PD
What is the acronym for PD symptoms and what are they?
TRAP
Tremor
Rigidity
Akinesia
Postural Instability
When did Judith start experiencing symptoms of Parkinson’s disease and when was she diagnosed?
She noticed symptoms approximately five to seven years before her PD diagnosis, which included left foot drag, difficulty threading a needle, micrographia, and difficulty with typing quickly and accurately at work. Diagnosed approximately four years ago.
When is it most difficult for Judith to move and why?
In the morning before getting out of bed. Her body and muscles have been immobile for many hours.
True or False?
Judith has dyskinesia as a side effect of her medication?
True
Do you guys think that LSVT BIG was a beneficial treatment option for Judith?
Needed one more question :)
How many stages of PD are there?
5
What is Judith's home environment like?
She lives in a single floor, 2 bedroom, open-concept condo with her husband Ken. She has already eliminated all rugs for safety purposes. There is a walk-in shower and tub shower combo, but she usually uses the walk-in shower, which has nonslip strips on the floor for safety. She uses night lights as well.
True or False?
Judith has had many falls due to her balance issues?
False.
Judith has only experienced one fall that occurred during a dream
What was Judith's career and why is she no longer working?
Judith was a physician who is no longer practicing due to complications of using a keyboard for EHRs
What is the LSVT BIG?
The Lee Silvermann Voice Treatment-BIG therapy (LSVT-BIG), a special training program aiming at an increase of movement amplitudes in persons with PD (PwPD), has shown to be effective on motor symptoms.
Is Parkinson's terminal?
No, however symptoms can lead to something else that is terminal
What are some of Judith’s hobbies and occupational roles?
She enjoys music, attending outdoor concerts, reading, hiking, walking, and riding a tandem bike with her husband. She takes spin cycle classes and boxing for PD classes, exercising in some way almost every day. She attends and/or helps to lead many exercise classes, support groups, education programs, and meetings.
What did Judith state some of her main goals were?
1. To stay as active as I am now
2. To “clean up a few areas” where I know I can do better, specifically, hand function
3. To increase speed of dressing so I am not affecting Ken’s day
4. To discover areas of function I can impact and do something about it
What non-motor symptom impairments from PD does Judith present with?
She notes increased difficulty with dual tasking, which is a common non motor symptom of PD that is impacting her speed, efficiency, and safety with ADLs, IADLs, and mobility-related tasks.
She also reports she has long term constipation.
True or False?
You have to be certified in LSVT BIG treatment method to deliver this treatment?
True
What is micrographia?
Small and crowded handwriting
Words get smaller as you continue to write
What occupations does Judith struggle with due to her symptoms of PD?
Flossing, dressing with buttons and zippers, changing earrings, multitasking such as making grocery list and planning the trip, carrying objects while walking, typing on computer
Why is Judith an excellent candidate for OT?
Dr. Judith is an excellent candidate for occupational therapy given her motivation to care for herself independently, reduce her risk for falls, and be able to maintain her active community participation safely despite the progressive nature of PD.
What potential barriers to therapy for Judith were identified?
The sensorimotor mismatch between her self-perception of normal amplitude when she is actually standing in a flexed posture and moving with smaller and slower movements than is typically required for a task.
What does the LSVT BIG treatment consist of?
1) 16 sessions: 4 consecutive days a week for 4weeks
2) Individual 1 hour sessions
3) Daily homework practice
4) Daily carryover exercises
What are some areas and occupations that OTs can help clients with PD?
Restoring arm and hand strength, handwriting, home modifications, driver evaluations & vehicle modification information, cooking and homemaking adaptations, energy conservation, computer modifications, workplace/work equipment modifications, leisure activities, toileting, dressing, and grooming.
What are Judith's main concerns?
Balance during ADLs, tripping on thresholds, walking in areas with uneven surfaces, increased time to complete functional activities
What motor symptom impairments from PD does Judith present with?
Bradykinesia, left foot drag and instability with turns and backing up, which is affecting her sense of steadiness and safety with functional mobility related to completion of her ADLs and instrumental ADLs.
What are some goals that we as OTs have for Judith?
Hint: Eval report from Simucase
1.Judith will be independent with an upgraded home exercise program.
2. Judith will demonstrate a 15% improvement in the 9-hole Peg Test in order to demonstrate ability to keyboard, write a grocery list, floss her teeth, and change her earrings.
3. Judith will demonstrate a 10% improvement in bradykinesia for dressing tasks, including buttoning and zipping, in order to make it to her medical appointments in a timely manner.
4. Judith will independently fold laundry with big amplitude movements matching the task demand in order to contribute to the household duties.
5. Judith will perform functional transfers from low surfaces with modified independence in order to attend outdoor concerts safely.
6. Judith will ambulate forward and backward, turn, and carry objects independently while engaged in a cognitive dual task over various level and unlevel surfaces for safety at home and community when attending exercise groups and support group meetings.
What did Judith report on her 1 week progress note from LSVT BIG?
She completed the exercises but struggled to remember how to do them correctly even with use of the handouts, has been “thinking BIG'' and discovering functional benefits with activities at home.
“I was able to use my BIG movement when I stepped onto the step stool at home last evening to water my houseplants. I paid special attention to lifting my left foot higher when stepping up and down, and I did not catch it like I so often do.”