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Occupational Therapy for People with Parkinson's

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Occupational Therapy for People with Parkinson's Occupational Therapy for People with Parkinson’s Best practice guidelines These practice guidelines draw upon the widest relevant knowledge and evidence available to describe and inform contemporary best practice Occupational therapy occupational therapy for people with Parkinson’s. They have been written as a pragmatic ‘pick-up-and-use’ guide, which includes practical examples of for people interventions to allow occupational therapists from a diverse variety of health and social care settings to readily apply new and existing treatments in their day-to-day practice. with Parkinson’s These occupational therapy best practice guidelines aim to: Best practice guidelines • Place the person with Parkinson’s and their family at the centre of all occupational therapy interventions. Ana Aragon and Jill Kings • Support occupational therapists in the holistic assessment and treatment of people with Parkinson’s. • Introduce novel and disease-specifi c occupational therapy interventions. • Provide a comprehensive overview of the nature and detail of currently agreed best practice occupational therapy intervention in the UK. Ana Aragon Dip COT Ana Aragon worked in a specialist service for people with Parkinson’s and related movement disorders from 1996 to 2007 and was a member of the occupational therapy working group for the 2006 NICE Parkinson’s disease National Clinical Guidelines. Ana now works independently, and is an Associate Lecturer for Leeds Metropolitan University as their specialist course tutor for an MSc in Parkinson’s Disease Practice. Ana also participates in occupational therapy for Parkinson’s research projects, as well as in training events and conferences around the UK. Jill Kings MSc Dip COT Jill Kings (nee Dawson) has spent 20 years working with people with complex neurological conditions. The effi cacy of treatment for people with long term conditions became a particular interest during the 7 years she spent at the National Hospital for Neurology and Neurosurgery, London. AvailableJill now works in independent practice undertaking consultancy, training and service development for Downloadprojects within neurological occupational therapy and rehabilitation. Available for Download Available for Download Available for Download In partnership with In partnership with Specialist Section Specialist Section www.cot.org.uk Tel: 020Download 7357 6480 forFax: 020 7450 2299 Neurological Neurological © 2010 CollegeBAOT of Occupational members Therapists Ltd. Practice Practice A registered charity in England and Wales (No. 275119) and in Scotland (No. SCO39573) and a company registered in England (No. 1347374) Download for BAOT members Download for BAOT members About the publisher The College of Occupational Therapists is a wholly owned subsidiary of the British Association of Occupational Therapists (BAOT) and operates as a registered charity. It represents the profession nationally and internationally, and contributes widely to policy consultations throughout the UK. The College sets the professional and educational standards for occupational therapy, providing leadership, guidance and information relating to research and development, education, practice and lifelong learning. In addition, 11 accredited specialist sections support expert clinical practice. www.cot.org.uk 1/10 Occupational Therapy for People with Parkinson’s Best practice guidelines Ana Aragon and Jill Kings in partnership with Specialist Section Neurological Practice PARKINSON'S ALL TEXT.indd i 27/4/10 11:44:33 First published in 2010 by the College of Occupational Therapists 106–114 Borough High Street London SE1 1LB www.cot.org.uk Copyright © Parkinson’s UK and College of Occupational Therapists 2010 Authors: Ana Aragon and Jill Kings on behalf of the College of Occupational Therapists Specialist Section – Neurological Practice Category: Practice Guidelines Date for review: 2015 All rights reserved, including translation. No part of this publication may be reproduced, stored in a retrieval system or transmitted, by any form or any means, electronic, mechanical, photocopying, recording, scanning or otherwise without the prior permission in writing of the College of Occupational Therapists, unless otherwise agreed or indicated. Copying is not permitted except for personal and internal use, to the extent permitted by national copyright law, or under the terms of a licence issued by the relevant national reproduction rights organisation (such as the Copyright Licensing Agency in the UK). Requests for permission for other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale, should be addressed to the Publications Offi cer at the above address. Other enquiries about this document should be addressed to the Practice department at the above address. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. While every effort is made to ensure accuracy, the College of Occupational Therapists shall not be liable for any loss or damage directly or indirectly resulting from the use of this publication. ISBN 978-1-905944-16-3 Typeset by Servis Filmsetting Ltd, Stockport, Cheshire Digitally printed on demand in Great Britain by The Lavenham Press, Suffolk PARKINSON'S ALL TEXT.indd ii 27/4/10 11:44:33 Contents Foreword iv Part 1 Guideline development and background 1 The process of developing the guidelines 3 iii)0 Introduction 3 iii)0 The aim of the guidelines and target audience 4 iii)0 Ratifi cation process 5 Background 7 iii)0 An overview of Parkinson’s 7 iii)0 Medical and surgical interventions 12 iii)0 Measuring disability and progression of the condition 14 iv)0 The impact of Parkinson’s on occupational performance 16 Part 2 The guidelines 19 1 Specifi c strategies for initiating and maintaining movement 21 1.10 Intrinsic cueing techniques 23 1.20 Extrinsic cueing techniques 24 1.30 Factors impacting on engagement, motivation, learning and carryover 27 2 Optimising activities 32 2.10 Mobility 33 2.20 Falls prevention 34 2.30 Transfers 35 2.40 Bed mobility 37 2.50 Posture and seating 39 2.60 Eating and drinking 40 2.70 Self- care routines 42 2.80 Domestic skills 43 2.90 Fatigue management 44 2.10 Handwriting 45 3 Supporting participation 47 3.1 Self- effi cacy 47 3.2 Roles and relationships 48 3.3 Work 49 3.4 Social, recreational and leisure activities 50 3.5 Driving 52 3.6 Community living skills and outdoor mobility 52 4 End-of-life care 54 4.1 A 24- hour approach to posture, positioning and pressure care 54 4.2 Manual handling and minimising risk 55 4.3 Alternative living arrangements 56 Glossary 58 Appendixes 60 References 71 College of Occupational Therapists iii PARKINSON'S ALL TEXT.indd iii 27/4/10 11:44:34 Foreword It has long been recognised that people with Parkinson’s want access to therapies. They recognise the benefi ts that occupational therapy, physiotherapy, and speech and language therapy can bring to their functional status and quality of life, and appreciate the way in which interventions are tailored to their specifi c activity and participation needs. This individual approach, while valued by people with Parkinson’s, has also presented obstacles to widespread recognition of the benefi ts of occupational therapy. Each individual with Parkinson’s is unique; the combination of a range of physical, mental and emotional symptoms impacting on a specifi c physical, social and vocational environment means that a ‘one size fi ts all’ intervention with a single outcome measure is of limited, if any, value. Not surprisingly there has been little consensus, few randomised controlled trials, and therefore little evidence to synthesise. As stated in the Cochrane reviews, ‘there is inadequate evidence to evaluate the effect of occupational therapy for people with Parkinson’s disease’ but lack of evidence does not mean lack of effi cacy. All this is now changing. First, there is an increasing recognition that other types of evidence should be considered as well as the gold standard randomised controlled trial. Second, there is a growing consensus about the role of an occupational therapist in treating people with Parkinson’s. And third, there is a large, multicentre randomised controlled trial starting, PD REHAB, funded by the Health Technology Assessment programme, which will examine the impact of occupational therapy and physiotherapy in people with Parkinson’s. Thus this best-practice guideline is timely. It synthesises the available evidence, drawing on information from a range of sources, including an understanding of the pathophysiology of Parkinson’s, theories of motor control, clinical trials, expert opinion and consensus, as well as experience gained in the treatment of other progressive long- term conditions. With this excellent document occupational therapists will have a resource that identifi es the considerable evidence base for their treatments and intervention strategies; clinicians, as well as people with Parkinson’s, will be able to argue effectively for the role of occupational therapy in the management of Parkinson’s; and interventions will be easier to defi ne and evaluate. The authors are to be congratulated for producing such a practical, relevant and accessible document. Dr E. Diane Playford Senior Lecturer, Institute of Neurology Consultant Neurologist, National Hospital for Neurology and Neurosurgery Queen Square, London, UK Occupational Therapy for People with Parkinson’s iv PARKINSON'S ALL TEXT.indd iv 27/4/10 11:44:34 PART 1 Guideline development and background PARKINSON'S ALL TEXT.indd 1 27/4/10 11:44:34 PARKINSON'S ALL TEXT.indd 2 27/4/10 11:44:34 The process of developing the guidelines i) Introduction The National Service Framework for long- term conditions (Department of Health 2005) and the National Institute for Health and Clinical Excellence (NICE) clinical guidance Parkinson’s disease: diagnosis and management in primary and secondary care (NICE 2006) provide clear expectations and set out explicit clinical standards to improve service provision for people with progressive neurological conditions such as Parkinson’s.
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