On Wednesday, Dec 3, 2003, at 03:09 Europe/London, Shona Paterson wrote:
I disagree that we can offer more to client's with physical problems than
cognitive. As a neuro OT I work primarily with cognitive and perceptual
problems. As an OT working with Older people I worked with many parkinson's
clients with a recent diagnosis who exhibited mild cognitive impairment.
Perhaps in the USA it is different?
-----Original Message----- From: Mike [SMTP:[EMAIL PROTECTED] Sent: Wednesday, 3 December 2003 13:33 To: [EMAIL PROTECTED] Subject: Re: [OTnow] Differences in Alzheimer's and Parkinson's
In my experience, the differences are enormous (a necessary
generalisation). Cognition is an early and significant problem in
Alzheimer's while physical difficulties usually present later. People
with Parkinson's usually present to us fairly early with problems in
performing certain ADLs and we usually get to know them long before any
cognitive difficulties manifest themselves significantly. We mostly
treat difficulties resultant from physical disability rather than
cognitive disability. We have few PD clients with significant cognitive
difficulty or Lewy body dementia but that may be because our particular
OT role has less to offer those with dementia than it does those with
problems that are more physical in their origin, so that if cognitive
difficulties become the primary problem the client is more likely to be
helped by the social work (care management) team than by us.
Having said that, I do often find that people with PD often don't use complex pieces of equipment like mattress variators and bath lifts, but, strangely, it seems that although they are able to show that they know how to use them, they just don't -- it's not at all straight-forward and can be difficult to get a handle on.
I would like to think that we don't vary our treatment approach based
solely on the disease but on our understanding of the problems and
strengths of each individual -- though we do obviously have to consider
the likely impact of cognitive loss on the person's ability to use
equipment, adaptations or new techniques if it is a part of their
diagnosis. For instance, there would be a need for a thorough risk
assessment if considering the recommendation of a stair lift for
someone with either Alzheimer's or Lewy body dementia, even if it's in
its early stages. We would probably need to be sure that a carer will
always be on hand to assist with its safe use or ensure that the case
would be reviewed regularly to ensure the person remains able to use
the equipment.
For what it's worth, it seems to me that in advanced cases of any dementia it is difficult to disentangle the cognitive component of the problem from the movement disorder aspect. Don't the two almost always coexist?
Bear in mind that the above comments come from a setting where we
mostly remediate occupational dysfunction using equipment, home
adaptations or task modification. People with Alzheimer's rarely
present to us until fairly late, when difficulties in transfers or
moving and handling issues emerge because whilst there's a role for OT,
there's not much of a role for OT as it manifests itself in my
particular service setting and this is largely due to the fact that our
treatment modalities require the person to be able to understand their
use and learn new techniques, though adaptations like stair rails and
toilet frames present themselves fairly intuitively to people with
cognitive dysfunction.
Cheers, Mike (London, UK)
On Tuesday, Dec 2, 2003, at 11:59 Europe/London, Ron Carson wrote:
Hello:
What differences if any do you all see in the way that Alzheimer's versus Parkinson's diseases manifest themselves in your clients?
Are your treatment approaches different based solely on the disease?
Thanks,
Ron
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