By Emily Snyder, PT, DPT
Physical Therapist, Central Pennsylvania
and Jenna Grow, MS, OTR/L, BCG
Occupational Therapist, Central Pennsylvania

Parkinson’s Disease (PD) is a neurodegenerative disorder affecting the lives of more than ten million people worldwide. It is considered to be the second most common neurodegenerative disease impacting older adults. PD affects normal movement patterns for participation in activities of daily living due to symptoms such as tremors, rigidity, bradykinesia, and freezing of gait. 

These symptoms can result in a significant decline in quality of life due to loss of independence and increased risk of falls and hospitalizations. People with Parkinson’s benefit from a multidisciplinary approach including both physical and occupational therapy programs. While the two disciplines each play their own unique role, a collaborative approach between PT and OT is essential to produce the best functional outcomes for those living with PD. 

How Patients with Parkinson’s Benefit from a Multidisciplinary Therapy Approach

An emphasis on a multidisciplinary approach to treating your patient’s limitations can aid in the identification and implementation of strategies that facilitate them to be successful, safer, and as independent as possible. The primary goal of PT is to enhance movement quality to allow for independence with functional mobility. Meanwhile, OT goals often include improving engagement in meaningful activities and optimizing safety and independence with ADLs. 

Collaboration between PT and OT can also help ensure your patient receives optimal treatment. While each discipline has a different approach, they complement each other and can add significant value to the plan of care when treating a person with Parkinson’s disease. 

As always, the goal of rehabilitation is for your patient to restore lost function and achieve the highest level of independence possible. In the case of rehabilitation for PD, it is important to consider compensation versus remediation. This does not mean one approach should be chosen over the other. Your patient should be given the opportunity for both approaches so that the highest level of function is obtainable. 

Compensatory Strategies for Patients with Parkinson’s Disease

In the case of PD, persistent symptoms may shift therapy treatment to the use of adaptive techniques to optimize function, and thus, compensatory strategies become a focal point of PT/OT treatment. 

One of the most beneficial compensatory strategies for people with Parkinson’s is the use of external cueing to improve gait. Research has shown cueing to be effective in improving amplitude, initiation, and timing of movement as well as decreasing gait asymmetries. 

Examples of external cueing include auditory and visual. Visual cueing to improve stride length can be achieved by placing bright-colored targets on the floor to facilitate increased step length. Some patients may benefit from bright colored tape on the floor in certain hallways or doorways in the home where freezing of gait is especially an issue. Visual cues may also be helpful in improving handwriting for patients with PD. Auditory cues such as the use of a metronome or playing music have proven to increase step cadence. It is also worth noting that internal cueing via singing has supportive research in improving cadence. 

Collaborate on the Home Safety Assessment

When initiating treatment with a patient who has PD, a home safety assessment is imperative and should be completed early in the plan of care. The home assessment should be a collaborative process between PT, OT, patient, and the family. It’s important to determine what your patient’s abilities are and identify barriers that ultimately impact their health, well-being, and ability to participate in meaningful occupations. 

Clinicians should consider the following and discuss them with patients and their families or caregivers.

1. Rearrange Furniture

Creating additional space or strategically placing furniture that can offer external support should be considered when completing a home assessment. The space needs to have adequate room to allow your patient to safely utilize assistive devices if necessary. 

2. Remove Clutter

An easy recommendation, however, is one that we know is not always easy to follow. Our PD patients are already at a higher risk for falls, and with the addition of clutter and throw rugs, this risk increases substantially. 

3. Add Grab Bars

Placing grab bars next to the commode, on the wall next to the shower, and inside the shower can significantly help with safe transfers and ease the burden of a caregiver to allow your patient to assist as much as possible. 

4. Place Non-Slip Strips in the Bathroom

When assessing the bathroom, consider adding non-slip strips in front of the commode and in the shower. This will give your patient more traction when going from a sit-to-stand position. These strips are inexpensive and can be purchased at Walmart. 

5. Widen Doorways

It may be necessary to recommend widening a doorway — particularly for patients who have a goal of aging in place and need to be able to utilize their assistive device throughout the home. Determining first which assistive device is most appropriate, and then collaborating with the family to determine how much wider a doorway should be to allow easier access. 

6. Elevate Seating

Assessing the height of the commode, shower bench, and all other seating your patient sits on in the home is imperative in order to help them be successful with sit-to-stand transitions. Consider using an elevated toilet seat, adjustable height shower bench, and gel cushions to improve ease and independence. 

7. Introduce a Bed Cane

Adding a bed cane to the bed can help your patient significantly with getting in and out of bed. If a bed cane is warranted, be sure to provide your patient and CG training on how to utilize it appropriately. 

8. Consider a Ramp or Wheelchair Lift

Depending on the home setup, a ramp or wheelchair may be necessary to allow your patient to safely enter/exit the home. 

9. Ensure Adequate Lighting

Adequate lighting should always be considered when completing a home assessment as this can help decrease glare, shadows, and reflections. There are a lot of options available, for example, motion-activated light sensors, night lights, and making lighting controls accessible and easy to use. If your patient has a smartphone, there are apps available to control lighting (and even the thermostat). 

OT and PT Collaboration Starts Early

When referred to see a PD patient, remember that collaboration between the PT and OT starts on day one. Working together in identifying the patient’s limitations (both personal and environmental), will help to establish the most appropriate and beneficial plans of care for both disciplines. 

A strong collaboration involves discussing the patient’s level of motivation, level of social support, and discharge plan, as well as their short and long-term goals. Remember the importance of a home assessment; collaborate to determine the most appropriate adaptations and home modifications to help to promote quality of life and maximize your patient’s independence. 

When determining the most appropriate assistive device, a strong collaboration ensures that not only is safety a primary focus, but your patient’s goals/roles/routines are being considered. As the plan of care progresses, each discipline should be developing an appropriate home exercise program while also educating your patient and any social supports available, regarding mobility strategies (PT) and ADL strategies (OT) to promote self-management and ensure a smooth transition at discharge.