1. Fay J. Tripp, MS, OTR/L, CDRS Department of Occupational Therapy and Physical Therapy Duke University Medical Center

2.  Increase awareness of:  ways to save your energy to put you in control of what you do.  ways to reduce the effect of tremors during function.  adaptive devices and techniques to increase self-care and home responsibilities and safety.  possible visual changes that may occur.  driving safety issues related to movement and process delays.

3.  Limit the amount of work you do  Plan ahead  Plan rest breaks  Be an efficiency expert  Organize your storage spaces  Use assistive devices to increase independence and safety

4.  Stabilize your forearm or elbow  Wear wrist support braces  Use weighted utensils or weights  Hold items with a “fist” grip

5. 5  Gently apply pressure to muscles  Gently move wrist side to side  When writing, print in large letters using lined paper with wrist brace  With computer work,use a forearm support system

6.  Bathing  Tub seat or bench

7.  Bathing  Grab bars  Adaptive devices

8.  Bathroom Use and Hygiene  higher commode seats  grab bars  care aids

9.  Dressing  Seated position  Adaptive devices

10.  Grooming and Hygiene  Tremor control ▪ Wrist brace ▪ Forearm support  Adaptive devices ▪ large, long handled devices ▪ electric razor ▪ nail care

11.  Eating  Tremor reduction ▪ wrist brace ▪ forearm support ▪ fist grip  Assistive devices ▪ large handled, tubing ▪ weighted utensils ▪ rocker knives ▪ long straws ▪ no spill mugs

12.  Cooking and Kitchen Work  Assistive devices ▪ utensils ▪ cutting boards ▪ jar openers ▪ can openers

13.  “Personal domain” care  Home care tasks  Workshop needs

14.  “Personal domain” care  Outdoor maintenance

15.  Leisure Skills  Safety first  Alternate interests

16.  Writing and Computer Work  Forearm stabilization  Forearm support  Micrographia ▪ Begin good habits early ▪ Used lined paper ▪ Print in large letters ▪ Incorporate strategies to reduce tremor

17. 17 Vision Changes  Double Vision (Diplopia)  impaired movement control  eye muscle fatigue  decreased tracking together, alignment  Color perception  Contrast sensitivity 17

18. 18 Vision Changes  Blurriness due to dry eyes  Decreased eye blink rate  Eye discomfort  Progressive pattern  Can impair motor functioning  Blepharospasm 18

19.  Possible changes that may affect safety  Physical ability and reaction time ▪ Response rate ▪ Freezing  Attention  Multi-tasking ability  Judgment

20.  Possible changes that may affect safety  Visual skills ▪ Acuity ▪ Depth perception ▪ Peripheral vision ▪ Perception

21. 21  NC Department of Motor Vehicles  Medical Review Group ▪ Physician Medical Form ▪ Optometric Evaluation ▪ Occupational Therapy Evaluation ▪ Clinical evaluation: physical, visual, cognitive skills ▪ Behind the wheel evaluation: licensed driver instructor  Referral to DMV Medical Review Group ▪ At time of license renewal ▪ Physician based ▪ Motor vehicle incident occurrence

22. Questions?