Week 1 Day 5 Entry 3

I spent this afternoon with the Parkinson's OT on home visits. There was no particular incident or issue during these visits but I thought I would share my experience and what I learnt. I found the experience really useful as it gave me first hand knowledge about what an OT does and how we can work together to provide the best possible care for a patient.

The visit was to an 83yo man who lived with his wife in a retirement unit. He was diagnosed with Parkinson's disease and suffered from dyskinesia (abnormal overactivity of muscles due to dopaminergic effect of meds), tremor, dysarthria, festinating gait, cognitive impairment, and a long/frequent history of falls. The reason for the home visit was to assess the patient's function following the installation of a new front step, hand rail, and opening door mechanism. These modifications were made in order to facilitate the patient's ability to leave the house independently and decrease the falls risk associated with the environment (as this had been a site of several falls in the past). The setup was designed so that the patient could prop the door wide open with the lever, walk through the door with his 4ww onto the porch step, push the walker off the step whilst holding the bar (positioned on the opposite side to the door), turn to face the bar and then side step down the stair to where his walker was positioned. This process was taught to the patient, with many repetitions and practice to consolidate the knowledge due to his memory deficits. The wife was also told what instructions should be used to prompt her husband to act in a safe and practical manner.

The patient did express his apprehension regarding the step, and commented on the fact that he was keen for a ramp (like his neighbour). With Parkinson's disease there is often a high risk of falls associated with any slope, in particular ramps as this can cause the COG to be displaced and the person to fall either forwards or backwards. The ramp was also inappropriate due to space constraints. According to the Australian Guidelines for builders and designers of ramps, the must be a 1:20 ratio. This means that every 1 cm displacement in height gained occurs across a 20cm horizontal distance (therefore a 10cm step would be the equivalent of a 2m long ramp). Therefore, a large part of the home visit was spent educating the man and his wife about the inappropriateness of a ramp and the need to conduct his actions without rushing and in a safe, controlled manner. This was necessary as we both observed the man's impulsive behaviour and his frustration when tasks could not be performed with ease.

I felt that the treatment session could have included more strategies for the man's festination habit (which was causing many of his falls). Although it is usually the physio that instructs the patient with these strategies and the OT does not usually include this in her treatment, I was able to provide the patient and his wife with a few ideas to trial before a more formal assessment at the day hospital/outpatient clinic.

Both the patient and his wife were very friendly and welcoming into their home which made it a very pleasant and comfortable treatment environment. I felt confident speaking and educating the patient on strategies for his Parkinsonism as I could easily recognise his symptoms, how they were contributing to his falls, and the interventions necessary to help prevent further falls.

Next time I might ask if I could have practiced the strategies with the patient a number of times and ensured that the patient could demonstrate how and when the strategies should be employed, instead of purely having an education role in his treatment session.

Overall it was another very informative day with lots to learn and absorb. I look forward to next week where I will have more involvement in the treatment and assessment of patients.