July 2009

Sharon Gaskin, an Occupational Therapist from Inova Fair Oaks Hospital,
came to speak to us today. She sees people on an outpatient basis and noted that they don’t see a lot of people living with Parkinson’s. Therapy is a team process which is why therapists ask a lot of questions so they can help people work towards their goals. The goals are specific and functional, for example, getting into the bathtub independently and safely with adaptive equipment.

Sharon said if you’re having trouble with something, then that’s the thing you need to practice. I couldn’t have said it better myself!

To turn over in bed, bend your knees and they will act as a weight when you drop them to the same side as the edge of the bed. You can use a bed rail or pole as something to reach for. A ladder pull up can help you sit up.

Sharon showed us a wide range of adaptive equipment. The following information comes from her handouts with some additional comments from me:

• Dycem (www.dycem-ns.com) – a non-slip mat that can be used to keep plates from sliding on the table. Also good to prevent paper from slipping when you’re writing.
•  Weighted utensils: also pens, shavers, etc. The weight can reduce tremors.
•  Scoop plates / plate guards – help keep food on the plate
• Rocker knives – one-handed way to cut food.

•  Foam to enlarge pens – also works on utensils. Makes the handles bigger and easier to hold.
•  Weighted pens – when writing relax your grip to make the letters larger. Another suggestion is to place wide lined paper underneath the paper you’re writing on.
•  Enlarged keyboards and telephone pads 

•  Elastic shoelaces
•  Velcro shoe closures
•  Velcro closures for clothing
•  Button aides / zipper pull
•   Sock aid – useful if you have trouble bending. 

Meal Preparation:
•  Cutting board – no slip cutting board with corner guards and prongs to keep food from moving around
•  Reach stick – to pick up things from the floor.

•  Long-handled sponge

You can find these products at the following websites:

Fall Prevention / mobility

Movement Recommendations
•  Use good sit to stand technique
•  Sit in chair with hips, knees 90º, scoot forward, sit in chairs with arms when possible, lean forward pull feet back slightly, feet 8-10 inches apart. Stop before moving.
•  Practice slowing down and stopping
•  Practice transitional movements – changing directions
•  Lie prone (on your stomach) 10-20 minutes per day to straighten spine
•  Synchronize activities to medications
•  Reduce distractions, avoid rushing, do one activity at a time.

Environmental modifications *
•  Avoid narrow spaces, clutter, crowds
•  Equipment – Superpol, Smartrail, U-step walker

•  Add rails along full length of stairs extending beyond the bottom step 12 inches
•  Mark the edges of the step
•  Replace worn runners
•  Insure stairs are well lit

•  Increase intensity 2-3 times especially in baths and stairways
•  Add nightlights and bedside lamps with secure bases
•  Add easy to find switches (accessible, contrasting colors, pressure sensitive)
•  Add automatic turn on timers (avoids having to turn)
•  Use 3 way bulbs

•  Avoid thick or padded carpet
•  Use double faced tape at carpet edges
•  Remove loose throw rugs (typically found in bathrooms and kitchens)
•  Use reachers when feasible to pick up items from the floor

•  Avoid unsteady tables
•  Avoid low-lying, glass and mirror top tables

•  Use grab bars securely fastened into studs of wall (not towel bars which are generally glued to the wall)
•  Use raised toilet seat with bars
•  Use nonslip strips in tub or shower
•  Use tub seat or tub bench and hand held shower in bathtub or as appropriate
•  Install soap dispenser

•   Place at easiest transfer height. Should be the same as for a chair so that hips and knees are both at 90° angles. Risers are available for beds and chairs

•   Tailor to the height of the person
•  Feet should rest firmly on the floor; feet at 90°; seat depth 15-18 inches
•   Armrests should be 7 inches above the seat

Shelves (including kitchen cabinets, refrigerator, and bathroom shelves)
• Move frequently used items to middle shelves

*Adapted from Tideiksaar, R. (2001) Falls. In Bonder, B.R. & Wagner, M.B. (Eds) Functional Performance in older Adults (pp. 265-287). Philadelphia, PA: F.A. Davis

Sharon Gaskin can be reached at 703-391-3642 

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