Battling the degenerative nature of Parkinson’s disease in patients is a difficult task for occupational therapists. But recent studies suggest that new therapies used by OTs can slow or even reverse some of the debilitating symptoms of the degenerative disease.

“There is no cure, and nobody knows the etiology of Parkinson’s disease,” says Ben Herz, OTD, MBA, OTR/L, an assistant professor in occupational therapy at the Medical College of Georgia in Augusta. “But we’re trying to keep the person as independent as possible.”

A Movement Disorder
First described in 1817 by James Parkinson, an English doctor, Parkinson’s disease is a movement disorder of the central nervous system that results from the loss of cells in certain parts of the brain. The disease affects production of dopamine, a chemical messenger responsible for transmitting signals in the brain that control coordination of movement. Without dopamine, brain neurons fire abnormally, leaving patients less able to direct or control their movements.

Sixty thousand new cases of Parkinson’s disease are diagnosed each year in the U.S., adding to the 1.5 million Americans who have the disease, according to the National Parkinson’s Foundation. Although the condition usually develops after age 60, about 15% of those diagnosed are younger than 50.

Medications, Surgery Offer Some Help
A combination of dopamine replacement and nonpharmacologic therapies is still the most effective treatment for helping patients with Parkinson’s disease control symptoms such as muscular rigidity, bradykinesia, and tremors, says Marilyn Trail, MOT, OTR, co-associate director of education for the Parkinson’s Disease Research, Education, and Clinical Center at the Debakey Veterans Administration Medical Center in Houston and an assistant professor of neurology at Baylor College of Medicine.

“It’s helpful in the beginning, but as the disease progresses it becomes less effective,” says Trail, who recently published a book for OTs and other healthcare professionals on an evidence-based treatment model for Parkinson’s disease.

Another common treatment for patients with Parkinson’s is surgery that involves deep brain stimulation, she says, followed by physical therapy, occupational therapy, and speech therapy.

“Overall, the state-of-the-art OT therapy for Parkinson’s disease is a one-time visit that focuses on the use of adaptive equipment and safety in the house,” says Elizabeth Moyer, MS, OTR/L, FAOTA, assistant clinical professor in the department of occupational therapy at the University of New England in Biddeford, Maine.

Most insurers limit visits for people with chronic diseases such as Parkinson’s, but if you can show improvements, you can justify more visits, Moyer adds.

In an OT session, patients with Parkinson’s disease can learn to manage the activities of daily living by increasing safety, independence, and motor coordination of the upper extremities. OTs can make recommendations for use of orthotics and assistive devices, as well as home and workplace modifications for ease of movement and safety, according to Trail. “The best unifying theory for treatment is motor control and motor learning - the task-oriented approach,” she says.

Some modifications for dressing include a long-handled shoehorn, zippers or Velcro closings, and elastic shoelaces. Grab bars and tub railings can be used in the bathroom, along with a shower chair and raised toilet seat. Newer devices include canes with a laser light to help guide patients while walking and reachers for extending arms to pick up items.

Studies have shown that patients with Parkinson’s disease do better with small- to medium-sized spoons when eating than with large spoons, but that weighted cups and spoons have proven to be ineffective, Trail says. According to clinical studies, relaxation therapies are not proven effective for Parkinson’s patients, but visual and auditory cues are proving to help patients with bradykinesia, or a slowing of voluntary movement, she adds.

Studies Have Good Outcomes
Clinical researchers are providing promising studies to show what occupational therapists can do to improve the outlook for patients with Parkinson’s. One study, led by Moyer, used challenging cognitive and perceptual tasks. The study showed that exercising the body and performing handwriting tasks to music with a strong beat can stabilize and even reverse the symptoms of Parkinson’s disease. “Our preliminary results show OTs can make a definite difference in visual perception and cognitive speeds,” she says. “We have had good, positive improvements in about every area we tested, whether the patients were low functioning or just diagnosed.”

In the music study, which is in its third phase, Moyer tracked more than 70 different measurements, including small handwriting, set shifting, balance, straightening the back, and controlled walking. Patients would perform simple tasks, games, exercises, and activities of daily living to music set to a beat for one-hour sessions.

Moyer found keeping the beat to a setting of 110 to 115 beats per minute was optimal for patients and that once the patients finished the sessions, that beat stayed assimilated in their brains even in post-testing a year later. Another study, in which patients with Parkinson’s played sports games using the Nintendo Wii video game system, also showed positive results, says Herz, a principal investigator of the study.

“Using the Wii, patients have increased endurance, fine motor coordination, and balance,” Herz says. “Exercise, even with video games, increases the dopamine levels.”

Now in its second phase, the pilot study results will be published in Movement Disorders. •

Teresa McUsic is a medical writer for the Gannett Healthcare Group.

Resources
• National VA Parkinson’s Disease Consortium: http://www.parkinsons.va.gov/Consortium/index.asp
• Trail M, Protas E, Lai E, eds. Neurorehabilitation in Parkinson’s Disease: An Evidence-Based Treatment Model. Thorofare, NJ: Slack Inc.; 2008.