Chapter 10: Parkinson’s Disease

Chapter 10: Parkinson’s Disease

I’m finally adding to my “OT Chronicles” page! I am in desperate need of a way to review for my upcoming fieldwork placement and (eventually) my boards. Writing is a way for me to solidify what I know and determine what I still need to learn; therefore, I’ve decided to start going in depth about certain conditions and injuries that OTs may work with. This is my way of educating myself and others by using both medical and layman’s terms. By doing so, I’ll learn all the “fancy” words and try my best to teach others in simpler terms. If you’re interested, keep on reading. If you’re not, keep on scrolling. I’m going to start this “series” with Parkinson’s Disease.

What is Parkinson’s Disease?

Parkinson’s Disease (PD) is a progressive neurodegenerative disease (Schultz-Krohn, Foti, & Glogoski, 2018). Let’s break that down. “Progressive” means that the condition and its related symptoms will slowly worsen over time. “Neurodegenerative” means that neurons within the brain are degenerating (breaking down). Neurons are the communicators within the brain. Neurons receive and send signals throughout the brain to help produce movement. As a result of the degeneration, movement becomes progressively impaired for individuals with PD.

PD is associated with loss of dopamine and the presence of Lewy bodies (Schultz-Krohn, Foti, & Glogoski, 2018). Too many science-y words? Let’s break it down. Dopamine is a “chemical messenger” within the brain that is responsible for relaying messages that plan and control body movements. A loss of dopamine results in less effective message relaying, which, in turn, results in decreased ability to plan and control body movements. This causes the movement impairments mentioned in the previous paragraph. In continuation, Lewy bodies are globs of protein found in the brain which cause cell death. As a result of their presence, cognitive impairments occur.

What does Parkinson’s Disease “look” like?

There are three common signs/symptoms of PD: tremors, rigidity, and movement deficits (Schultz-Krohn, Foti, & Glogoski, 2018). Tremors often start unilaterally (on one side of the body) and tend to look like a “pill-rolling” motion. To understand the “pill-rolling” motion, rub your thumb in a constant circular motion over the palm side of your middle and pointer fingers. As PD progresses, the tremors will appear bilaterally (on both sides of the body). Rigidity is described as stiff movements. This means that movements aren’t as smooth as an individual who does not have PD. Movements are rigid.

Movement deficits vary. This may include akinesia (difficulty initiating movement), bradykinesia (slow movements), and hypokinesia (small movements). Individuals who experience akinesia may present with “freezing” which is a sudden cessation of movement or inability to initiate or maintain movement upon changing directions while walking and/or walking through doorways/thresholds. Individuals who experience bradykinesia will simply move slowly. Picture this as an individual who slowly reaches for their coffee mug or slowly walks through their home. This presents much differently than someone who is purposefully moving slow because they are distracted by their phone or a child who is moving slow to annoy their parent. Hypokinesia (small movements) sounds like what it is. Their steps while walking will be small. Their arm swing while walking will be small. Handwriting will become very small (this is called micrographia). As a result of these movement deficits, balance becomes impaired and fall risk increases, in addition to difficulty with movement in general.

Along with these primary signs/symptoms, PD includes a mask-like expression (also known as flat affect). This means that the individual may not change facial expressions upon hearing sad or happy news. They will appear “mask-like”. Similar to hypokinesia (small movements), an individual with PD will also have a “small voice” – muffled speech, monotone, and decreased volume (like a whisper). Just imagine everything “getting smaller” for an individual with PD. Other impairments include issues with attention, decision making (executive functioning), bowel/bladder function, sexual dysfunction, fatigue, and sleep disturbances, among others. Depression is also possible due to changes in function/independence or embarrassment of one’s presenting symptoms.

How do OTs help individuals with PD?*

OTs have a role in PD treatment throughout the disease progression. In the early stages when an individual with PD may still be working, OTs can educate the individual about workplace modifications to ensure safety. This may include requesting a different shift time or a shorter shift to accommodate for fatigue or altering one’s work environment to promote optimal posture, decreased fall risk, and energy conservation.

As PD progresses, home modifications could be recommended to decrease fall risk and to decrease the likelihood of  “freezing” in doorways or rooms. Such recommendations may include removing throw rugs, cleaning up clutter within the home, and making walkways as unobstructed as possible.

Adaptive devices will be beneficial as well. These may include built-up handles on utensils or writing devices (“built-up” just means thick/wide handles), use of bathing/dressing devices (i.e. long-handled sponge, reacher, dressing stick, shoehorn, sock aid), and installation of grab bars and a tub bench in the bathroom for increased safety and independence.

Special programs specifically for individuals with PD include Rock Steady Boxing and LSVT-Big. Both of these programs focus on making movements BIG. Punch big, walk big, dance big, big, big, big. OTs can become certified and specially trained for these programs or referrals can be made to locations that offer these programs.

There are so many other ways that OTs can help individuals with PD improve their quality of life and independence. This is merely a brief overview of the OT-PD relationship. I hope you’ve been informed through this post and I hope to educate myself and you more in upcoming posts!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Schultz-Pendleton, W., Foti, D., & Glogoski, C. (2018). Degenerative diseases of the central nervous system. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 871-903). St. Louis, MO: Elsevier.

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