In early October 2023, the American Parkinson Disease Association (APDA) held a webinar on staying independent with PD, especially when doing everyday activities. Amanda Landsbaum, an occupational therapist, spoke on ways to reduce the chance of falls, and make everyday tasks easier. These goals in particular will improve home safety and functioning, making aging at home possible for more people. This webinar was the second in APDA’s “Thriving Through OT” series on occupational therapy (OT).
Some of the key points include:
- Stiffness and slowness have the most impact on actions like sitting down and standing up from couches/chairs and the toilet, entering and exiting the shower/tub, and getting in and out of the bed and car. Amanda calls these “in and out,” and “on and off” motions.
- Actions most affected by tremor and fine motor control trouble are eating, writing, using the phone, dressing oneself, and personal hygiene.
- For slowed thinking and impacted cognition, Amanda recommends keeping to a routine, and using either a physical or digital planner.
Amanda recommends looking for an occupational therapist (OT) or certified aging in place specialist (CAPS). These could be a vital part of your care team, or your loved one’s care team. If you are lucky enough to live in the area of Stanford University, see our list of local OTs:
Stanford Local Occupational Therapists
A recording of the webinar is available on the APDA YouTube channel:
Independence with Everyday Activities
You can find resources for staying independent with PD on the Stanford Parkinson’s website:
Below are my notes on the webinar.
– Jordan
“Independence with Everyday Activities: Thriving Through OT”
Speaker: Amanda Landsbaum, MS, OTR/L, director of APDA Missouri chapter
Webinar Host: American Parkinson Disease Association (APDA)
Webinar Date: October 12, 2023
Summary by: Jordan Dagan, Stanford Parkinson’s Community Outreach
Occupational therapy can help those with Parkinson’s disease (PD) manage exercise, nutrition, home safety, and more. The goal of occupational therapy is to improve and maintain the person’s independence, which also reduces the tasks a care partner would need to help with or take responsibility for. Goals for independence will vary per person, but common goals are improving safety and reducing the frequency or chance of falls, aging at home, and making daily tasks easier in general.
Amanda described the approach occupational therapists take as “person centered.” An occupational therapist will consider the person’s environment and the context of their activities when formulating a care plan to help the person with their goals. The therapist will help the person get better at the task with practice, or modify how the person does the task in order to make it easier. They might modify the environment to help the person succeed, such as reducing distractions. If the person needs an aid or tool to complete the task on their own, the therapist will connect them with those resources, evaluate which would work best for them, and if needed, teach them how to use the aid safely.
Amanda reviewed common challenges for those with PD which prevent them from living fully independently, and some examples of solutions. She noted that this is not an exhaustive list, and that one-on-one time with an occupational therapist will help personalize the person’s care, and help them achieve their specific goals.
SLOWNESS AND STIFFNESS
Slowness and stiffness of movement can make certain tasks especially difficult for someone with PD. Amanda sees that “in and out” and “on and off” motions are most affected, such as using couches and chairs, the toilet and shower/tub, and the bed and car. An occupational therapist would watch the person make these motions to identify specific areas of difficulty, then recommend one of the following changes, or several changes in combination.
Changing the person’s approach to getting in and out. Switching which leg they put forward first might help if the person is more stiff on one side of the body. Sleeping on the other side of the bed could reduce obstructions by the bed, and could reduce the distance to and from the bathroom.
Changing the environment. Using different sheets on the bed could reduce friction enough that the person can get in and out easier. If the seats of couches and chairs are made firmer, or a booster placed on top of them, this might help the person stand up.
Using mobility aids and tools. The therapist might consider adding a cane built to help people get in and out of beds and chairs. They might add a toilet safety frame, which raises the height of toilet seats and adds arms like on a chair. Inside the car, a swivel seat could be placed on top of the seat, so the person could rotate instead of needing to scoot. There are handybar accessibility devices that can be clamped on the door hinge to give the person a place to hold onto for balance. These are often portable, and can be moved so the person can use different cars.
Grab bars could be installed beside the toilet or shower; these can be multifunction! Grab bars need to be permanently installed in order to be safe, and must be installed at the right height and angle for the person to use them. If you can’t install permanent grab bars, use a clamp-on kind rather than using ones that depend on tension or suction to stay in place. Amanda recommends at least two grab bars, with one inside the shower and one outside.
Amanda recommended two online businesses for buying medical equipment: RehabMart and MaxiAids.
TREMOR, DYSKINESIA, AND FINE MOTOR CONTROL
Areas most affected by tremor and fine motor control trouble are eating, writing, using the phone, dressing oneself, and personal hygiene.
There are many options for adaptive tools and utensils! These help stabilize tremor or adapt to it actively, and offer larger handles to grab tools.
- Adaptive utensils: weighted, “swivel” or “wobble” utensils, or with thick handles.
- Foam tubes to thicken handles: useful on utensils, toothbrushes, pens and pencils.
- Plate guards and non-skid placemats.
- Adaptive cups: weighted, lightweight, or with a lid, depending on need.
- Electric toothbrushes.
- Floss holders for dental floss.
- Electric razor, with a guard to prevent cuts. Safety razors, if you prefer a closer shave.
- Adaptive clothing and shoes: alternative closures such as velcro or snaps, pull up pants rather than a fly, and zipper pulls that are easy to grab. Some brands offer adaptive clothing pre-made, such as Zappos Adaptive, Buck and Buck, Amazon, and Tommy Hilfiger.
- Long handled shoe horns.
- Locking laces reduce the need for fine motor control, and keep laces tied and out of the way. This also reduces the chance of falls!
- Adaptive writing utensils: weighted pens and pencils, added grips.
- Custom stamps for signing letters, bills, and checks.
- Accessibility settings on phones: changing the display, text size, touch sensitivity, background and lighting, and using voice-to-text features.
COGNITION AND SLOWED THINKING
Amanda recommended maintaining a schedule to reduce the amount of thinking and planning one needs to do. This also helps with remembering to take medications! Use a portable calendar, either a physical book or on your phone or tablet. If your calendar is digital, you can add appointments and a reminder system. Pill organizers with reminders or alarms, or a pill holder on a keychain that you can take with you, can help you remember medication.
QUESTIONS AND ANSWERS
Kim Sanders, OTA/L, joined the question and answer section.
Question: What is a bed cane?
Answer: A bed cane attaches to the bottom of the bed frame, or slides under the mattress. It provides something to grab onto, to help with balance and stability.
Question: Why shouldn’t we use suction cup grab bars?
Answer: Grab bars that depend on suction, tension, or adhesives to stay in place should not be trusted. These may pull off of the wall, if much pressure is applied to them! They aren’t stable, and may cause injury. Especially in the bathroom, grab bars should be permanently and professionally installed, at the right height and angle for your needs.
Question: When we’re traveling, could we use a portable chair?
Answer: Yes! There are many options, and portable chairs are often foldable and lightweight. Make sure you and your loved one can get into and out of the chair before using it for traveling, since some camping chairs are low to the ground and hard to lift yourself out of.
If you’re considering a power wheelchair or scooter, make sure you can lift them if they fall over or get stuck! Many can be pulled apart or disassembled for transport. Consult an occupational therapist to evaluate what type is right for you; the speed, time you plan to use it, size of you and of the mobility aid, and mobility at home, should all be considered. You don’t want to waste money on an item that doesn’t work, and you don’t want to get yourself stuck somewhere!
Question: How can we find an occupational therapist?
Search your local zip code for an occupational therapist near you. Find someone you’re comfortable working with! Hospitals and the Veterans Administration (VA) may be able to connect you with occupational therapists. Occupational therapy is a “rehabilitation therapy,” and is usually covered by insurance if you have a doctor’s note that this is necessary for your care. You may have a co-pay to cover.
Question: When I drop an item, I often lose my balance when trying to pick it up. How can I avoid falling?
Answer: Use “good body mechanics,” especially in small spaces. Work with an occupational therapist to improve your safety! A tool for reaching and grabbing items may reduce your chances of falling. Use these tools to reach high over your head, far in front of you, or reach down low. Place the tools in areas you’re likely to drop things, so you don’t need to fetch the tool in order to use it.
Question: What adaptations can we use for meal prepping?
Answer: There are cutting boards with edges or sides, prongs or textures to hold the food still while you cut it, and tools that will cut food for you so you don’t have to handle a knife. Carrying items in the kitchen can be unsafe, since you don’t have your hands free to catch yourself if you lose your balance, or to shield yourself from splashes. Amanda recommends using a cart to move heavy items, hot items, or numerous items.
Questions: Can safety features inside a vehicle make it safer to drive?
Answer: Lane assist technology can reduce the impact of tremors on your steering. Some newer cars offer a light or noise to notify you of objects or people in your blind spots.