(Written for Canadian Association of Occupational Therapists publication, OT Now)
April is Parkinson’s Awareness Month. Over 100,000 Canadians have Parkinson’s disease, making it the second most common brain disease in Canada. Parkinson’s is a complex disease. It’s not just about tremor, stiffness, rigidity, postural instability and poor balance/coordination; it has cognitive aspects, as well. Occupational therapists like Sheri Corkum, an occupational therapist at the Movement Disorders Centre in Markham, ON, can help people with Parkinson’s manage their disease symptoms and have better quality of life through:
Advice about managing activities of daily living (ADLs). Problems with multi-tasking are common in Parkinson’s. This is a cognitive issue as well as a motor issue. “We recommend that people do their ADLs sitting down and we help them learn to isolate one movement at a time and one step of the movement at a time,” says Corkum. “Incorporating energy-conservation techniques is also critical since fatigue is common.”
Clear communication. Communication difficulties in Parkinson’s go beyond the motor issues of speech production and writing. People may experience subtle changes in their thinking ability and language early in the disease, so when working with clients, it is important to simplify the communication environment by speaking slowly, clearly and carefully. It is suggested to use simple words and short sentences. If necessary, repeat your message using different words. Ask closed – yes or no – questions. Be aware of your tone of voice, facial expression, and body language.
Movement and visual strategies to address shuffling and freezing. Shuffling and freezing severely impair mobility in Parkinson’s. Corkum suggests, “Movement strategies include side-to-side weight shifting and lifting the toe and foot of the unweighted foot to take an exaggerated step. Visual aids could include lines of tape that mimic steps to help people step forward past them, laser canes and walkers.”
Using contrasting colours as a strategy to help daily activities in the home. People with Parkinson’s have decreased color discrimination and contrast sensitivity.
Exercise recommendations. Regular exercise has been shown to be beneficial for people with Parkinson’s. Corkum, who leads an exercise program for people with movement disorders, places a high premium on:
- Flexibility exercises, especially neck mobility exercises, such as yoga.
- Endurance exercises, such as walking. “Walking technique is important. Especially, when people are at the earlier stages of Parkinson’s, we encourage them to maximize their walking technique – take big steps, lift the toes, put the heel down first, maintain proper posture when walking, with weight upright and not flexed forward, good arm swing. These are things that need to be emphasized.”
Depression. Depression in Parkinson’s can be part of the actual Parkinson’s disease process and is thought to be related to neurochemical changes in the brain. Researchers estimate that 50% of people with Parkinson’s experience depression. Occupational therapists can play a role in helping individuals and families seek treatment for depression. “As part of our work, we help people understand the high prevalence of depression in Parkinson’s, the side-effects, the need for a clinical diagnosis and the availability of treatment – not just medications but day programs, activation, ways to link people socially and get them to function in new ways,” says Nira Rittenberg, an occupational therapist working with the Geriatric Psychiatry Community Service at Baycrest Centre in Toronto, ON. Rittenberg also notes that caregivers themselves are at high risk for depression, so they, too, need support and help.