NAJMA ADAMLECTURER OCCUPATIONAL THERAPY

DOW UNIVERSITY OF HEALTH SCIENCES/

PINE GROOVE REHABILITATION CENTER

HILAL-E-AHMER

Occupational Therapy

Help for people with Parkinson’s

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?

HOW WOULD YOU…

• You have rigidity in your muscles?

• You had poor balance?

• You couldn’t reach your arms up to your hair?

HAVE A SHOWER IF…

HOW WOULD YOU…

• 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?

HAVE BREAKFAST WITH FAMILY IF…

HOW WOULD YOU…

• You were paralyzed from the waist down?

• You were fearful leaving the garage?

• You lost the use of your right hand?

DRIVE A CAR IF…

HOW WOULD YOU…

• You had pain in your back?

• You heard voices in your head?

• You had tremors in your hands?

HAVE COME TO ATTEND THIS LECTURE IF…

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 anOccupational Therapist?

Health Care Professionals who enable people to lead a more productive, satisfying, and independent life.

Who do Occupational Therapists work with?

ChildrenAdolescents

Adults

Seniors

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

Self care• Feeding• Grooming• Dressing• Bathing• Personal hygiene• Toileting

Instrumental ADL’sInteraction 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) Gait(2) Balance (3) 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 ActivitiesWork 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