TPwP and Occupational Therapy

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"Thanks to advances made in medical treatment, the symptoms of Parkinson’s disease can be kept under control for a longer period of time. Nevertheless, Parkinson’s disease remains a progressive disease which is accompanied by increasingly greater limitations in carrying out everyday activities. For many persons with Parkinson’s Disease (PwPs), this leads to major problems in social and societal participation. Occupational therapy focuses on increasing or, for as long as possible, maintaining the level of meaningful activities and societal participation of people with Parkinson's disease."

Guidelines for Occupational Therapy in Parkinson’s Disease Rehabilitation 

Ingrid Sturkenboom, Marjolein Thijssen, Jolanda Gons-van Elsacker, Irma Jansen, Anke Maasdam, Marloes Schulten, Dicky Vijver-Visser, Esther Steultjens, Bas Bloem, Marten Munneke

"For occupational therapy to be effective for people with Parkinson’s, three key principles must be understood and incorporated wherever possible into all therapy interventions: 

1. Conscious attention is required for the performance of well-learnt motor skills and movement sequences performed automatically prior to onset of Parkinson’s. By employing a high level of attentional resources, as used for performance of a novel task, it appears that physical actions can be directed via voluntary control mechanisms, effectively bypassing lower brain involvement. The application of focused attention seems to reduce spontaneous reliance on dysfunctional systems and enables people with Parkinson’s to be in more direct control of their motor performance.
2. Consider the value of limiting multitasking and of practising instead only certain selected multitask activities. Multitasking allows several well-learnt motor plans to be performed simultaneously. This facility is in fact highly intricate and relies on well-functioning basal ganglia acting as an ‘auto-pilot system’. One of the paradoxical features of Parkinson’s is that being stretched by multitask performance impacts most on the least attention-demanding or most automatic task. For example, standing balance is affected or gait deteriorates, while talking. Therefore, sitting down to paint, for other manual tasks, or to eat or drink, may reduce the risk of falls and balance problems, or swallowing difficulties during performance.
3. Encourage the use of cognitive and sensory cues and triggers to guide the flow of motor performance and ideas. Cues work in real time and function as a compensatory mechanism which uses higher brain circuits, accessed without major disturbance, despite dopamine deficiency. Over a period of time (several years in many cases) a chosen method may become less effective. If this happens, another phase of experimentation will be needed and usually involves switching to a different category of stimulus or ‘cue’. Cognitive and sensory attentional strategies seem to utilise alternative pathways for reaching a goal."

Occupational therapy for people with Parkinson’s - Best practice guidelines

Ana Aragon and Jill Kings