The Impact of Parkinson’s Disease on the Occupational Performance
Parkinson’s disease is a complex condition of neurological character. This condition tends to progress insidiously for the patient’s life. The disease is constantly studied and researched by multiple professionals all around the world. To date, the scientists and healthcare providers agree that the complexity of Parkinson’s disease and its effects on the patient’s lives require multidisciplinary and thorough approach (Jansa & Aragon, 2015; NIH, 2016).
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The main effects of Parkinson’s disease are related to the occupational performance of the affected individuals, namely, in their motor functions and mental capacity (Parkinson’s Disease Health Center, 2016; NIH, 2016). The mechanism of Parkinson’s disease affects the production of dopamine by the substantia nigra and, this tendency occurs due to the death or degeneration of the neurons that are situated in the basal ganglia (Aragon & Kings, 2010).
Also, scientists suspect that there are some other processes involved in the occurrence and development of Parkison’s disease. For instance, there is a version that such neurotransmitters and structures as GABA, serotonin, noradrenaline, and glutamate may be affected in the course of the disease; however, the researchers are uncertain and cannot currently provide a detailed explanation of these processes (Aragon & Kings, 2010). The most common symptoms of Parkinson’s disease are tremors, rigidity and weakness of muscles, problems with speech, and changes in gait (Parkinson’s Disease Health Center, 2016).
Some of these problems can be observed in the daily life of the patient from the case study, Mrs Meredith Duncan, a 74-year old woman who was diagnosed with Parkinson’s disease three years ago. Over this time, her condition progressed and started to produce a negative influence on her performance of daily activities. From the patient’s description of her daily activities and the problems she has been experiencing, it is obvious that Mrs Duncan suffers from such effects of Parkinson’s disease as the weakness and rigidity of muscles while bathing. According to the information provided by the patient, her shower is set over her bathtub, and she usually has difficulties lifting her leg over the edge of the tub.
An additional effect of muscular weakness is the patient’s inability to use stairs. She lives in a single-storey cottage with one step of 5 centimetres at her front door which she can manage for now. Besides, Mrs Duncan reported changes in her gait. Moreover, the patient has honestly informed her GP that she has been experiencing problems with toileting as occasionally she would fail to get to the toilet in time. This information adds to the patient’s issues with muscle control. Finally, the most recent problem Mrs Duncan is worried about is her mental capacity as she began to have memory blackouts where she would forget actions that used to be performed automatically.
The interventions for this condition and its physical impacts on the patient’s daily lives are based on the person-environment fit, a concept that refers to the suitability of the space and location of objects and appliances for the ease of use of the patients with Parkinson’s disease (National Parkinson Foundation, 2016). In other words, the discomfort Mrs Duncan has faced due to the progressing condition could be overcome using a variety of environment adjustments to maximise her existing level of independence. For instance, it is recommended that the patients with this condition have their bathrooms modified for their needs (National Parkinson Foundation, 2016).
The modifications suitable for Mrs Duncan may include the installation of rails and bars for better support as she gets in and out of the tub and the placement of rubber mats in and next to the tub to avoid slipping. Further, as Mrs Duncan sometimes “gets stuck” and has problems with getting up, she might consider taking her cellphone with her to the bathroom and placing it within reach so that she could call for help if there is such need.
As to her mobility problems, Mrs Duncan may consider getting a cane as it is recommended for support for the patients with changes in gait (National Parkinson Foundation, 2016). A straight and reliable cane with a rubber tip will help Mrs Duncan feel more confident while walking and make it easier for her to manage the stairs and steps. Cane will also prevent falling.
Finally, cognitive impairment is another negative effect that occurs as Parkinson’s disease progresses over time. As pointed out by Tröster (2016), traditionally, Parkinson’s disease is perceived as a movement disorder where the most typical symptoms are tremors and mobility problems. However, as the condition reaches farther stages, the patients begin to notice cognitive issues as well. The disease tends to affect a variety of mental abilities and skills.
The cognitive impact of Parkinson’s disease is individual for different patients. Besides, the changes in cognitive abilities and skills are difficult to measure because multiple assessment tools focus on different mental capacities and evaluate how much they were damaged due to various processes. Tröster (2016) reports that several individuals affected by Parkinson’s disease tend to develop cognitive impairments of a mild level at some point in their lives whereas the others may suffer from dementia. In the case of Mrs Duncan, her old age suggests she could have been experiencing dementia, and that could explain her forgetfulness.
However, the impact of Parkinson’s disease is possible as well. According to Tröster (2016), the cognitive changes may occur at any stage of the disease starting with the time the patients are diagnosed. However, these effects are not severe enough to make a serious impact on the patient’s lives. Mrs Duncan is distressed because of the changes as she does not seem to be able to rely on her memory anymore. For now, the patient has managed to bring back the information she forgot, and not severe impact on her daily life was produced. However, if the condition worsens this may suggest dementia and not the effects of Parkinson’s disease.
The Potential Assessment Tools for the Patient with Parkinson’s Disease and Setting Goals
As mentioned earlier, Parkinson’s disease has multiple effects on the patients’ performance of the daily activities is characterised by the motor as well as cognitive impairment. This tendency occurs because the same processes in the patient’s brains that lead to the limitation of physical abilities create cognitive problems such as memory problems and slowness in thinking.
As a concept, cognition is challenging to define for since it refers to a multitude of functions and capacities such as the perception of the world around, making sense of information, applying knowledge, learning, storing and retrieving memorised information, solving problems, using language, planning tasks and activities, forming insights, to name a few.
Attempting to measure the cognitive impacts of Parkinson’s disease, the researchers presented a variety of conflicting and inconsistent data (Tröster, 2016). This tendency occurred because, in different studies, the authors used different tools to assess the effects of the condition on the mental capacity of the affected individuals (Tröster, 2016). Approaching the impairments from various perspectives, the tools generated diverse results. The tools and tests available today provide the professionals with an ability to assess even the mildest impacts of Parkinson’s disease on the cognitive capacities of the patients that they do not notice in daily life.
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In the situation of the case study patient, Mrs Duncan, two types of effects are to be measures – motor and cognitive. The patient has been complaining about the problems with memory retrieving skills, changes in gait, and weakness of muscles. There is a variety of assessment tools that could help a professional measure the level of Mrs Duncan’s occupation and cognitive performance daily. Among such tests and tools, there are self-report scales (the Webster Rating Scale, the Northwestern University Disability Scale, the Self-Care Scale, and the Activities of Daily Living Scale) (Gaudet, 2002).
Some other scales that have to be administered by the supervisors include the King’s College Hospital Parkinson’s Disease Rating Scale, the University of California Los Angeles Scale, the New York University Parkinson’s Disease Disability Scale, and the Unified Parkinson’s Disease Rating Scale (Gaudet, 2002). Also, some assessment tools were developed for the occupational therapy, in particular, these tools include the Canadian Occupational Performance Measure ( also known as the COPM), and the Assessment of Motor and Process Skills ( also referred to as the AMPS) (Gaudet, 2002; Sturkenboom et al., 2013).
Occupational therapy is recognised as one of the most successful interventions for individuals whose performance of daily activities is affected by Parkinson’s disease (NIH, 2016). As noted by Parkinson’s Disease Foundation (2014), the occupational therapist can help the patients with this condition to improve their performance of such activities as chores and self-care and increase the control over muscles of various body parts. The effectiveness of occupational therapy is evidence-based and described in a variety of studies specifically conducted to evaluate the effects it can create (Parkinson’s Disease Foundation, 2014).
Exploring the application of the Unified Parkinson’s Disease Rating Scale (or the UPDRS), Perlmutter (2009) points out that it is comprised of four subscales designed specifically to assess different types of effects of Parkinson’s disease. The first subscale refers to behaviour, mood, and mentation changes; the second one covers the activities of daily life such as dressing, eating, writing, resting, hygiene, mobility, tremors and freezing, and sensory impacts (Perlmutter, 2009).
The third subscale focuses on the motor changes in depth also involving speech, and the fourth covers the complications of therapy. Since Mrs Duncan is not in therapy, her condition may be assessed using the UPDRS focusing on the first three subscales. This tool would allow the medical professional working with her to find out the severity of her condition and the changes it has resulted in. This assessment would provide a professional with an opportunity to understand just how many challenges Mrs Duncan has to face in her everyday life.
Having that information, the practitioner would help the patient to set and achieve the primary goals and objectives to increase the level of her comfort and independence as she is already in need of help when she is to move around the city (since she has not been driving for a decade), and sometimes she requires help while getting up. Judging from the report provided by the patient about her condition, Mrs Duncan is quite objective and honest; that is why the Parkinson’s Self-Assessment Tool may be a good start. The tool proposed by The Cure Parkinson’s Trust (2010) allows a patient to track their performance of a selected activity over two weeks. For this test, Mrs Duncan could select her gait, cooking, or bathing – the activities with which she has had difficulties the most often.
Besides, the cognitive problem (namely, the occasional loss of memory), is the change that worries the patient the most. There are several tools available for the assessment of this impact in particular. They include the Six Item Cognitive Impairment Test (6CIT), Mini-Mental State Examination (MMSE), and the Abbreviated Mental Test (AMT) (Knott, 2013). These tests are reliable and valid tools developed by geriatricians to assess cognitive impairments caused by such conditions as Alzheimer’s disease, dementia, and Parkinson’s disease. Additionally, such tools and Stroop (attention and focus) and Trail Making Tests (planning, processing, and speed) could help the professionals evaluate Mrs Duncan’s condition in the areas she has not pointed out as there may be changes that the patient has not noticed yet (Romann, Dornelles, Maineri, Rieder, & Olchik, 2012).
Finally, another instrument suitable for the assessment of Mrs Duncan’s cognitive impairments is called PANDA (or the Parkinson neuropsychiatric dementia assessment). This tool represents a cognitive test and also a brief assessment instrument for mood changes that involves five tasks for the mental performance and depression level evaluation (Kalbe et al., n. d.).
As seen from the research, a variety of tools suitable for the assessment of Mrs Duncan’s cognitive and motor issues are available for the evaluation of the identified problems. Based on the specific reports of the patient that include the occasional memory loss and mobility issues, the tools of choice may include one self-assessment test tracking specific activities, one general test administered by the medical professional to assess the quality of life of the patient, and one instrument that would be used to evaluate the cognitive impairments and changes the may be in place without the patient noticing them.
Based on the results of the tests, the assessor would help Mrs Duncan set appropriate goals and priorities to improve her level of confidence and independence. For instance, the results concerning the patient’s level of physical and motor abilities would be used to identify the environment adjustments, appliances and tools the patient would have to use to ensure her comfort and safety. These appliances may include walkers or canes for mobility independence; rubber mats, rails, and handles for bathing and toileting.
Moreover, the cognitive changes (both reported by the patient and possible problems that for now remain unnoticed) may require that Mrs Duncan hires an assistant (a nurse or a social worker) who would help her daily. The patient’s memory loss may be addressed by recording and writing down the most important information such as emergency contacts and phone numbers, attaching name tags, contact numbers, and medical information to the clothes of the patient.
Given the condition of Mrs Duncan, her age, and the fact that she does not have a husband or children to help her in daily life, hiring an assistant would be extremely helpful as this person would ensure the patient’s safety and comfort knowing that Mrs Duncan experiences difficulties getting up, walking, moving around the city, and forgets information occasionally. Such assistant would function as a reminder and a helper improving the quality of life of the patient.
Unfortunately, there are no medications that would reverse the changes Mrs Duncan has reported. There are remedies for mild memory loss; however, it is likely that because Mrs Duncan is suffering from Parkinson’s disease, a chronic and irreversible condition that eventually progresses and turns into severe disability, no pharmaceutical treatment would produce an effect powerful enough to enable the patient function with complete independence daily. According to the information disclosed in the case study, Mrs Duncan has been using help regularly as she needed to be driven to the library or assisted with daily activities from time to time. Based on the recent changes, the patient’s condition may have deteriorated due to her age or Parkinson’s disease so that she may need to consider getting more steady help.
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