Occupational therapy practitioners are skilled health care professionals who use education, research and scientific evidence to provide effective interventions to impact the lives of their patients. Occupational therapists have training and education to prepare them for understanding the medical, psychological, physical, emotional and social implications of living with Parkinson’s. It is important to seek out an occupational therapist with additional training and experience working with neurological disorders and specifically Parkinson’s disease. Orthopedic OT and neurological OT’s are different.

We sat down with Lisa Warren to discuss the reasons why people with Parkinson’s should seek out an occupational therapist.

Who is Lisa Warren?

Lisa Warren graduated from the University of Texas Medical Branch with a B.S. in occupational therapy. She received a Master’s of Health Science from the University of Florida. She has more than 30 years of experience as an occupational therapist. Lisa is the rehabilitation site manager for the UF Health Norman Fixel Institute for Neurological Diseases. She has been a member of this team since 2010. This rehab clinic provides occupational therapy, physical therapy and speech therapy evaluations and treatment for persons with neurological disorders. Lisa has lectured healthcare providers locally, nationally and internationally on therapy for Parkinson’s Disease, Huntington’s Disease, dystonia, essential tremor and other neurological disorders. She frequently speaks to support groups, teaches therapy students and provides community workshops.

Lisa has lectured locally and nationally on therapy for Parkinson’s Disease, Huntington’s Disease, dystonia, essential tremor and other neurological disorders. She frequently speaks to support groups and at community workshops. She has established a quarterly meeting of therapists across the US and Canada for information sharing on the treatment of patients with neurological disorders. She is considered a world expert on OT for Parkinson’s disease.

1) To improve or maintain your quality of life when mood changes from Parkinson’s interfere.

Parkinson’s doesn’t just cause movement problems but can also cause mood changes. According to the National Parkinson’s Foundation, 40 percent of PwP experience apathy. Apathy is a disorder that effects the motivation to participate in daily activities. Occupational therapists are experts in finding ways to keep you occupied in life. Most of us are aware of the benefits of exercise, but in addition to exercise it is important to stay engaged in all aspects of life The simple things in life like visiting with family, having coffee with friends, doing a video call with grandchildren, playing cards, playing golf, preparing a meal or participating in a book club are important to our mental health. Our desire to participate in activities can be impacted. Your occupational therapist can help you identify what is interfering with your participation in activities and make suggestions on improving. Scheduling activities for specific days and times will help take the decision making out of participating. Your walk outside or card game with family should be treated as an appointment with equal importance as a medical appointment. The more active you are, the better you can manage your Parkinson’s symptoms.

Activity and social engagement has become more challenging with the social distancing necessary for staying safe during the current pandemic. Taking walks outdoors, talking with friends and family on the phone, preparing a meal, playing board games, card games, or computer games are a couple of ways to maintain activity. Remember, this must be balanced with a healthy dose of exercise. Your Parkinson’s OT will prepare a plan for activity participation.

2) To learn strategies that combine activities and Parkinson’s medication timing for success

Establishing a routine that aligns your Parkinson’s medication timing with activities can significantly improve your success with the things you do daily. The medication prescribed for your Parkinson’s symptoms can improve your ability to move and function. These medications can reduce muscle stiffness, decrease muscle cramping, decrease tremor and improve overall ease of movement. Taking your medication before certain tasks like exercising, bathing, dressing, etc… may help you complete these with less effort. However, if you are getting too much movement after taking your Parkinson’s medication (dyskinesia) then certain tasks that require refined movement, like shaving, may be better performed before the medication is fully “on”. Your occupational therapist will help you establish a routine of daily activities that works in conjunction with your Parkinson’s medication schedule that was prescribed by your neurologist.

Key points:

• Take your medication on time. Make every effort possible to take your Parkinson’s medication on the schedule your neurologist prescribed. This is how the medication works best to help you function at your best. Phone alarms can be helpful in reminding us when it is medication time.

• Some activities, like most exercise, will be easier when your Parkinson’s medication is working (on). PD medication often decreases muscle stiffness (rigidity). It takes more effort to move a stiff muscle. Let your medication help to reduce the rigidity, thus requiring less effort to get through your day.

• If you get extra movements (dyskinesia) after taking your Parkinson’s medication, activities like which require refined carefully planned movements, may be performed more safely a few minutes after you take your medication but before it is fully “on. Examples of these activities include shaving and cooking.

Your Parkinson’s trained OT will help you lay out a daily plan connecting your medication regime with your activity and exercise routine.

3) To learn techniques for improving sleep

The American Sleep Association reports 50-70 million people in the U.S. report sleep difficulty. People with Parkinson’s are no exception and may experience sleep difficulty in greater numbers that those without Parkinson’s. Sleep related issues are reported in 75% of people with Parkinson’s. When we don’t sleep well, we don’t function well. Parkinson’s symptoms are worsened by emotional and physical stressors. Fatigue is a physical stressor that can cause difficulty with movement and cognition. Balance, tremor, and thinking difficulties are likely to be exacerbated from poor sleep. Poor sleep causes daytime fatigue. Occupational therapists use a non-medication approach to improve sleep for people with Parkinson’s. Your therapists will analyze your day and night time habits and make recommendations to improve your ability to get restorative sleep at night. Your therapist will also make recommendations for daytime rest, when needed. When you rest, how you rest and how long you rest will be a part of your treatment plan.

Some of the recommendations made by your Parkinson’s OT , to improve your sleep, may include:

• Avoid caffeine late in the day

• Maintaining a consistent bedtime routine

• Stop using electronic devices, phones, tablets, computers or tv’s, 30-60 minutes prior to bedtime

• Do not watch tv in bed.

• Sleep in a cool dark room

• Utilize the bed for sleep and sexual activity only

• Exercise early in the day

• A healthy balance of exercise, activity and sleep

• A bed rail, firm mattress and a satin fitted sheet can help with mobility at night to decrease the time and effort needed for bed mobility

4) To decrease fatigue, conserve your energy, and increase your stamina

When you have Parkinson’s, it takes more effort to get through your day. This increased effort leads to fatigue. Other symptoms like poor sleep, fluctuations in symptoms, mood changes, rigidity, dystonia and decreased activity all lead to increased fatigue. Resting or sitting all day does not give us more energy it has the adverse effect of making us more tired. To have good stamina, we need a healthy combination of sleep, exercise, nutrition and activity. Some of the tasks you do daily can be completed with less effort and therefore saving energy for exercise and enjoyable activities . An example of this is sitting during a shower.

This decreases the amount of energy expended during the shower, thus conserving energy for other activities.

Additional examples of daily tasks that can be completed differently to save energy include:

• Using a light weight towel for drying after a shower, will allow you to dry with less effort and greater ease. • Sitting to get dressed takes less effort and is safer by minimizing the risk of falling. Standing to dress requires your brain to attend to your balance, weight shift, and coordinating the task of dressing while sequencing the process and orienting the clothes into the correct position. Sitting to dress will reduce the attention needed for balance and the weight shift. This will increase the ease of dressing. You can practice on your balance AFTER you get dressed.

• Adaptive devices like a button hook, reacher, sock aid, elastic shoe laces, and a long shoe horn can improve your success with getting dressed while minimizing the amount of effort required.

Occupational therapists are experts in energy conservation techniques and the use of adaptive devices. Your Parkinson’s OT can help you with strategies to decrease the effort needed to get through your day. This will increase the amount of energy you have later in the day. The addition of an aerobic exercise like walking, running, biking, swimming, dancing, will help to improve your endurance. The use of simple adaptive device can improve your success, independence, safety and reduce the effort needed to complete the task.

5) To improve your ability to eat, dress, bathe, use the computer/phone, read, write, participate in hobbies, work, garden, socialize and to drive

Stiffness, tremor, slowness, balance changes, fatigue, apathy, multi-tasking difficulty and visual changes can be a few of the possible symptoms of Parkinson’s. Each of these negatively impact our ability to complete our daily activities. These activities include everything from getting food to our mouths to the more challenging task of driving a vehicle. Any of these tasks can be impaired by tremor, stiffness, balance, dyskinesia, dystonia, freezing, visual changes, cognitive changes, fatigue and apathy. Identifying which of your symptoms is limiting your success is the role of the OT. Your OT will evaluate your Parkinson’s motor and non-motor symptoms and provide treatment, compensatory strategies, or adaptive devices recommendations to increase your independence and safety with the things you want to do.

Visual changes associated with Parkinson’s and those associated with aging can make daily tasks more challenging. Your Parkinson’s OT can assess a few of the changes that may be impacting your vision like difficulty with color contrast, blurred vision, and eye fatigue. When a PwP is having difficulty with color contrast, the foreground and background are difficult to differentiate, if the colors are the same. This works closely with depth perception. When stairs and the floor at the bottom of the stairs are the same color, people with Parkinson’s experiencing difficulty with color contrast or depth perception may miss the last step leading to a potential fall. Your Parkinson’s trained OT can test your vision for these deficits and provide education and recommendations to improve safety.

There are OT’s which specialize in driving evaluations and treatment. To find a Certified Driving Rehabilitation Specialist near you, go to The Association for Driver Rehabilitation Specialist website: https://www.aded.net/page/725/Member-Directory.htm

Participating in daily activities is beneficial for our brains and provides a purpose. Your OT will facilitate your ability to stay mentally and physically engaged in life. It is never too early to see your occupational therapist who specializes in Parkinson’s care. Being educated about your diagnosis and the medical and therapeutic treatments available will help you make informed decisions.

This blog is brought to you by Michael S. Okun and Indu Subramanian.

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD #ParkinsonPACT #Parkinsonsecrets and https://www.tourettetreatment.com/

He also serves as the Medical Director for the Parkinson’s Foundation.

To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance

5 Reasons to Seek Out an Occupational Therapist For Your Parkinson's Disease

Who is Lisa Warren?

1) To improve or maintain your quality of life when mood changes from Parkinson’s interfere.

2) To learn strategies that combine activities and Parkinson’s medication timing for success

3) To learn techniques for improving sleep

4) To decrease fatigue, conserve your energy, and increase your stamina

5) To improve your ability to eat, dress, bathe, use the computer/phone, read, write, participate in hobbies, work, garden, socialize and to drive

To read more on Indu Subramanian M.D. she does live interviews of experts in Parkinson’s for the PMD Alliance. She is one of the few doctors in the world trained in both Parkinson’s disease neurology and in integrative medicine.

To see more on our blog by artist Jonny Acheson MD check out his website at JonnyAchesonArt.com. Jonny is a physician in the U.K. who also has Parkinson’s disease.

Dr. Michael S. Okun

Hot Topics in Parkinson’s Disease

5 Reasons to Seek Out an Occupational Therapist For Your Parkinson's Disease

Who is Lisa Warren?

1) To improve or maintain your quality of life when mood changes from Parkinson’s interfere.

2) To learn strategies that combine activities and Parkinson’s medication timing for success

3) To learn techniques for improving sleep

4) To decrease fatigue, conserve your energy, and increase your stamina

5) To improve your ability to eat, dress, bathe, use the computer/phone, read, write, participate in hobbies, work, garden, socialize and to drive

To read more on Indu Subramanian M.D. she does live interviews of experts in Parkinson’s for the PMD Alliance﻿. She is one of the few doctors in the world trained in both Parkinson’s disease neurology and in integrative medicine.

To see more on our blog by artist Jonny Acheson MD check out his website at JonnyAchesonArt.com. Jonny is a physician in the U.K. who also has Parkinson’s disease.

Dr. Michael S. Okun

To read more on Indu Subramanian M.D. she does live interviews of experts in Parkinson’s for the PMD Alliance. She is one of the few doctors in the world trained in both Parkinson’s disease neurology and in integrative medicine.