Parkinson's disease is a neurological condition that affects movement. It has been estimated that around 1 in 500 people are affected by Parkinson's disease in the UK alone, totalling around 127 000 people living with the condition (NHS England, 2019). Parkinson's disease occurs when the cells in the substantia nigra die; this is the part of the brain that controls movement. These cells produce a chemical messenger called dopamine, which is crucial in enabling smooth and coordinated movement of the body. The main symptoms of Parkinson's disease include tremors, muscular rigidity, bradykinesia, postural impairments and speech problems (Saint-Hilaire, 2014; NHS England, 2019).
The cause of Parkinson's disease remains unidentified and, at present, there is no known cure. The disease affects each individual differently and, because of this, the way that each case is managed must be specific to the person (Royal College of Occupational Therapy (RCOT), 2018). Thus, any recommendations for equipment, aids and adaptations should be provided for the affected individual by an occupational therapist or physiotherapist.
For people with Parkinson's disease, an important goal of treatment is independent living, including ensuring that they maintain the ability to perform activities of daily living (ADLs) (eating, bathing, dressing, toileting, transferring, etc.) for as long as possible. This article highlights some tools or aids that can be adopted to help people with Parkinson's perform ADLs with relative ease and safety. In addition to recommending these tools, occupational therapists and physiotherapists also teach people with Parkinson's disease a modified way of performing ADLs that are better suited to their abilities.
Mobility
As Parkinson's disease is a movement disorder, it can make getting out and about more difficult. There is an array of equipment designed to help with this, and some of the most common pieces of equipment are discussed below.
Handrails are the most frequently fitted adaptation that promote independence, and they can be installed almost anywhere in the person's home, including entrances, stairways and bathrooms, as well as bedrooms, to assist with getting out of bed or standing to get dressed or do exercises. Permanent, fixed rails are the safest option and should be recommended by an occupational therapist (Parkinson's UK, 2018; RCOT, 2018). In some instances, the therapist can order or arrange the handrails for the patient. Inexpensive moveable suction-fixing rails can alternatively be purchased. These cannot bear the same weight as a fixed rail, so caution should be exercised when using them. It should be ensured that they are attached to a sturdy surface (Parkinson's News Today, 2018; RCOT, 2018).
Walking sticks and frames can improve balance—these are good if there are concerns about the patient falling. Fixed frames without wheels are the most supportive and help maintain a good upright position. However, these type of frames are best used over short distances (usually kept within the home). A wheeled walker is preferable for use outside and over longer distances, and many have the advantage of coming with a storage bag or tray, so the patient can transport items without having to carry them. Again, advice must be sought from an occupational therapist or physiotherapist, who can help the patient select an option that would be best suited to their needs. They may even be able to lend the patient a frame or walker to try at home. Wheeled walkers with brakes are the safest option, as they can reduce the risk of falling if the frame gets too far ahead (Parkinson's UK, 2018; RCOT, 2018). If a person finds a frame useful for getting around the house, it should be ensured that they have one on each floor and in an easily accessible and safe position, as frames cannot be used on stairs.
Managing personal care
Bathing and showering can sometimes be difficult for people with Parkinson's disease. Reduced mobility and balance as well as a fear of falling combined with a wet and slippery environment can make getting in and out of baths and showers treacherous. There are many different pieces of equipment available that can help people use the existing facilities, including handrails and bath/shower boards which can help them use their existing facilities; alternatively, housing adaptations and wet-room installations can be considered. Seats, either fixed or free-standing, and boards can be added into showers and baths as a simple, first-line option for helping people who struggle with transfers or standing for prolonged periods to manage their self-care. Anti-slip mats or floor tiles are also a must to help prevent falls. Motorised bath lifts are available but cannot be removed as easily as a bath board (a consideration if the bathroom is shared with other members of the family). Bath steps, often combined with a handrail, can be used to assist people who have difficulty raising their legs to step over the side of the bath. These can be used in conjunction with a bath board or swivel chair.
Handrails can also be helpful near the sink to help with standing and maintaining balance while attending to personal care; alternatively, a perching stool can be used. Coloured handrails are an excellent visual prompt for individuals with memory or visual impairment. For those who struggle with getting off the toilet, raised toilet seats with or without a frame and handles can be useful. This makes standing easier if positioned at the correct height, and they can be easily removed and replaced. Again, advice must be sought from an occupational therapist who can assess the individual's needs and promote independence and dignity while ensuring safety. Although it is common and can be tempting for the patient pull themselves up using pieces of furniture, sinks, etc., this can be dangerous and should always be discouraged.
Bed transfers
The stiffness and difficulty with turning that is commonly experienced by people with Parkinson's disease can make getting in and out of bed very problematic (RCOT, 2018). The first thing to consider is the height of the bed. As with a chair, a suitable height bed allows the person's legs to be at a 90 degree angle before they attempt to stand (Parkinson's UK, 2018; RCOT, 2018). Physiotherapists can recommend exercises that can improve the patient's strength and confidence when performing a sit-to-stand manoeuvre. As with the bathroom, it is important that the person avoids using bedside furniture to pull themselves up when getting out of bed. If handles or rails are needed, they should be specially fitted.
Eating and drinking
There are many different items available to help with eating and drinking. Individuals with Parkinson's disease have reduced grip and dexterity, which can make the preparation and eating of meals very difficult. Large-grip cutlery can be useful, or existing cutlery can be adapted with foam tubing to make gripping easier. Light-weight cutlery can help in cases where there is reduced arm strength. Alternatively, heavier, weighted cutlery can be helpful if the person experiences Parkinson's tremors, a common symptom of the condition.
Non-slip grip mats and deep plates with raised edges can be useful for people who have trouble with food spillages, as can sporks (combined spoon and fork). These can all be purchased from mobility and adapted living specialists. For people who have difficulty with drinking, an angled or two-handled beaker or a cup with a weighted base should be considered, as these can provide stability and prevent spillage if there are issues with tremors or reduced muscle control. Kettle tippers also help people to pour boiled water without having to lift the weight of a filled kettle, thus minimising the danger of people scalding themselves.
Managing medication
Taking medication on time every time is important for the management of Parkinson's disease, but medication regimes are often complicated, with individuals taking multiple medicines at various times of day.
To make this easier, patients should be encouraged to set an alarm, as this is a simple and helpful reminder to prompt them to take medicines. There are also specially designed pill timer boxes and pill organisers with a range of functions. Some provide a visual cue with the names and times of day being written on the compartments, while others have alarms as a reminder or will dispense pills automatically. Some will even close again if the tablet is not taken out within the allotted time frame. Pill timers can be very expensive, so the advice of a nurse or pharmacist should be sought to decide which option might be the most helpful for the patient. If a patient struggles with getting tablets out of a blister pack, they can use a small pill-popper device, which is especially helpful for those with reduced hand strength or dexterity.
Where to go for advice and equipment
These professionals can ensure that the equipment or It is always best to discuss any equipment with a physiotherapist or occupational therapist beforehand. Adaptation is best suited to the patient's needs and, in some cases, they can help arrange funding for items or home adaptations. There are also equipment demonstration centres that people can visit to view and try the equipment before they buy it. GPs can usually advise patients on local centres, or this information can be found on the Disabled Living Foundation's website (https://www.dlf.org.uk/). If patients do not have an occupational therapist or physiotherapist, they can find practitioners in their area through the Chartered Society of Physiotherapy website (www.csp.org.uk) or the Royal College of Occupational Therapists (www.rcot.co.uk). However, it is advisable that they first discuss this with their GP or Parkinson's specialist nurse, as these professionals may be able to refer them.
Conclusion
In summary, this article describes some equipment that people with Parkinson's disease can find useful when performing ADLs. It is, however, important to remember that equipment is not always the answer. Often, teaching a person with Parkinson's disease adapted techniques or new ways of doing a task is preferable. Cognitive impairment can arise at any time in the course of the disease, and it primarily affects executive functioning. This can lead to difficulties with planning, organising and problem solving, and while equipment is intended to be helpful, it can sometimes just be confusing. On the other hand, older people who are used to doing tasks in a certain way may find it difficult to change their techniques. The aids described here are particularly useful in such cases.
It should be kept in mind that preserving and promoting independence for as long as possible while maintaining safety is the aim of any occupational therapy intervention, in addition to ensuring the individual and their family are always at the centre of any treatment, regardless of the diagnosis.