ROLE OF OCCUPATIONAL THERAPY IN
PARKINSONISM
HISTORY OF DISEASE
 First described in 1817 by an English physician,
James Parkinson, in “An Essay on the Shaking
Palsy.”
 The famous French neurologist, Charcot,
further described the syndrome in the late
1800s.
Three cardinal symptoms






1. Resting tremor:
Most common first symptom, usually asymmetric and most evident in
one hand with the arm at rest.
2. Brady kinesia
Difficulty with daily activities such as writing, shaving, using a knife
and fork, and opening buttons; decreased blinking, masked facies,
slowed chewing and swallowing.
3. Rest tremor
Muscle tone increased in both flexor and extensor muscles providing a
constant resistance to passive movements of the joints; stooped posture,
anteroflexed head, and flexed knees and elbows.
Other Features:
1. Postural Instability: loss of postural reflexes.
2. Dysfunction of Autonomic Nervous system: Impaired
gastrointestinal motility, bladder dysfunction, sialorrhea,
excessive head and neck sweating, and orthostatic hypotension.
3. Depression:Mild to moderate depression in 50 % of patients.
4. Cognitive impairment: Mild cognitive decline including
impaired visual-spatial perception and attention, slowness in
execution of motor tasks, and impaired concentration in most
patients; at least 1/3 become demented during the course of the
disease.
THE ROLE OF OCCUPATIONAL THERAPIST FOR
PEOPLE WITH PARKINSON’S
 INCREASE
AND MAINTAIN
INDEPENDENCE IN ACTIVITIES OF
DAILY LIVING (ADL’s)
 INCREASE
MOBILITY & COORDINATION
Activities of Daily Living(ADL’s)
Basic ADL’s
Self care
 Feeding
 Grooming
 Dressing
 Bathing
 Personal hygiene
 Toileting
Instrumental ADL’s
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
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
(1)
(2)
(3)
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.
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)