This is a brief overview of possible adaptive devices to recommend to your patients with Parkinson’s.
Outline • What is Parkinson’s? • Assistance with Gait • Assistance with Eating/Feeding • Bed Mobility • Bathroom Assistance
Brief Overview of Parkinson’s • Problem with certain nerve cells which create dopamine • Dopamine helps to control movement • If there are problems, your body cannot create dopamine and this affects how a person moves • Parkinson’s is progressive, but slow • Symptoms: tremor, stiffness, slow movement and problems with balance and walking
Use of a rolling walker encourages a continuous gait Those with Parkinson’s typically have a freezing gait A walker allows for greater independence Make sure the walkers have brakes Rolling Walkers Canes • The best option would be a cane that has a visual cue for stepping • This cue can be a laser beam or an wand on the base of the cane • The visual cue breaks up the freezing episodes as the person tries to step on or in front of the cue • This allows for a person to walk around with more confidence and less fear of falling
If gait is severely impaired, in order for a person to be able to stay in the community and participate safely, a wheelchair may be recommended An electrical wheelchair would be the best option since a person would not be able to push him/herself Wheelchairs
Adaptive forks, spoons, knives • Utensils with angled handles for better grasp • Utensils with larger areas to grasp • Spoons to help scoop hard to eat food • Weighted utensils to help minimize hand tremors Utensils
Allows for rolling assistance • Helps to go from laying down to sitting and from sitting to standing • Allows for help with balance when initially standing • Attached to bed • Not recommended for everyone, especially since it requires upper body strength • Do not want patients to become too reliant on using this piece of equipment • Slides under bed and trapezee bar dangles above at about shoulder level Bed Assist Rail Other Devices- Overhead Trapezee Bar
Beneficial for safety in a slippery environment • Allows patient to have increased independence in the shower • Patient can sit while showering • Having grab bars increase safety in the shower/bath • Allows for patient to hold on for balance • Increases independence in the bathroom Shower Bench Grab Bars
Reflective Letter I would imagine that this presentation would be made during a multidisciplinary discussion in a larger outpatient setting or in a nursing home setting. The people who would be interested in adaptive equipment for Parkinson’s are the people with the most contact with that population. As Physical Therapists, it is important that we keep our patient’s safety in our goals at all times, especially when those with Parkinson’s are at an increased risk for falls and balance issues. Physical therapists need to know what is available for clients, in case we need to write for insurance coverage for any of the adaptive equipment. Occupational therapists are more likely to need the adaptive equipment pertaining to feeding, dressing and grooming. Physical therapists will have more of a need to know what is out there for gait, bed mobility and bathing. Physical therapists have the capability to recommend equipment to their patients and can make sure that the patient is using the most appropriate adaptive equipment that is necessary at that time. Even though this document is very basic, it is able to be used not just in multidisciplinary rounds or in-services, but also to distribute to clients and/or clients’ caregivers. A slightly more interactive presentation would be interesting for health care professionals, but it is a presentation that is also able to be printed out and converted into a brochure to hand out. I would use this piece in my final portfolio. It shows that I have researched a topic and that I understand the importance of having a multi-disciplinary approach to certain populations of patients.
References • Information • The Story Behind NextStep. Accessed Oct 9, 2012. http://www.icanstep.com/about.htm • International Tremor Foundation. Parkinson’s Disease. Accessed Oct 9, 2012. http://www.pdmdcenter.com/articles/HopkinsWeb/index.html#stepoverwand • Northwestern University. Parkinson’s Presentation. Accessed Oct 9, 2012. http://www.parkinsons.northwestern.edu/pdf/NU_PD_Presentation4.pdf • Boelen M. Health Professional’s Guide to the Physical Management of Parkinson’s Disease. Accessed Oct 9, 2012. http://books.google.com/books?id=EeSxQHNLfTcC&pg=PA122&lpg=PA122&dq=bed+mobility+Parkinson's&source=bl&ots=87xzo4NsoJ&sig=GyCZZXX97VVOgiFKA64ErD-HBTY&hl=en&sa=X&ei=rkt0UO2UKsmS0QHnqYCIAg&ved=0CDQQ6AEwAw#v=onepage&q=bed%20mobility%20Parkinson's&f=false • Russell A. “Parkinson’s Disease and Occupational Therapy- Adaptive Equipment.” Parkinson’s Insider. University of Miami, Parkinson’s Disease and Movement Disorder Center. Summer/Fall 2010. Issue 6. Accessed Oct 10, 2012. http://neurology.med.miami.edu/documents/Parkinson%20Insider%20-%20Issue%206.pdf • Pictures • http://wpms2063.com/images/invacare/rolling-walker-rollator-4-wheel-blue-invacare-65851B.jpg • http://www.icanstep.com/images/fulldevice.gif • http://www.scooterdirect.com/images/category/GOGO-ELITE-3-Wheel-Medium_65a9.jpg • http://www.elderstore.net/Images/products/Mecanaids/MC1001MelawareMED.jpg • http://www.elderstore.com/images/products/Kinsman/Optimized-KE11540WEightedUtenMED2.jpg • http://d3f8w3yx9w99q2.cloudfront.net/1687/drive-bed-assist-rail/drive-bed-assist-rail_0_400x360.jpg • http://a248.e.akamai.net/origin-cdn.volusion.com/j575u.gtsw7/v/vspfiles/photos/Nova_6050-2.jpg • http://www.sportaid.com/images/D/1771-0321_Lg.jpg • http://www.thistlehelp.co.uk/dressing/images/PR55028_shoe_horn.jpg • http://www.buckandbuck.com/mens_clothing/shirts_and_pants/pants/corduroy_putter_pants.html • http://www.buckandbuck.com/mens_footwear/shoes/mens_leather_velcro_shoe_by_propet.html • http://www.showerremodel.org/wp-content/uploads/2012/05/Shower-Bench.jpg • http://www.johnsoncityhandyman.com/images/stories/grab-bars.jpg