What is Parkinson’s disease (PD)?

It is a slowly progressive, degenerative movement disorder. Three classic symptoms are associated with PD: tremor, rigidity, and bradykinesia. The diagnosis of PD is usually made after the age of 55. Although PD is not considered fatal, the degeneration of various neurologic structures severely compromises performance of functional tasks.

Clinical Picture

PD is characterized by dysfunction in both voluntary and involuntary movements.

• The disturbances in voluntary movement are identified as difficulty initiating movement (AKINESIA) and slowness in maintaining movement (BRADYKINESIA). The delay in initiating movement patterns and the slowness in executing the motion compromise functional tasks such as driving, dressing, and eating.
• The characteristic Resting Tremor with a rate between 4 and 5 Hz is a disturbance in involuntary movement. This tremor often diminishes with activity, but in some clients the tremor persists during performance of functional activities.
• Additional symptoms of PD are disturbances in Gait and Postural reactions, a Masked face with decreased facial expressions, and Emotional Disturbances, including depression and psychosis.
• The characteristic Festinating Gait is often seen; as the client walks, stride length decreases in length and speed slightly increases, thereby creating a shuffling effect. Reduced arm swing during ambulation is evident, and trunk rotation is markedly decreased during walking.
• Another motor disturbance associated with gait is the phenomenon of “FREEZING” .
• Postural abnormalities associated with PD include a flexed, stooped posture with the head positioned forward. The client tends to stand with flexion at the knees and hips. Righting and equilibrium reactions are markedly reduced in effectiveness, and a person with PD may experience frequent falls.
• Additional symptoms associated with PD include autonomic dysfunction, dysphagia, and dysarthria.
• Mental status is fairly normal throughout the early stages of PD, but visual-spatial perception is frequently compromised. Higher-order cognitive disorders are common in clients with PD. Clients with PD often have difficulty shifting attention among various stimuli.

Role Of Occupational Therapy

Occupational therapist helps in recover or maintain the daily living task or work skill of people with parkinson’s disease.

• Focus on adapting the environment, modifying the task, teaching the skill, and educating the client/family in order to increase participation in and performance of daily activities, particularly those that are meaningful to the client.
• Work evaluation if the client is employed; work simplification for work and home settings; develop the habit of taking frequent rest breaks.
• Energy conservation techniques related to ADLs; develop daily flexibility exercises focused on trunk rotation.
• Use of environmental controls to allow access to the environment.