Shamp 1

Abigail Shamp
Section I. Clinical Condition:
Parkinsons Disease
Description:
Parkinson's is the second most common neurological disease after Alzheimer's (Simuni and
Sethi, 2008). It has been described as a chronic, progressive, neurological disorder, which is
generally not life-threatening but is incurable (Harris et al, 1998). Parkinsons disease originates
in the Substantia Nigra, which is located in the Basil Ganglia of the brain; it produces Dopamine
which helps control muscle movement. Parkinsons disease causes the cells that produce
dopamine to be slowly destroyed. A shortage of dopamine to act on these receptors results in the
4 cardinal parkinsonian symptoms of resting tremor, bradykinesia, muscle stiffness (rigidity),
and, in later stages, postural impairment (balance problems). By the time symptoms appear,
dopamine has been depleted by 70% to 80% (Pahwa, R. et al). This decrease in the dopamine
causes individuals with Parkinsons to have impairments with motor movements, postural
stability, speed, cognitive, and affective expression. This disease most often develops after the
age of fifty, and usually affects males. People with Parkinsons often have tremors, muscle
rigidity, bradykinesia, and unstable posture. Secondary symptoms can include short, shuffling
steps, cognitive impairments, decreased coordination, sensory loss, swallowing impairments,
poor balance, little to no expression of emotions, and depression. Poor posture can cause
difficulty in speaking clearly and loudly, difficulty with neck and upper extremity movement,
altered balance which can cause falls, headaches and difficulties with swallowing can also
happen.
Diagnostic Criteria:
Diagnosis is based on medical history and a neurological examination. Parkinsons disease is
difficult to diagnose accurately. Sixty thousand new cases of PD are diagnosed every year. The
age range for initial diagnosis is 40 to 80 years; the average age at presentation is 60 years. Early
diagnosis can be difficult, and an estimated 5% to 10% of patients are misdiagnosed. A family
history is seen in 5% to 10% of patients with PD (Pahwa, R. et al). Requirements to be diagnosed
include that one of the primary symptoms (resting tremor, rigidity, bradykinesia, postural
stability) must be present. Neurological tests also rule out other disorders.
Etiology and Prognosis:
The underlying cause of Parkinsons disease is unknown although there is some evidence that
implications could be both genetic and environmental factors. Two types of Parkinsons include
familial Parkinsons which there is a genetic association and the more common type called
sporadic Parkinsons. The environmental factors that have been associated with Parkinsons are
dietary intake and exposure to environmental elements. There are three stages of Parkinsons
disease. Preclinical period is when the neurons start to degenerate, no symptoms with this stage.
Prodromal period can last months to years and generalized symptoms can appear. Symptomatic
period is when only one side of the body is affected, in stage two bilateral sides of body are
affected, and balance is not impaired. For stage three, bilateral sides of body and balance are
affected, in stage four individuals have disabled functional abilities, and stage five is when
individuals will be confined to bed or a wheelchair.

Shamp 2
Implications for function and OT treatment:
Motor:
Teach individuals with Parkinsons functional mobility and transfers, strengthening, stretching,
cardiovascular exercises, and train them to conserve their energy. Postural stretching and
strengthening exercises could include scapular retraction, back extension, and chin tuck to
decrease forward head posture and make sure they have their ears over their shoulders. Having
workplace evaluations is important and then teaching them how to be successful in the
workplace. Also to make sure they will be able sit and take breaks during work so they dont get
too tired.
Sensory:
Be aware of pressure sores and cuts or busies on skin due to loss of sensation. Make sure that
clothing doesnt cause discomfort and that it fits correctly.
Cognitive:
Individuals with Parkinsons disease may have various cognitive impairments and will need
directions that are easy to follow and understand. In educating them they will need to be
reminded of the steps of exercises and how to conserve energy. They may also have difficulties
with depression and expressing themselves and being outgoing, they tend to be quiet and dont
talk very much.
Intrapersonal:
Encourage individuals with Parkinsons disease to participate in group activities and go out and
do their favorite hobbies with their friends and family. Social participation can be helpful if the
person has depression, they will feel better if they are surrounded by people who love them.
Self-Care:
For eating and swallowing it is important to take small bites and sips, alternate liquids and solids,
sit upright after meal, and food consistency may need to be altered. For dressing use Velcro,
elastic shoe laces, elastic waist pants, dress while sitting, flat leathered shoes, no buttons on
clothing and make sure clothes are big enough. For grooming individuals should use electric
tooth brushes, electric razors, suction brushes, suction soap holders, wrist weights, and to sit at
the sink verses standing. For bathing they should use bath benches, tub transfer bench, non-slip
surfaces, and handheld shower, grab bars, and use a long handled sponge. To help with toileting
using a raised toilet seat and having toilet rails will be helpful.
Section II:
Personal and Social History
Ruth was born on September 4, 1930 to Switzerland immigrants Abram and Martha
Miller whom were strong believers in the Amish faith. Ruth was the second oldest of four
children. Ruth had an older brother named Isaac, a younger brother named Jacob, and the baby
of the family was a girl, named Katie. The Millers decided to move their family from their
community called Ebenezer, which was close to Buffalo, New York to Amana, Iowa. Then they
settled in the South Amana village which was where she lived for the rest of her life. Ruths
parents were not particularly wealthy, but they made sure the family had the necessities they
needed and they based their values on family not wealth. Ruth went to school until she was
fourteen years old. She enjoyed going to school and writing was her specialty. After Ruth
completed the eighth grade she was expected to work on her homemaking skills. Ruth cooked,

Shamp 3
cleaned, took care of her younger siblings, and also worked in the garden. During Ruths free
time she enjoyed writing in her journal and sewing. It came to the point that Ruth had to decide
if she was going to join the church or not. If she decided to join the church she would be making
a lifelong commitment, but if she did not join the church she would be shunned. Ruth decided to
join the church and became an active member. Once she made this commitment she was
baptized.
At the age of twenty, Ruth met Leroy Yoder, an active farmer, during a Sunday night
singing event. This is where they were allowed to spend time together and they courted for a
few years. At the age of twenty-two, Ruth married Leroy Yoder and they moved into their own
house close to Ruths parents home. Ruth and Leroy had three children. Their firstborn was a
girl named Rebecca, their second child was a boy named Aaron, and their last child was a boy
named Elijah. Ruth loved her husband and her children and enjoyed taking care of them. When
Ruth was diagnosed with Parkinsons disease at the age of 52 she became limited in the activities
that she could participate in. This included taking care of her family and home. She struggled
with this disease for the rest of her life and had to be in a wheelchair by the age of 60. Ruth
peacefully passed away on January 22, 2014 with her husband Leroy at her side. She was 84, and
she was in the comfort of her home; she died because of old age and the progression of her
Parkinsons disease. Ruth was preceded in death by her parents Abram and Martha Miller.
Section II.
Developmental Stages from Birth Death
Birth to 7 years: This area of development is not impacted by the condition.
Cognitive development: During Ruths first year of life her mother would wrap her up in a
blanket and hold her close creating a strong bond between Ruth and her mother. This was the
base of Ruths attachment to her mother. Ruth was allowed to play with her younger siblings and
interact with them and use simple toys including homemade dolls and wooden blocks. By the
age of two, if Ruth misbehaved she would be spanked or was immediately corrected. Ruth was
around her mother most of the time because her father was usually outside with her older brother
doing farm work. Ruth watched her mother closely and around the age of five she started to
show interest in helping with cooking and cleaning. Ruth was taught German and English and
was able to speak both languages by the age of seven.
Psychosocial development: When Ruth needed something as a baby her mother was right there
fulfilling those needs. Ruths mother made a sling that would allow her to hold Ruth close to her
while she worked. When Ruth got too big for the sling her mother would let her lay around on
the ground on a blanket and she would observe her surroundings. During the toddler ages Ruth
was able to walk and she would explore objects by touching them. Ruth would need reminders of
what was okay to touch and what was not. When Ruths mother was outside working in the
garden, Ruth would be right beside her trying to help. Sometimes though, Ruth would put dirt in
her mouth and her mom would tell her not to do that.
Moral development: When Ruth was six and seven she did chores outside and around the
house. Hard work was a big part of her moral development. Ruths parents were pretty strict
when it came to doing work. If she did not get her work done in a timely manner there would be
consequences, punishments or extra work. Ruth started to get used to these rules and did not like

Shamp 4
getting in trouble. Eventually she got used to her parents authoritarian ways and did what they
told her.
Physical development: Ruth started to crawl around eleven months and she could walk
independently around fifteen months old. When Ruth was almost two her mother let her draw on
paper with a pencil and this allowed her to start strengthening her fine motor skills. Ruth would
also pick up small objects and place them into a container. When Ruth was old enough to write
her name she fell in love with the way she could spell and write different words. Ruth also loved
to help her mother cook, she would stir the cookie batter when baking and if she was lucky she
could even have the first cookie that came out of the oven.
8 years to 11 years: This area of development is not impacted by the condition.
Cognitive development: Ruth started to think about things more abstractly and understand why
things happen the way they do. She was more willing to help out around the farm, with cooking,
and she also started to enjoy gardening. She loved to bake chocolate chip cookies and loaves of
homemade bread. She started realizing that not everything is about her and she wants to help
others. Ruth cares so much about her family and is a hard worker for her age. Ruth knows that
if she does not help out on the farm or in the house she will get in trouble. When Ruth
communicates with the people around her she realizes that they may have different ideas than she
does and that she should respect and listen to their opinions.
Psychosocial development: When Ruth successfully finishes the task of feeding the horses she
is proud of herself for doing it independently. Ruth quickly goes to her parents and tells them
that she fed the horses by herself; they praise her and thank her for what she did. Ruth knows
that she will be praised for the work she does and it made her more willing to do things for her
parents. Ruth was seeking praise and appreciation from her parents at this age. Even though
Ruth wanted to help out as much as she can she had trouble being organized and she also had
selective memory and was forgetful at times.
Moral development: Ruth was eager to please her family and make them happy. Ruth made
her parents proud by doing hard work which, simultaneously, makes Ruth happy too. She had a
great deal of respect for her parents because they are her main authority role at this time in her
life. Ruth was also kind to her siblings and loves to play with them and help them out.
Physical development: Ruths appearance is at the awkward stage, her bones, muscles and
organs are growing and developing, resulting in looking different. Ruth was not allow to talk
about growing and developing openly, if she had questions she asked her mother in a private
matter. Although it is a private matter, her mother was willing to talk to her about her changing
body and answer all her questions. Ruth is getting stronger and is able to carry pretty heavy
buckets of grain for the cattle and pigs. She enjoys taking care of the animals and spending time
outside.
11 years through 20 years: This area of development is not impacted by the condition.
Cognitive development: Ruth has learned to think ahead and think critically about different
situations. Since Ruths family did not have electricity, she had to be creative in what she did in
her free time and how she completed her daily chores. Ruth had to use a hand pump to pump the

Shamp 5
water from the well and then carry it back to the house. The water was used for cooking,
cleaning, and their weekly showers. Ruths love for writing was growing as she was becoming
an avid thinker; she loved to jot down her idea and thoughts about life. Any chance Ruth got she
was outside enjoying the sunny weather and writing her stories.
Psychosocial development: Ruth enjoys spending time with her close friend Lydia. Lydia has
been Ruths best friend ever since they were little. Ruth values her time with Lydia because it is
a chance for her to get away from her sometimes hectic life at home. Ruth and Lydia gossip and
discuss the daily events, gaze at good looking gentlemen, and sew together. Around age sixteen
Ruth was allowed to court, and was interested in boys but did not start courting Leroy until she
was about twenty.
Moral development: Ruth is getting to the age that her faith is very important to her family and
the Amish community. The Ordnung is the Amish's set of unwritten rules that are based on
scripture. Ruth can decide to follow this set of rules or leave the Amish church and be shunned.
Ruths faith is very important to her and she would never leave her family and friends so she
chose to live by the rules of the Ordnung. This is also the point in her life were Ruth can
officially court and think about her future with a husband and children.
Physical development: Ruth is continuing to get taller, her body is entering puberty. She has an
increasing appetite and is in need of more sleep. Towards ages eighteen through twenty Ruth is
completing her growth spurts and is at the end of puberty. Ruth has accepted her body
development and appearance. Ruth believes that working hard is good for her physical health
and fitness.
20-35 years old: This area of development is not impacted by the condition.
Cognitive development: Ruth is getting to the age where she has to make big decisions that
will affect the path of her life and her future. Ruth wishes to marry and have children someday.
Ruth tends to worry a lot and question her abilities. She tries to be strong, but sometimes she
lets her guard down and goes to her mother. Her mother gives her advice and talks Ruth through
her issues. Even though Ruth is getting older and should act as an adult, her mother still cares
for her no matter how old she may be.
Psychosocial development: Ruth has been courting Leroy for about two years now and is
building a strong relationship with him. They would spend time at each others houses, have
picnics together, and attend social events like barn raisings. Leroy and Ruth had a special spot
where they could meet and it would be just the two of them. This spot was deep in the woods by
a peaceful, flowing stream. At their spot they would go wading in the stream, lie down on the
soft, green grass, and have many conversations about their dreams and wishes. They would
discuss how they wanted to get married soon. Once they get married they want to have at least
three children and raise them in the Amish church and faith.
Moral development: Marriage is a major deal to the Amish community. Leroy and Ruth kept
their engagement a secret until late August when they told the church deacon who then
announced it to the church. Leroy and Ruth were to be married on November 14, 1952. Ruths
wedding reception took place at her home where her family frantically got everything prepared.
During the preparation for the wedding Ruths mother made her dress, it was a simple shade of

Shamp 6
blue and did not have any lace or a train. Leroy wore his nicest overalls with a bow tie. The
wedding itself lasted four hours, and then the celebrations and feasting lasted into the dark hours
of the night. Ruth and Leroy spent their first night at Ruths parents house. Their honeymoon
was spent visiting various relatives where they received many wedding gifts. Ruth and Leroy
lived with Ruths parents until the spring. Then they established a home of their own where they
would start their family.
Physical development: Ruth is at her prime time of her life. She is active in her family and has
had three children now. Ruth had her first daughter, Rebecca, when she was twenty three. She
had her second child, Aaron, when she was twenty six. Ruth and Leroy had complications in
having more children, but then they were blessed with their last child, Elijah, when Ruth was
thirty one. After having children and being very busy Ruth is still active but not as much
because she pours all her physical energy into her children. She cares for her family very much.
35-65 years old: Affected
Cognitive development: Ruth still continues to think about her life a lot and she is happy. At
times Ruth gets frustrated with her husband because he expects a lot from her. While he was out
working in the fields she got stuck with the majority of the housework. Ruths children helped
out and had many responsibilities both outside and inside. Ruth was thankful for her children as
they helped her out around the house and in the garden, making her life easier.
Psychosocial development: Ruth tries to connect with her friends as much as possible. She
tries to set a time where she and her children can go to her friend Lydias house and have social
interaction outside of their family. Ruth enjoys being able to do this because it gives her a
chance to talk to other adults her age versus being at home all the time with her children. Ruth
also had a sewing group she attended with Lydia a few times a month and she left her children
home so she could have some relaxing time. Lydia and Ruth also went out for coffee or lunch
whenever they got the chance to.
Moral development: Ruth and Leroy take their children to church and encourage them to focus
on their faith and what it really means to them. Their children are very obedient when it comes
to church; they were expected to be very respectful to all of the church members. Ruth and Leroy
teach their children the importance of respecting others and treating others how they would want
to be treated. They also make sure to stress the importance of having good manners, social
skills, and to be polite and kind.
Physical development: Ruth is starting to have lots of aches and pains as her body is getting
older and overused. Ruth tries to stay as healthy as she can. She has trouble with her hips, knees,
and her right shoulder. These troubles have limited her activities, and it is getting more and more
difficult for her to be as physically active as she was in her younger years. When Ruth was 52
she was diagnosed with Parkinsons disease. What she thought was just signs of old age were
actually the early onset of Parkinsons disease. The biggest change Ruth noticed was that she
would constantly shake and tremor and they would only go away when she was moving. She had
problems with her balance and would find herself falling more often; her muscles would ache
and were very stiff. Ruth always seemed to have an upright posture but lately her posture was
stooped and her back was starting to curve forward. She also had difficulty eating and
swallowing her food and she would often choke on it. Her voice became very quiet and it was

Shamp 7
hard to understand what she was saying. These changes were very complicated for Ruth to get
used to; she was often depressed because of these changes from Parkinsons disease.
65+ years: Affected
Cognitive development: Ruth spends most of her time reflecting over the years that have so
quickly gone by. She wonders if she should have been a better wife, or mother, and she also
thinks what her life would have been like if she made some different choices when she was in
her twenties. But at the same time Ruth was content with the way her life went and with the
decisions she made throughout her younger years. Ruth had problems with depression because
she thought that Parkinsons took away her last thirty years of life and that she was not able to do
the things she could have done. Around age 60, Ruth was growing more and more confused and
she did not know what she was doing or how to complete simple everyday tasks. She would
often forget important dates and events that were once important to her. This memory loss was
affecting her ability to function and take care of herself.
Psychosocial development: Since the children are all out doing their own activities and meeting
their potential spouses and Rebecca having her own family, Ruth has more free time to do what
she enjoys. Ruth used to get together with the older generation of ladies and she would quilt,
bake, and converse with them. Ruth also enjoys having more time alone with her husband. If
Ruth felt up to it they would go out on with him every once and awhile. When Ruth is alone she
still enjoys writing and reading. Parkinsons disease limited Ruths ability to sew, write, and
bake or cook for her family and friends. She would often just sit with her friends and watch and
talk to them and give her advice to the other ladies and help out as much as she could.
Moral development: In the Amish community elders are cherished and looked to for guidance
and direction. Ruth would be asked for advice for many different occasions. It was usually the
younger generation who saw Ruth as being very knowledgeable and they felt comfortable asking
her questions about life and how to get through different situations. Ruth was willing to help out
with pretty much anything as long as she was still able to. Because of her memory loss and
confusion she was not able to remember things that had happened in her early years. People
would still talk to her and help her to remember what she once told them and help her bring back
those memories.
Physical development: Walking is getting harder and harder for Ruth. She was wheelchair
bound by the age of 70 and she had to depend on her family to help her out with most of all her
daily tasks. Ruth often felt useless, but her family tried to have her do as much as she could on
her own so that she would feel better about herself. Her back is curved and her posture is not
good so she has to have postural support and needs to be repositioned many times throughout the
day. A caretaker comes to her home and helps her with her daily activities, cooking, and helps
remind Ruth to take her medicine. Ruths Parkinsons disease had made the last years of her life
very difficult for her. Ruth peacefully passed away at her home at the age of 84 due to her
declining body and her Parkinsons disease.
Section IV: Impact of the clinical condition on occupational performance.

Occupational Role: Mother

Occupations: cooking, cleaning the house, taking care of children,

Shamp 8
Description of how an occupation is impaired by clinical condition:
Mother: cooking meals for her family
Ruth is unable to cook for her family because of her tremors and poor postural stability
that comes along with her Parkinsons disease. She cannot stand for long periods of time
because she gets tired easily and she gets irritated and sore because her muscles ache.
Ruth may be able to help someone else with making meals, she could stir something,
open packages, or cut up vegetables.
Occupational Role: Gardening
Occupations: working the soil, planting the seeds, weeding and caring for the plants
Description of how an occupation is impaired by clinical condition:
Gardening: Taking care of the garden
Ruth would not be able to do much gardening. She would have troubles with the hard
work of breaking up the soil and preparing it for the seeds because she would tire easily
and have muscle aches and pain. She could kneel and do some seed planting or sit down
and do some weeding, but she would have to take breaks and then go back to it later.
Occupational Role: Wife
Occupations: spend time with husband-dates, intimacy, and care for husband
Description of how an occupation is impaired by clinical condition:
Wife: Spending time with husband
Ruth can still spend time with her husband, but it wont be the same as before she got
Parkinsons disease. They can go on simple dates but, for example, she would be able to
go for long walks, go to dances with him, or have romantic evenings with him. She will
get tired easily and most likely get sore and her tremors will get in the way. Ruth will
have to deal with this change in her relationship and her husband will also have to accept
this change.
Section V: Treatment Implementation:
Impaired Occupation: Mother: Cooking meals for her family
Goal: To be able to cook a meal in one to two months.
Activity: Ruth should practice getting all the necessary ingredients that she needs and put them
in one place so that it is easier for her to conserve her energy. She could also use a basket or a
tray to transport these ingredients, utensils, and bowls that she will need in order to cook a meal.
Ruth also should sit down when mixing the ingredients and take breaks when possible. If Ruth
has trouble getting items into the oven she can ask her family members to help her, so she can
avoid the possibility of getting burned or injured. Ruth will be able to successfully cook a decent
meal for her family.
Impaired Occupation: Gardening
Goal: To be able to be successful in gardening in about a month.
Activity: Ruth should get used to sitting or kneeling when gardening in order for her to complete
gardening tasks. This will allow her to strengthen her trunk and core muscles that will help
support her posture and stability. She will not tremor as much when she is grabbing onto weeds
and pulling them our or when she is harvesting vegetables and flowers. Ruth should remember to

Shamp 9
take breaks and keep herself well rested. For the bigger tasks of hoeing and digging up the
ground she should ask her husband to do that for her. She should ask her children to help her out
when she needs it. Ruth will be able to do as much gardening as she possibly can.
Impaired Occupation: Spending time with husband.
Goal: To be able to do what she did with her husband before her diagnosis.
Activity: Ruth and her husband should try to do what they used to but they may have to choose
different activities. Instead of going for long walks together they could go on short ones and stop
for a picnic before they start walking back. They could change the way they share their love for
one another and try to be more creative. Ruth and her husband could go out for simple dinners
versus high stress dates. Ruth and Leroy will still be able to do the things together that make
them happy.

References

Shamp 10

Wise, S. (1998-2014). How the Amish Work. How Stuff Works, Inc.
Inside the Amish Family. Exploring Amish Country.
Magennis, B., & Corry, M. (2013). Parkinson's disease: making the diagnosis and monitoring
progression. British Journal of Neuroscience Nursing, 9(4), 167-171.
Pahwa, R., Suchowersky, O., & Weiner, W. (2006). Diagnosis and prognosis of new-onset
Parkinson's disease. Patient Care For The Nurse Practitioner,