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HOME SAFETY CONSIDERATIONS FOR INDIVIDUALS WITH PARKINSON’S DISEASE: AN OCCUPATIONAL THERAPY PERSPECTIVE

• Dr. Kathleen Stoklosa

Nazareth College Occupational Therapy

OT Goals

Maintain independence, interests, and roles

• Safety issues
• Hand Function
• Mobility, especially in bathroom and kitchen
• Feeding
• Evaluate and address care partner needs
• Educate

OT Intervention

Focus on Activities & Participation

• Environmental Modifications
• Compensatory strategies: plan and structure day;

time pressure management

• Balance goals of client with caregiver

time/burden!

PwPD report their top 5 of relevant problems:

Case 1:

• 1. Exercise
• 2. Sexuality
• 3. Daily functioning
• 4. Social environment
• 5. Nutrition

Case 2:

• 1. Future expectations
• 2. Medication
• 3. Support caregiver
• 4. Daily routines and

structure

Types of Limitations

• Slowness
• Increased effort (energy)
• Reduced self-confidence
• Need for supervision/help
• Unpredictability/ fluctuations
• Safety concerns

Activity limitations as prioritized by PwPD

• 1. Mobility (walking, transfers, transportation)
• 2. Self care (dressing, eating/drinking, grooming)
• 3. Communication (e.g. using telephone, writing, using

computer)

• 3. Leisure activities
• 4. Household activities
• 5. General tasks and demands (e.g. daily routines, dealing

with stress, multitasking)

• 6. Work
• 7. Learning and applying knowledge (e.g. Problem-solving)

Participation

• ‘Lifespace”
• Becomes smaller and less diverse
• More time at home
• Reduced participation with others and in community

Problems impacting PwPD

• Tremor
• Mobility: Rigidity/Stiffness & Smaller/Slower movement
• Postural instability
• Fatigue
• Cognition

These impairments may contribute to safety concerns of: Spills , Falls, Accidents

Mobility deficits & Postural instability

• Reduced arm swing
• Head & trunk leaning forward
• Shorter strides
• Shuffling gait
• Freezing

Falls

Fatigue in PD

• 33%-58% fatigue, often from early on
• Impact on participation (work, social activities)
• More than half of clients with fatigue indicate it is one of 3

most debilitating symptoms

Thinking Difficulties Affecting Functional Performance

Cognitive impairments that mainly impact on occupational performance: Mental slowness/ difficulty switching Judging required time Reduced initiative, taking action

Simple Modifications for Safety at Home

• Living Room
• Kitchen
• Bathroom
• Bedroom

Living Room

• Reduce clutter
• No throw rugs!
• Lighting!
• Chairs with arms
• Non-slip mats
• Mark thresholds in doorways
• Grab bar/handles with rest stops

Kitchen

• Reorganize cupboards
• Reorganize refrigerator
• Adapted cooking equipment
• Weighted utensils, cups
• Non-skid bowls, plates, cups
• Adapted plates

Bathroom

• Non-skid mats
• Bath seat
• Tub bench
• Grab bars, NOT towel bars!
• Toilet frames with or without elevation

Bedroom

• Good lighting
• Silk sheets
• Reusable transfer/mobility sheet
• Bed rails, bed handles, bed pole
• Firm mattress or adapt with wood
• Chair with arms
• Reorganize dresser and closet
• Bedside commode, urinals for men & women

Outdoor Safety

• Patios
• Garage
• Garden and Yard

Individualized Approach is BEST

• No two people with PD are the same!
• Therapists can make recommendations

Occupational Therapy Physical Therapy Speech Therapy ...in Collaboration with your medical team