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Karsen Walker
RCTX 3240: Disability Survey
22 November 2019
Parkinson’s Disease

Part 1: Description of Diagnosis/Condition:

Parkinson’s disease (PD) is a progressive nervous system disorder that focuses on the

brain in which affects voluntary and involuntary movement. Although it is easily identifiable by

tremors, most symptoms are gradual which can cause stiffness and a decrease in motor skills.

Some symptoms may also include rigid muscles, impaired posture and balance, loss of automatic

movements, sleep changes, and writing changes (Parkinson’s disease, 2018). According to our

class notes, there are about 50,000 new PD cases reported each year. Currently, this disease

affects over 500,000 people around the age of 60 but can start as early as age 40 in 5-10% of

patients. Over the age of 40, PD affects 1 in 250 people, 1 in 100 people over the age of 65, and

1 in 10 adults over the age of 80. Lastly, approximately 15-20% of affected people have a

genetic component that increases their risks of developing PD, but it is more common in white

males.

Also known as the most common neurological disorder, PD results from the

degeneration of nerve cells in the basal ganglia called the substantia nigra. Other causes of this

disease may include genetics and environmental triggers. Researchers have studied specific

genes as a cause of PD, but these are uncommon unless in rare cases throughout family members

who are affected. For environmental triggers, being exposed to pollution and toxins can increase

the risk of PD, but the risk is very low. Although these are common factors, the actual cause of

PD is unknown. For an individual to be diagnosed with PD, they need to visit a doctor who

specializes in nervous system conditions. Then, the neurologist may conduct a neurological and

physical examination to review certain signs and symptoms (Parkinson’s disease, 2018). Some
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might use the Hoehn and Yahr Scale to determine and describe the progression of PD. It is

divided into five stages:

1. Stage one: unilateral disease where symptoms are mild and only occur on one side of

the body.

2. Stage two: bilateral disease where symptoms occur on both sides of the body without

impairment of balance.

3. Stage three: mild to moderate bilateral disease where some postural stability is

affected, but the patient is still fully independent in their daily living activities.

4. Stage four: the patient experiences significant disability, but are still able to walk or

stand unassisted.

5. Stage five: most advanced, where the patient uses a wheelchair and loses

independence (Diagnosis – Rating Scales, 2017).

Ordering lab tests such as blood tests and imaging tests may also be conducted to rule out

any other conditions that may be causing certain symptoms. If the neurologist suspects the

patient has PD, then they will recommend revisiting the office to evaluate their conditions and

symptoms over time and officially diagnose them. Once a patient is diagnosed, the neurologist

will recommend a course of action for the patient (Parkinson’s disease, 2018).

Because the cause of PD is unknown, there aren’t many treatment options, so controlling

certain symptoms is the route most doctors recommend. Lifestyle changes, physical therapy,

recreational therapy, language pathologist, and medications are some of the few treatment areas

people can start. Medications can help manage problems with walking, movement, and tremors

by increasing or substituting for brain dopamine. Although patients begin to respond to

medications significantly, over time the medications tend to decrease and become less consistent.
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If PD continues to worsen, surgical procedures, like deep brain stimulation (DBS), may be

recommended depending on the patient’s current health (Parkinson’s disease, 2018).

The prognosis of PD doesn’t fall on the actual disease but depends on any secondary

complications one might develop after. According to MedicineNet, PD itself isn’t a fatal disease

because life expectancy is similar to people without the disease. So, secondary complications

such as pneumonia, falling-related injuries, and choking can lead to death (Heyn, Davis, &

Stöppler, 2019).

Part 2: Effect of Condition and Related Limitations of Functioning:

When an individual is diagnosed with PD, physical functioning tends to be the most

affected. According to our notes, resting tremors, postural tremors, stiffness in the legs or neck,

mast like staring, bradykinesia (slowed movements), difficulty maintaining balance & posture,

intestinal problems, spontaneous muscle movements, and speech changes are just some ways

physical functioning can be affected. Their cognitive function can also be affected. For example,

if an individual has PD they are prone to experience dementia, a disorder that causes problems

with memory and thinking, as well as, “predominant executive function deficits, attention

difficulties, visuospatial dysfunction, slowed thinking, difficulties in word-finding, and

difficulties in learning and remembering information” (Barros).

Social functioning may also be affected while a person has PD. They may experience

depression and anxiety leading to social withdrawal and them avoiding social settings. For

emotional functioning, individuals may experience an effect on their emotional recognition,

which includes recognizing emotional faces and voices. Also, an individual’s ability to express

emotions is reduced. This is important because as their PD progresses, “patients need to have
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complete emotional cognitive ability to communicate effectively with their caregivers” (Mumal,

2017).

PD can affect an individual’s independence in important life activities through work, self-

managing, and leisure and community involvement. For example, PD can affect a person’s

ability to work depending on the type and severity of one’s symptoms as well as their type of

job. According to the Michael J. Fox Foundation, some people with PD are still going to work

after 20 years of being diagnosed, but for others, their symptoms become more severe and make

it difficult for them to continue their jobs. So, if this happens, individuals usually transfer to a

more manageable job or wok part-time (Workplace Challenges). Next, according to an article,

there are seven ways individuals can self-manage PD. These ways include: educating oneself,

living a healthy lifestyle, hobbies and socializing, complementary therapies, mobility aids,

keeping one’s independence, and joining a support group (Henderson, 2018). Finally, PD

decreases an individual’s ability to participate in specific exercises involving extreme physical

activity and lifting heavy objects that require you to strain. Also, if an individual is participating

in a leisure activity, they are at high risk of swelling in feet or ankles, so this will shorten or

affect their leisure participation (Lava, 2018).

Someone who is affected with PD in which has developed gradually around the age of 60

can live for 10-20 years after being diagnosed. Although individuals may live 10-20 years after

diagnosis, “the patients current age and general health status factor into this estimate.” Because

there is no cure, individuals may experience chronic and progressive tremors as well as various

symptoms. These symptoms include: bradykinesia, rigidity, and tremors (Videnovic, 2019).

Client Description:
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Justin is a 65-year-old male who was recently diagnosed with Parkinson’s Disease. He is

currently receiving medications to help control his symptoms and has been recommended to

change his lifestyles. A few recommended changes include aerobic exercises, nutrition

management, and social support. He was recently moved into an assisted living nursing home for

seniors with PD where he has developed anxiety in social participations. His family rarely visits

him because they are busy with their jobs and families which is making him depressed. Before

coming to the nursing home, his interest was playing golf, fishing, and reading the newspaper.

Part 3: Client Needs and RT Service Provision

NEEDS: Reducing anxiety in social participation.

- OBJECTIVE: The client will attend two social events per week to reduce anxiety during

social participation when engaging in Social Therapy with the recreational therapist.

o INTERVENTION: Social Therapy

Social Therapy allows for individuals to develop friendships as they becoming

older. It is an intervention and group-based therapy where the individual attending

experiences psychological issues or anxiety to therapeutic group settings (Social

Therapy). Some precautions may include allowing plenty of time for the

individual to attend event, have a plan for individuals with bathroom needs, and

be aware of rigidity and trembling of head and extremities. Some

contraindications may include being aware of fall prone to areas due to the

individual’s forward tilt of trunk, be aware of facial expressions to indicate mood,

be aware of possible injuries due to tremors and loss of fine hand movements.
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Possible equipment may include wheelchair for individuals to be transported

easier from room to room.

NEEDS: Increasing mobility and function through interest in aerobic exercises.

- OBJECTIVE: The client will attend one Aerobic Therapy Exercise class per week to

increase their interest in aerobic exercises and increase their mobility and function with a

recreational therapist.

o INTERVENTION: Aerobic Therapy Exercise

Aerobic Therapy are exercises that are performed at a level of intensity that is

comfortable for the individual. Exercises may include swimming, dancing,

walking, and aerobic exercise classes. Some precautions may include reminding

clients to drink fluids during and after exercise, not increasing temperature inside

the workout room, and remind participants to wear supporting and comfortable

shoes. Some contraindications may include being aware of excessive heat in the

exercise room leading to dehydration and exhaustion and being aware of injuries

and muscle tears in older adults. Possible equipment may include adaptive

exercise equipment, medical power lifting chairs, wheelchairs, and walkers.

According to the notes, as a recreational therapist, we can tell individuals with PD to

make a more active role in their management of their condition. If they are able to cope, then it

can help manage their disease which with decrease PD itself.

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Reference List

Barros, A. D. A. de. (n.d.). Cognitive Impairment in Parkinson's disease. Retrieved November 7,

2019, from https://parkinsonsnewstoday.com/parkinsons-disease-symptoms/non-

motor/cognitive-impairment/.

Diagnosis - Rating Scales. (2017). Retrieved October 30, 2019, from

https://parkinsonsdisease.net/diagnosis/rating-scales-staging/.

Henderson, W. (2018, February 7). 7 Ways to Self-Manage Your Parkinson's Disease. Retrieved

November 7, 2019, from https://parkinsonsnewstoday.com/2018/02/07/7-ways-self-

manage-parkinsons-disease/.

Heyn, S. N., Davis, C. P., & Stöppler, M. C. (2019, September 11). Parkinson's Disease Early

and Later Symptoms, 5 Stages, and Prognosis. Retrieved October 30, 2019, from

https://www.medicinenet.com/parkinsons_disease/article.htm.

Lava, N. (2018, October 21). Parkinson's Disease Daily Activities, Care, and Energy. Retrieved

November 7, 2019, from https://www.webmd.com/parkinsons-disease/guide/parkinsons-

daily-activities#1.

Mumal, I. (2017, December 15). Impaired Emotional Recognition and Expression Seen in

Parkinson's. Retrieved November 7, 2019, from

https://parkinsonsnewstoday.com/2017/12/08/parkinsons-disease-impaired-emotional-

recognition-expression/.

Parkinson's disease. (2018, June 30). Retrieved October 29, 2019, from

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-

causes/syc-20376055.
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Social Therapy. (n.d.). Retrieved November 22, 2019, from https://www.cerebralpalsy.org/about-

cerebral-palsy/treatment/therapy/social-therapy.

Workplace Challenges. (n.d.). Retrieved November 7, 2019, from

https://www.michaeljfox.org/news/workplace-challenges.

Videnovic, A. (2019, June 12). How Long Can Someone Live with Parkinson's Disease?

Retrieved November 7, 2019, from https://www.agingcare.com/articles/parkinsons-

disease-how-long-can-a-person-live-after-diagnosis-123302.htm.