PARKINSONS DISEASE Occupational Therapy Best Practice Parkinsons UK

PARKINSON’S DISEASE Occupational Therapy Best Practice Parkinson’s UK – Fife Local Branch Dunnikier House Hotel, Kirkcaldy Charlie Chung – occupational therapist charliechung@nhs. net

Philosophy of occupational therapy "Occupation" refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day-to-day tasks such as self-care, work or leisure (College of Occupational Therapists 2016) Two key points: People need to participate in occupation to maintain physical, cognitive and psychological health. Occupational therapy uses occupation as a treatment medium as well as an outcome

Parkinson’s disease and occupation Potential for limited participation in many occupations due to motor and non-motor features.

Techniques to increase participation in occupation • Allowing adequate attentional resource to be applied to automatic tasks. • Limit multitasking as the most automatic tasks deteriorate when multitasking. Then train multitasking. • Encouraging the use of cognitive and sensory cues and triggers to guide the flow of motor performance and ideas.

Techniques to increase participation in occupation Intrinsic Cueing • Positive attitude – basal ganglia links with limbic system and a positive mental set at the point of starting movement can enhance movement. • Mental rehearsal – can compensate for reduced pre-movement brain activity. This should be in as much detail as possible. • Internal dialogue – self-talk while performing the movement • Visualisation – e. g. freezing in doorways can be addressed by visualising stepping over a log.

Techniques to increase participation in occupation Extrinsic Cueing • Adapting the visual environment – reducing clutter, taking away patterned rugs. • Visual cues – floor markers (contrasting coloured strips) and cue cards (brief written directions for a specific task - can be use at the time of movement or memorised). • Auditory cues – üConcise spoken instructions by another person can be effective in some people. üMetronomes have been shown to be effective in some studies, units which can be worn on a belt and with ear pieces. üRhythmic music can enhance voluntary movements.

Other factors which reduce participation • Executive dysfunction • Apathy • Depression

Optimising occupation Three principles for occupational therapists: 1. Skill level intervention – hands-on treatment for body level problems. 2. Knowledge level intervention – supplying the knowledge on how to modify occupation. 3. Attitude level intervention – the management of expectations in relation to occupational performance.

Top ten goals of intervention as identified by people with Parkinson’s disease (Jain et. al 2005) • 1 st Maximise safety and reduce the risk of falls when mobilising indoors. • 1 st Reduce effort and increase safety with bath transfers. • 1 st Reduce effort and improve efficiency during kitchen/domestic/meal preparation tasks. • 4 th Reduce impact of fatigue on all activities of daily living. • 4 th Reduce effort during bed transfers. • 4 th Reduce effort and increase safety during chair transfers. • 7 th Decrease effort with toilet transfers. • 7 th Improve efficiency and satisfaction when eating and drinking. • 7 th Increase satisfaction with leisure activities. • 10 th Reduce effort and increase safety when dressing.

SUMMARY There are many techniques and considerations which occupational therapists can apply to work with people to increase their participation in occupation.

Actions • Engage with the local branch to improve awareness of what occupations are important to people with lived experience of Parkinson’s disease. • Liaise with multi-professional colleagues to share knowledge and develop combined and complementary interventions. • Contribute to the establishment of a national occupational therapy Parkinson’s disease network to share experiences and ideas for practice.