In early September, occupational therapist and program coordinator of the St. Louis, Missouri chapter of American Parkinson Disease Association (APDA), Amanda Landsbaum, gave a talk introducing people with Parkinson’s disease (PD) to occupational therapy (OT). She described occupational therapy, listed the areas of life occupational therapists might address, and provided case examples of how occupational therapy can benefit someone with PD. Amanda’s talk is the first of a three-part series on “Thriving Through Occupational Therapy.”
“Occupation,” in a therapy context, refers to anything that occupies our time, and can include any meaningful activity. Amanda emphasized that occupational therapists focus on the individual person’s needs and desires during their daily activities, and that OT can make most parts of someone’s routine easier and safer. Every person living with PD is different, not only in their symptoms, but in their home structure, what appliances they use every day, social preferences and support systems, and daily routine. An occupational therapist considers multiple aspects of a person’s life when adapting a treatment plan for them.
Amanda drew contrasts between occupational therapists and physical therapists:
While a physical therapist helps an individual with balance, posture, strength, and exercise, an occupational therapist helps them achieve safety and independence in their home and their community.
A physical therapist personalizes an exercise plan to the needs of the individual, and an occupational therapist can help the person implement that exercise plan.
Some common areas an occupational therapist can assist with, for someone with PD, include:
- Independence with daily activities, such as bathing and eating
- Memory and thinking strategies, especially for maintaining healthy routines
- Managing taking medications
- Conserving energy to help manage fatigue
(A more complete list is in my notes below.)
A recording of the early September webinar is available on the Here is a link to the contact page.
The next part of the series, titled Independence with Daily Activities, will be held on October 12, 2023, at 11:30am (Pacific Time).
My detailed notes are below.
– Jordan
“Occupational Therapy 101: Tips for Daily Success”
Speaker: Amanda Landsbaum, MS, OTR/L, with APDA, St. Louis Missouri chapter.
Webinar Host: American Parkinson’s Disease Association (APDA)
Webinar Date: September 14, 2023
Summary by: Jordan Dagan, Stanford Parkinson’s Community Outreach
DEFINING OCCUPATIONAL THERAPY
Occupational therapists support performance and participation in everyday tasks, with the goal of improving overall health and wellbeing. Occupation, in a therapy context, refers to anything that occupies our time, and can include any meaningful activity. Amanda refers to OT as “the therapy of doing.” Occupational therapists can help adapt nearly any activity of daily living, or ADL, to suit an individual’s unique needs. This can include rest and sleep, social participation, play, and education, as well as health management and work.
While a physical therapist helps an individual with balance, posture, strength, and exercise, an occupational therapist helps them achieve safety and independence in their home and their community. A physical therapist personalizes an exercise plan to the needs of the individual, and an occupational therapist can help the person implement that exercise plan.
Amanda emphasized that the person’s needs are at the core of occupational therapy work, and that the person’s desired outcomes, skills, strengths, and habits or routine are all taken into consideration when practicing occupational therapy. The environment and context surrounding that person are also evaluated, to make a plan for the person’s improved well-being.
Occupational therapists usually have a Master’s or Doctorate degree, and may have a degree in a variety of fields. Amanda advised people with PD to seek out an occupational therapist who specifically has education and experience working with PD.
TREATING AND MANAGING PARKINSON’S WITH OCCUPATIONAL THERAPY
Amanda said those with PD who have the best outcomes for health and well-being, especially in the long term, are those who have good management by their healthcare team, and who integrate their PD medication with daily exercise, emotional support, and nutrition. A thoroughly put together health care team should include a neurologist or movement disorder specialist, a physical therapist, an occupational therapist, a speech-language pathologist, a nutritionist, and a psychologist or psychiatrist.
Common areas an occupational therapist can assist with, for someone with PD, include:
- Independence with daily activities, such as bathing and eating
- Memory and thinking strategies, especially for maintaining healthy routines
- Managing exercise routine
- Managing taking medications
- Conserving energy to help manage fatigue
- Home safety and fall prevention
- Work accommodations, and adapting essential job functions
- Community mobility and safety, including driving and transferring in/out of a car
- Sleep routine
SPECIFIC CASE EXAMPLES
Case 1: A person was diagnosed with PD four years ago. They’re noticing new symptoms, and would like to get the most out of their doctor’s appointments. They’re unsure how much exercise they should be getting, and how their food and medications interact.
In this case, an occupational therapist would focus on educating the person about PD, and help them access resources about diet, exercises, and medications for PD. She would help them make specific goals for their care, and problem solve what works best for them.
Case 2: A person with PD has noticed they are unsteady getting in and out of the shower, and that they are tired easily. It is especially difficult for them if they drop an item in the shower, or when they wash their feet.
Amanda says this is the perfect time to ask for a referral to OT from your primary care provider or neurologist. Don’t wait until you’ve fallen to access the resources OT can provide!
In this case, the therapist would evaluate the person’s strength, mobility, and balance, and clarify where they’re having the greatest challenges. He would then evaluate their showering routine and the bathroom setup, and spot any safety hazards or sources of physical support. The therapist would work with the client to identify what tasks are needed during a shower, and help break the process into pieces.
The intervention for this case might include installing grab bars for both during a shower, and transferring in and out. Amanda said that the placement of grab bars should be correct for the individual. The occupational therapist might recommend using a liquid soap with an easy dispenser, to reduce the risk of a fall while picking up dropped bar soap. He might recommend a bath stool or chair. Amanda emphasized that the type and placement of a bath chair varies greatly by the individual’s needs, noting that the incorrect type of bath chair can add to the danger of falls. Finally, an occupational therapist would practice the shower routine with the person with PD, and make sure the supports put in place are helpful and achievable.
Case 3: The neurologist of a person with PD has recommended that the person change their medication routine, from taking 3 doses a day, to 4 doses a day. With the added dose, the person with PD is unsure when to eat and when to take their meds, and has occasionally forgotten to take their medicine.
In this case, the occupational therapist would evaluate the person’s ability to take their pills, including their fine motor skills, what kind of pill box they’re using, their current system of reminders to take their medicine, and their cognition and memory. She would evaluate the person’s typical schedule of waking up, eating, and daily activities, and identify any patterns around when the person has been forgetting to take their medicine.
The therapist and person with PD would work together to make a schedule for the person’s meals and medication, and solve the challenges that result in them missing some doses. This would probably be in the form of timers on the person’s phone. They would practice the new routine, and fine-tune if needed.
FURTHER RESOURCES
Amanda said that Medicare will cover 80% of occupational therapy costs, if the following conditions are met:
- The person is over 65 years old.
- The OT is medically necessary, and this has been confirmed by a doctor’s signature.
- The OT services are provided in an outpatient setting, rather than at a person’s home.
People with PD should look for an occupational therapist who has education and experience working with people with PD. They can get a referral from their neurologist, or other therapist who’s also working with them. Support groups for PD can be a great source of word-of-mouth referrals to OTs. People with PD can also consult their local rehabilitation center, local APDA chapter, or a national hotline. Some OTs can practice telehealth, if none are available locally.
QUESTION AND ANSWER
(32:30) What is the difference between OT at home versus in an outpatient setting?
This depends on the situation. OT at home isn’t always needed, but it’s especially helpful if the person with PD has a safety concern specific to their living situation.
(34:40) How can OT help with sleep and fatigue?
A therapist would evaluate the person’s exercise routine, sleep habits, caffeine intake, and any medications that might be interfering with sleep. They could help solve issues like trouble moving around in bed, and getting out of bed to use the bathroom.
(36:00) How can OT help with social participation?
People with PD may be reluctant to engage in activities they once enjoyed. An OT would evaluate what barriers are keeping you from your favorite activities, putting special focus on what the client wants. For example, they might help adapt how you interact with children, go out to eat, or speak with friends.
(38:10) How can OT help with eating in public, for someone with PD?
The approach to solving problems eating in public depends on what’s causing the challenge. Someone with tremors might benefit from a set of weighted utensils, which they could bring along to restaurants. Someone with dyskinesia might use a swivel spoon, which keeps their bite of food upright as it moves. There are many options for these issues, both high and low-tech. There are also plate guards people with movement disorders can put on their plates, which offer a surface to scoop food against, and help prevent spills. Putting a non-skid material under the plate can help keep it still.
(41:00) Are there insurance benefits for veterans who want to pursue OT?
Yes, especially through the Department of Veterans’ Affairs (VA). There are benefits available for veterans exposed to Agent Orange, or who have other health circumstances.
(41:50) How could an OT help with mood swings in someone with PD?
An occupational therapist would evaluate when the mood swings are happening, how frequently, and how intense they are. They might ask when the mood swings started, and if there was any change in medication or living situation, or other event, around that time. They could also refer the person to a psychologist or psychiatrist. They would likely suggest a multi-faceted approach to emotional or mental health concerns, focused on what the person with PD would like to do.
(43:45) How can OT help modify hobbies for PD?
Amanda says this is what OT is all about! She says there are a wide variety of options for adapting your favorite activities to your current needs, including modifying the equipment and techniques used. Engaging in meaningful activities is super important for people with PD.