Occupational Therapy Best Practice Parkinson’s disease Occupational Therapy Best Practice Parkinson’s UK – Fife Local Branch Dunnikier House Hotel, Kirkcaldy Charlie Chung – occupational therapist charliechung@nhs.net

Philosophy of occupational therapy "Occupation" refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day-to-day tasks such as self-care, work or leisure (College of Occupational Therapists 2016) Two key points: People need to participate in occupation to maintain physical, cognitive and psychological health. Occupational therapy uses occupation as a treatment medium as well as an outcome

Parkinson’s disease and occupation Potential for limited participation in many occupations due to motor and non-motor features.

Techniques to increase participation in occupation Allowing adequate attentional resource to be applied to automatic tasks. Limit multitasking as the most automatic tasks deteriorate when multitasking. Then train multitasking. Encouraging the use of cognitive and sensory cues and triggers to guide the flow of motor performance and ideas.

Techniques to increase participation in occupation Intrinsic Cueing Positive attitude – basal ganglia links with limbic system and a positive mental set at the point of starting movement can enhance movement. Mental rehearsal – can compensate for reduced pre-movement brain activity. This should be in as much detail as possible. Internal dialogue – self-talk while performing the movement Visualisation – e.g. freezing in doorways can be addressed by visualising stepping over a log.

Techniques to increase participation in occupation Extrinsic Cueing Adapting the visual environment – reducing clutter, taking away patterned rugs. Visual cues – floor markers (contrasting coloured strips) and cue cards (brief written directions for a specific task - can be use at the time of movement or memorised). Auditory cues – Concise spoken instructions by another person can be effective in some people. Metronomes have been shown to be effective in some studies, units which can be worn on a belt and with ear pieces. Rhythmic music can enhance voluntary movements.

Other factors which reduce participation Executive dysfunction Apathy Depression

Optimising occupation Three principles for occupational therapists: Skill level intervention – hands-on treatment for body level problems. Knowledge level intervention – supplying the knowledge on how to modify occupation. Attitude level intervention – the management of expectations in relation to occupational performance.

Top ten goals of intervention as identified by people with Parkinson’s disease (Jain et.al 2005) 1st Maximise safety and reduce the risk of falls when mobilising indoors. 1st Reduce effort and increase safety with bath transfers. 1st Reduce effort and improve efficiency during kitchen/domestic/meal preparation tasks. 4th Reduce impact of fatigue on all activities of daily living. 4th Reduce effort during bed transfers. 4th Reduce effort and increase safety during chair transfers. 7th Decrease effort with toilet transfers. 7th Improve efficiency and satisfaction when eating and drinking. 7th Increase satisfaction with leisure activities. 10th Reduce effort and increase safety when dressing.

Summary There are many techniques and considerations which occupational therapists can apply to work with people to increase their participation in occupation.

Actions Engage with the local branch to improve awareness of what occupations are important to people with lived experience of Parkinson’s disease. Liaise with multi-professional colleagues to share knowledge and develop combined and complementary interventions. Contribute to the establishment of a national occupational therapy Parkinson’s disease network to share experiences and ideas for practice.