Neurocog D/o Flashcards
Major Cognitive Disorder
New name for dementia
Psychological behavioral symptoms as well as acquired deficits in ADLs and IADLs
DSM neuro cognitive disorders
Delirium
MCI
Major Neurocognitive Disorder
Mild Cognitive Impairment
Memory/thinking problems, able to take care of self, no personality changes
-lose things, forgetting events/appointments, having trouble coming up with words, movement difficulties, problem with sense of smell
May be early sign of more serious memory problems
See MD every 6-12 mo for monitoring
Signs of Major Neurocognitive Disorder
Forgetfulness maybe normal
Sign if aging, but dementia is not
Sx: memory loss, loss of cognitive function, thinking, remembering, learning, reasoning, behavioral abilities- language skills, visual perception, attention, personality changes
Dementia types
Alzheimer’s Disease, Lewy Body dementia, frontotemporal dementia, vascular dementis
Factors that may cause memory problems
Head trauma/concussion
Blood clots
Tumors
Infections
Thyroid, kidney, or liver problems
Medication side effects
Mental health conditions ie depression
Alcohol/drug use
Sleep problems
Decreased B12
Decreased eating healthy foods
Causes of neuro-cognitive disorders
Brain injury by trauma: ICH, SAH, blood clot, concussion, hypoxia, hypercapnia, dementia due to stroke, Alzheimer’s d/s, creutzfeldt-Jakob Disorder, diffused lewy body disease, Huntington’s disease, MS, Normal pressure hydrocephalus, Parkinson’s disease, Pick’s disease
Metabolic cause: kidney disease, liver disease, thyroid disease, deficits in vitamin B1, B12 folate
Drug/alcohol withdrawal: wernicke-korsakoff
Infections: septicemia, encephalitis, syphilis, prion infection
Creutz-feldt Jakob Disease
Brain damage leading to rapid decline in movement (involuntary muscle movement) loss of mentation (thinking, reasoning, confusion) secondary to prions (eating infected meat), progress unusually fast, folded proteins destroys brain cells
Huntington’s Disease
Genetic defect on chromosome 4, CAG repeat
Sx: hallucinations, irritability, moodiness, restfulness/fidgeting, behavioral disturbances, paranoia, psychosis
Abnormal facial movements/grimacing, head turning to shift eye position, quick jerky movements of arms, legs, face, slow uncontrollable movements, unsteady gait, prancing and wide walk
Dementia
Multiple sclerosis
Autoimmune disease affecting brain and spinal cord, effects women more, inflammation and damage to myelin sheath
Sx: LOB, muscle spasms, numbness, trouble moving UE/LE, trouble walking, bowel/bladder problems, constipation, double vision, trouble urinating, tremors, tingling/burning, fatigue
Parkinson’s disease
Certain brain cells dying, shaking tremors, trouble walking, decreased dopamine, dx after 50, more in men
Sx: rigidity/stiffness, muscle aches/pains, constipation, slow blinking, drooling, no facial expressions, LBP when you stand, stooped posture, sweating, difficulty swallowing, slowed quiet speech, decreased handwriting
Pick’s Disease/frontotemporal dementia
Group of d/o due to damage in frontal and temporal lobes, genetic component, abnormal substances inside nerve cells in damaged areas, may be as young as 20, common 40-60, average 54
Seen in ALS, progressive supranuclear palsy
Behavior variant vs primary progressive aphasia
Not able to keep a job, compulsive, impulsive, inappropriate behavior, inability to function, interact socially, problems with personal hygiene, repetitive behavior, withdrawal, abrupt mood changes, decreased recognization of behavioral changes, decreased empathy, mutism, shrinking vocabulary, weak uncoordinated speech, echolalia, aphasia, increased tone, memory loss, apraxia, urinary incontinence
Extreme behavioral changes and lack of insight
Neuro degenerative disorders
Range of conditions that share primary feature of degeneration and loss if neurons in the brain, incurable/debilitating resulting in death of nerve cells, caused problems with movement (ataxia) and mental functions (dementia)
Most common: PD, Alzheimer’s disease
Less common: MS, atypical Parkinson’s, huntington disease, ALS
6 neurocognitive domains
1) perceptual-motor function: visual perception, visuo constructional reasoning, perceptual motor coordination
2) language: object naming, word finding, fluency, grammar/syntax, receptive language
3) learning/memory: free recall, cued recall, recognition, memory, semantic/autobiographical long term memory implicit learning
4) social cognition: theory of mind, insight, recognition of emotion
5) complex attention: sustained attention, divided attention, selective attention, processing speed
6) executive function: planning, decision-making, working memory, responding to feedback, inhibition, flexibility
Occipital lobe
Visual perceptual and visual
Motor, distance/depth perception, color determination, object/face recognition, memory function
Temporal lobe
Learning/memory, managing emotions, processing information, information from senses, storing/retrieving memories, understanding language
Parietal lobe
Perceptual motor function, language, receiving/processing sensory input of touch, pressure, heat, cold, and pain
Perception of body awareness and spatial coordinate system (mental map)
Frontal lobe
Executive function, social cognition, complex attention, role in voluntary movement, expressive language, managing higher, level executive function
Plan, organize, initiate, self-monitor, control one’s responses to achieve a goal
Functional Cognition
Combines constructs of function/cognition in context of performing everyday activities/occupations
Performance Skills
Observable, goal-directed actions that result in a client’s quality of performing desired occupations, skills supported by context
Assessing Functional cognition
Assess functional cognition, not specific cognitive skills, identifying client’s capacity to perform essential tasks given the totality of their abilities, includes use of strategies, habits, and routines, context/environmental resources
Why assess functional cognition?
Evaluate how a person can participate in/perform ADLs/IADL tasks, identify barriers to function, provide recommendation about appropriate care environments and facilitate a successful dc plan to match functional abilities, provide education about most effective ways to support/communicate with pts, clinicians, family/caregivers
Research support to assess cognitive fxn for all geriatrics pt, early detection necessary for client-centered care, early intervention maximizes function, safety, and independence
Performance based assessments
Executive Functional Performance Test (EFPT)
Performance Assessment of self care skills (PASS)
Weekly Calendar Planning Activity
Multiple Errands Test
Actual reality Assessment
AMPS
COPM
Executive Function Performance Test
Elements of executive function impacting function, individual’s capacity for independent functioning amount of assistance for task completion
Performance Assessment of Self Care Skills
Client-centered, performance based observational tool, assesses ADL/IADLs to provide snapshot of person’s ability to live (I)
Multiple Errands Test
Performance based test, measure how executive performance deficit affect functioning in natural environments, multiple versions, 5 different settings
Actual Reality Assessment
Performance based assessment approach use of internet to perform real everyday life activities
MS
AMPS: Assessment of motor and process skills
observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living
Based on MOHO
Skill based assessments
Examine foundational cognitive skills and allow clinician to extrapolate how deficits in these skills affect overall cognition
MOCA
SLUMs
Mini Mental Status Exam
Trail Making A/B
ACL lacing screen
Motor Free Visual perceptual test
Clock drawing test
Cognistat NCSE
MOCA
Screen for MCI
St. Louis University Mental Status Exam (SLUMs)
Screen for dementia, cognitive deficits
Mini-mental Status Exam MMSE
Brief quantitative cognition screen, show cognitive changes over time
Trail Making A/B
Tests memory/executive functioning, correlate with driving ability component of other skill based assessments
Motor Free-Visual Perceptual Test
Visual perceptual skills in spatial relation, figure ground, visual discrimination, visual closure, visual memory
Clock drawing Test
Screening tool, draw a clock, place #s, assesses visual-spatial, numerical sequencing, and planning abilities
Cognistat NCSE
Neuro behavioral cognitive status exam, neurocognitive assessment in consciousness, orientation, simple attention, language, constructional ability, memory, calculation skills, executive skils
CMS recommended Cognitive screening due to Impact Act
CAMS-confusion assessment method: ID delirium
BIMs-Brief Interview for Mental Status: ID cognitive impairment
Do not identify mild cognitive impairments, failing to identify subset of clients at risk for failed care transitions
Use skip pattern/gateway: use functional cog tool for individuals who pass CAM/BIMs
Dementia/major neurocognitive disorder
Syndrome resulting from a variety of disease processes which there is deterioration in cognitive function beyond expected from normal aging
55 million people, 7th cause of deaty
Risk factors for dementia
Age: strongest risk factor, doubles every 5 yeas after 65
Genetics: family hx
Poor health: increased BP, increased cholesterol, diabetes, smoking
Race/ethnicity: African Americans are 2x more likely to develop dementia, hispanics 1.5x more likely to develop dementia, possibly due to increased heart disease with lower accessibility to preventative medicine
TBI
SDOH and dementia
Education: lower levels of education and lower levels of cognitive reserve
Decreased access to health-prevention dx and tx, risk factors such as heart disease and DM
Loneliness/social isolation increased risk
Socio-economic: lower socio-economic linked to increased dementia and may correlate with other factors
Alzheimer’s Disease
60-80% of those with dementia, nerve cells are damaged by by beta-amyloid plaques and tau protein tangles build up in nerve cells
Alzheimer’s Disease Symptoms
Insidious onset and gradually progressive memory loss
Early on difficult with familiar tasks
Displacing/losing things
Difficulty with new learning
Loss of orientation to place, time, situation
Difficulty communicating leading to withdrawal
Depression
Neuropsych sx: agitation, wandering, delusions, sleep disturbances
Visuospatial/language deficits
Gait disturbances
Vascular Dementia
2nd most common dementia
Caused by vascular disease with smoking, DM, obesity, Afib, atherosclerosis
Risk factors: frequent h/o CVA/TIA
Vascular Dementia Symptoms
Rapid onset when caused by cerebral vascular event, sx related to location
Slow/gradual when secondary to small
Vessel disease
Change in mood/personality
Executive functioning difficulty, loss of cognitive flexibility
Slow processing speed
Gait/balance impairment
Incontinence
Often progresses to more advanced level when there is Another CVE, step-like progression
Sx of depression, anxiety, and apathy
Lewy Body dementia
Caused by abnormal protein deposits in the brain, called alpha-synuclein, 5% of all dementia, cases 2x more in men than women difficult to dx as similar to PD and Alzheimer’s
Lewy Body Dementia symtoms
REM sleep D/O may be early sign
Executive function and attention impacted early on, memory is less affected
Fluctuating alertness/cognition
Parkinson’s type movement d/o, slow shuffling gait, rigid movement patterns
Visual hallucinations, early specific and vivid delusions, paranoia, anxiety, agitation common as disease progresses
Visuospatial deficits
Frequent falls
Highly sensitivity to antipsychotic medication
Creutzfeldt-Jakob Disease Symptoms
Sporadic: develops spontaneously, 85% of cases,60-65 yo
Familial: caused by changes in the chromosome, 20 gene coding, 10-15% of cases, develops 20-40 yo
Acquired: from exposure to an external source of abnormal prion to protein, sources medical procedure involving instruments in neuro sx, growth hormone from transplanted human tissue vs meat or other products from cattle
Depression, agitation, apathy, mood swings, rapidly worsening confusion, disorientation, problems with thinking, memory, planning, and judgment, difficulty walking, muscle stiffness, twitches/involuntary jerky movements, vision problems
Normal Pressure Hydrocephalus
Excess cerebrospinal fluid accumulates in brain ventricles causing thinking and reasoning problems, difficulty walking, loss of bladder control, affects people on 60/70s
Caused by tumor, head injury, hemorrhage, infection/inflammation
Normal Pressure Hydrocephalus symptoms
Difficulty walking-body bent forward, legs held wide apart and feet moving as if stuck
Mild dementia that involved loss of interest in daily activities, forgetfulness, difficulty completing routine tasks, STM loss
Decline in thinking skills that includes overall slow thought processes, apathy, impaired planning, and decision-making, decreased concentration, changes personality and behavior, loss of bladder control
Korsakoff Syndrome
Chronic memory d/o caused by severe deficiency of thiamine (B1) caused by ETOH, decreased thiamine =cells cannot generate enough energy to function properly, can be associated with AIDS, Ca, poor nutrition, bariatric sx
Korsakoff Syndrome symptoms
Problems learning new info
Inability to remember recent events
Long term memory gaps
Confabulate
Mixed dementia
Brain changes of more than 1 cause of dementia occur, most common AD and vascular dementia
Sx depend on types involved
Similar sx to AD
Stages of Dementia: 7 stage model
1) no impairment
2)very mild
3) mild
4) moderate (early stage dementia)
5) moderately severe (early to mid stage dementia)
6) severe (late mid stage dementia)
7) very severe (late stage dementia)
Stages of dementia: 4 stage model
Mild
Moderate
Severe
Terminal
4 stages model of dementia: mild
Forgetfulness of words/names
Misplacing/losing things
Difficulty tracking
Decline in goal oriented behavior outside of self care
Getting confused/disoriented in familiar places
Losing track of time
Poor judgement with planning and decision making
Concrete thinking
Loss of abstract thinking
Impaired attention to tasks/environment
Impaired safety awareness
Visuospatial changes/deficits
Mood changes
Difficulty with IADLs and multistep tasks
I with ADLs
Accesses community with some risk of getting loss
More successful in a structured environment
ACL 4.4-4.8
4 stages model of dementia: moderate
Increased loss of orientation to time, place, situation, people
Not able to manage environment effectively requires assistance for safety
Communication difficulties, decreased use of language
Visuospatial deficits
Poor attention to safety and increased impulsivity, may lose socially appropriate behavior, safety risk is high
Loss of much purposeful activity
Needs support to initiate/engage in previously enjoyed activities
Benefits from sensory engagement
Difficulty with ADLs
Requires A for ADLs for safety
Assistance with incontinence and hygiene
Assistance for IADLs
Community activity limited
Wandering risks
Cues for hygiene
Eating may need adaptive dining strategies
cues to maintain routine
Can no longer live safely
Hallucinations, agitation, sleep disturbances with nightmare
ACL 3.6-4.2
4 stages model of dementia: severe
No longer oriented
May recognize caregiver/family; however unable to name
1 step commands
Incoherent language
Assists with ADLs
May need 2 person assist
Benefits from routine
Incontinent
Cues to eat
Benefit from social engagement and repetitive action
Physical assistance to move safely
Neurological impact on movement (apraxia, possible tone)
Increased fall risk
Increased behaviors (resistance to care, agitation, aggression)
Unable to make needs known
May have unmet need increasing symptoms
24 hour care
At risk for pressure ulcer
Aspiration
Poor nutrition
Dehydration
Weight loss
Visuospatial deficits
ACL 3-3.4
4 stages model of dementia: terminal
Limited responsiveness
Limited language if any
Benefits from comforting stimuli (familiar voices, soothing touch, music, massage)
Likely bed bound
Total a for care
Difficulty swallowing
Modified diet at risk for aspiration
Pain management
Palliative care
Supported positioning
Assistance for repositioning for pressure relief
Increased time
Contracture/rigid movement
Loss of mobility
Agitation
Toward end of life
At risk for pressure ulcers
Hospice Care
ACL less than or equal to 3
Delirium
Sudden and severe change in brain function that causes person to appear confused/disoriented
difficulty maintaining focus
Thinking clearly and Remembering recent events
Fluctuating course
Causes of delirium
Advanced age
existing brain disease such as dementia, h/o CVA, Parkinson’s disease
Immobility
Fracture
Malnutrition
Use if bladder catheter
Polypharmacy leading cause
Sleep deprivation
Poor eyesight/hearing
Advanced Ca
Organ failure
Sudden w/drawal of regular medication or cessation
ETOH
Delirium symptoms
Hours to days
Unusual changes in levels of consciousness and thinking
May be withdrawn
Sleepy
Flat affectionate (hypoactice delirium)
Hyperactive delirium:
Active/agitated
Difficulty maintaining focus
Difficulty retaining new info
Disorientation to time and place
Visual hallucinations
Variable outcomes weeks to months
Can result in Long term memory/processing difficulties after recovery
Delirium linked to prolonged hospitalization and residual trauma
Assessing delirium
Get assessment prior to planned hospitalization for a baseline, can be done by OT on primary care setting
Pre-admit tools: MOCA, Mini Adden Brooke’s Cognitive Exam
Delirium screens should be 2-3x/day due fluctuations
Screening tools: intensive care delirium screening checklist, confusion assessment measure (CAM) completed at regular intervals
Treatment of delirium
Encourage movement
Time out of bed
Support person in maintaining regular sleep/wake cycle
Make sure using hearing aid/glasses
Avoid under/over stimulation
Someone at bedside for reassurance
Educate friends/families
Pharma - tx medical reason for hospitalization, avoid deliriogenic meds such as benzos antipsychotics, and histamine 2 receptor agonist
Polypharmacy/adverse drug effects
Can be prescriptions, regular alcohol, illegal drug use
Ceasing medication suddenly
Some medications overtime increase likelihood of neurocog disorder
Increased polypharm in PD abd MS
Fatigue, cognitive complaints, fall secondary to dizziness/hypotension
Treatments to reduce polypharmacy
Yearly medication review with PCP
Discuss strategies to reduce fall risk
Update cognitive screening regularly and monitor for changes
Update family, individual, and providers
General dementia interventions
Home modifications, caregiver education, fall prevention, activity modification
Dementia interventions: caregiver education
Improves ADL performance, reduces neuropsych sx, improves QOL
In person education on communication, behavior management, and adaptive strategies
Caregiver training on stress mgmt/reduction, respite resources, caregiver support groups
8 in home session 1-1.5 hours
Dementia interventions: home
Modifications-safety concerns
Safety concerns addressed: wandering, falls, inattention, poor judgment, medication management, temperature adaptation, cooking, use of appliances, use of sharps
Remove clutter, rugs, access to unsafe objects, add grab bars, commodes, lighting, door locks, gate alarms, AT, ramps, lifts
Dementia interventions: home
Modifications-neurospych symptoms
Improves neuropsych sx
Rooms designed with purpose of use
Ambient music (other than at meals)
Multisensory interventions
Reduced environmental noise/stimuli
Camouflage exits
Accessible environment with good visual access L shape cornets, visible toilet
Dementia interventions: fall prevention
Individual exercise program to increase balance, group exercise programs that increase balance, occupation based intervention to increase gait, strength, flexibility, and balance
Fall prevention education for staff
Need more research for fall
Prevention for neurocog d/o
Programs: stepping on, a matter of balance
Dementia intervention: activity modification
Personalized activity to increased engagement, decrease neuropsych symptoms, maintain function, and increase QOL
Individual program: draw on previous experiences/interest, support choice match existing skills/capacities, support with caregiver education and facilitation, match cues to cognitive capacity, use direct simple cues
Modify environment for success, decrease distractions, increased visual cues, use adaptive strategies that are familiar and intuitive
Tailored Activity Program
Person-environment-occupation framework, considers preserved capabilities, caregiver readiness, and environmental factors
Decrease symptoms through 3 meaningful activities tailored to match skills/interest of person
Requires training/certificate to practice
Skills 2 care
Caregiver training program that requires certification focused on education, routine modification, behavioral management, and home modification to promote function snd outcomes in the home
Multi modal OT program
Cog-oriented approach improve cognitive dysfunction and increased BADLs and IADLs
Reminiscence therapy
Effective in Alzheimer’s disease regarding cognition, depression, ADLs, QOL
Regular small group 45 minutes, 8-12 week duration, mild to moderate ADs
Photo, video, and music
Sensory Therapy
In residential facilities, strong evidence for massage
Moderate evidence for environmental based multisensory activity=lighting
Gardenunt, music, meal time (no music), montessori animal assisted therapy, dance/yoga
Inconclusive evidence for art, aromatherapy, snoezelen rooms
Goals of intervention in acute care setting for neurocog d/o
Return to prior environment
Return to PLOF
In unable, identify new supports for home setting, modify interventions for new baseline
Assessment in acute care setting for neurocog d/o
Functional cognition with performance based assessment
Consider baseline level of fxn vs expected fxn at d/c, recommend specific cognitive skill assessment secondary to neurocog screen, eval ADL/IADL performance
intervention in acute care setting for neurocog d/o
Retrain ADLs/IADLs with compensatory/adaptive strategies
Strength based intervention to support increase cognitive level
Collaborate with natural supports to anticipate challenges in dc environment,
Train and make environmental recommendarion
Goals of intervention in community/home health setting for neurocog d/o
Support function
Participate in home environment
Support autonomy with attention to safety
Assure natural supports support function and safety
Assessment in community/home health for neurocog d/o
Assess Cognitive status with performance based assessment
What is needed to function in environment for additional tool guide
Secondary neurocog screen, home safety assessment, evaluate ability to perform ADLs/IADL, interview natural supports to understand barriers/neuropsych symptoms
intervention in community/home health setting for neurocog d/o
Dementia specific concerns- wandering, safety, modify routine/environment, address underlying needs (pain, loss of meaningful activity), ADL/IADL training, AE/DME training, address accessibility, reduce falls, strength based interventions, caregiver training
Goals of intervention in memory care and palliative stages
Support function/participation in home
Support comfort, dignity, and safety
Assure natural supports can support routine care, safety, and comfort
Assessments in memory care and palliative stages
Functional cognitive performance test, with more advanced dementia, formal cog test not needed
Eval ADL with focus on insight, safety, and caregiver assistance
Environmental considerations, interview supports for barriers and neuropsych symptoms, home safety assessment
Intervention in memory care and palliative stages
Address safety, wandering, difficulty participating in ADLs
Accessibility tx
Fall prevention
Safety in eating, positioning, skin integrity
Underlying needs pain vs meaningful activities
Use activity plan, sensory interventions, and environmental modifications to reduce neuropsych symptoms
Mild neurocognitive disorder
Not part of normal aging, does not impact(I) functioning, but noticeable by family
May be reversible, not all leads to dementia
Early intervention best to address reversible causes
Mild neurocognitive disorder risk factors
Age, diabetes, smoking, increased cholesterol, htn, depression, sedentary lifestyle, limited mental/social stim
Causes if mild neurocognitive
Disorder
Reversible causes: delirium, depression, NPH, metabolic/nutritional deficiencies, sleep apnea, drug use, acute infection
Nonreversible causes: TBI, vascular events, PD, neurocog decline early stages of dementia, MS, ALS, atypical PD
Mild neurocognitive disorder impact on ADL
Less cognitive processing due to routine usually not affected
(I) maintain further in disease process than dementia
Can be mire affected by physical symptoms
Decline in ADLs means disease progression
Mild neurocognitive disorder impact on IADL
Requires more functioning in multiple cognitive domains and more varied take demands, needs executive functioning skills, physical impairment affects
changes can be subtle/compensated for prior to function being affected
Signs if mild neurocognitive Disorder
Challenges with more complex multi-step tasks
Medication errors
Forgetfulness/difficulty tracking leading to miss appointments
Misplacing items
Missing social events
Decreased attention to environment
Increased clutter
Unpaid bills
Spoiled food
Trouble remembering/tracking conversations
Difficulty with word finding
Decreased visuospatial skills
Assessing mild neurocognitive disorder
Functional cognitive assessment
Performance based activity
Formal performance based assessment
iADL predicting factor if rehospitalizations
Interventions for mild cognitive disorders
Exercise, cognitive training/retraining, skill training/modifications for lifestyle management
Simulate real like
Grade task in error less learning
Group tx to increase cognitive skills
Motor symptoms of Parkinson’s disease
Tremor including non-intention tremors in arms, legs, jaws, and head, pill rolling
Bradykinesia slowed movements and difficulty initiation movement
Rigidity lack of facial expression, decrease arm swing while walking
Postural instability impaired balance, related to combo of tremors, bradykisia, and rigidity
Vocal: soft slow speech
Non motor symptoms of parkinson’s
Depression
Sleep problems: fatigue, restless leg, insomnia
Loss of smell 95%, one of the first symptoms
Sweating and increased risk of skin Ca
GI-constipation
5 stages of Parkinson’s Disease
1) slight tremor on one side of the body, mild sx, changes in walking, posture, and facial expression
2) symptoms worsen, affects both sides, changes in walking making daily tasks more difficult
3) LOB, slowness of movement, falls more common, impaired ADLs
4) severe symptoms and limit ability to live alone, walkers and AD used
5)confined to wheelchair vs. bed, 24 hour caregiver, many experience hallucinations
PD dementia risk factors
Hallucinations in someone who does not have dementia symptoms yes
Daytime sleepiness
Postural instability and gait disturbances symptom pattern
Pharma tx if Parkinson’s Disease
Clonazepam/melatonin to tx symptom of REM disorder
SSRI tx depression
Cholinesterace inhibitor- visual hallucinations, sleep disturbances, and behavior changes
Medical tx of Parkinson’s disease
Levadopa to increase dopamine
MAO B inhibitor/COMT inhibitors slow enzyme that breakdown dopamine
Amantadine to reduce involuntary movement
Deep Brain stimulations-placing electrode into brain to stimulate areas of motor context related to movement symptoms
OT tx for Parkinson’s Disease
Physical activity: LSVT-Big based on proprioceptive recalibration, physical activity slows progression and improve symptoms
ADL-specific goal setting/tx, task analysis with forward chaining, decrease distractors, educate on cog load/avoid multitasking, adaptive strategies/AE
Cognitive strategies-cognitive retraining vs compensatory strategies, cog retraining can lead to LT cog improvements, compensatory may be for those not interested or have PD dementia
Fall prevention-home assessment for environmental modification, educate on fall triggers such as changing direction step to turn then move forward, avoid dual task, avoid carrying objects
Mindfulness-body scan, mindfulness meditation
ECT/fatigue management: caregiver/pt education on ECT, structure day so most valued activity at peak medication time, education on sleep hygiene
Mindfulness meditation based Complex exercise lrogram
Parkinson’s Disease
Prep phase: discuss HEP
Exercise: elastic band/stretching exercise, ball exercise, stretching with deep breaths
Meditation with basic breathing: breathing meditation, loving-kindness meditation, breathing imagery meditation
