm surface. A firm wedged cushion or rocking motion for rising from sitting. Raise the back legs of a chair slightly. Steady high chair with arm rest.

Co-ordination: large bilateral and rhythmic activities with little resistance. As co-ordination improves the time spent on each activity can be increased and the size of movement decreased. Regular practice of writing patterns.

large poster-sized sheets of paper Writing: Initially: Blackboard large poster-sized sheets of paper Later : Rhythmical writing patterns using widely spaced lines.

Progressions to writing letters and words. Writing aids: Padded pens Writing board Roller ball pen (easier than fountain or ball point pen).

Support for the patient and his family Reassure Therapist should help the family to be realistic in their expectations. The family should not expect the patient to perform activities beyond his capacity, but emphasize those he can do.

Social Activities Work in small groups (to avoid isolation and to assist communication). Positive and purposeful. Familiar and interesting activities A wide variety of stimuli in the form of colour, sound and touch. The therapist should work within the concentration span of the patient. Maintain social contact through Hobbies Pastimes. Visits. Outings.

work Part-time work. less responsibility at work may be considered. It is unwise for the patient to persist with work to the point where he becomes exhausted and possibly unsafe.

REFERENCES THE PRACTICE OF OCCUPATIONAL THERAPY An introduction to the treatment of Physical Dysfunction (II EDITION-ANN TURNER) QUICK REFERENCE TO OCCUPATIONAL THERAPY ( KATHLYN L.REED) WILLARD AND SPACKMAN’S OCCUPATIONAL THERAPY (XI EDITION)

Take Home Message ADD LIFE TO YEARS NOT YEARS TO LIFE