00:00
So, let's take a look
at the difficulty controlling movement.
00:03
You see we have an elderly patient
here for you to see.
00:05
We'll talk about the dyskinesias.
00:08
They can have a tremor at rest.
00:10
So, even when a patient isn't moving,
you'll notice that their hands
are severely shaking.
00:15
Now, you might be familiar
with an American actor
named Michael J. Fox.
00:19
He's been diagnosed with Parkinson's.
00:21
Actually, several prominent
and famous people
have been diagnosed with Parkinson's.
00:26
Michael J Fox was on a TV show
and he didn't want anyone
to know at that point
that he had been diagnosed
with Parkinson's.
00:34
So there would be times
when his tremors would get out of control,
he didn't want people to see that.
00:40
So, if you watch the show that he's on,
you'll see that he often
has his hands in his pockets.
00:44
That's one way
that he could control the tremors.
00:47
Now, when that was not good enough,
he would just stay in his trailer
and ask for a break.
00:52
Apparently, some people thought
he was kind of a diva
when, really, he wasn't.
00:57
He was just waiting
for his medication to kick in
for a diagnosis that the other actors
were not aware that he had.
01:03
So, the tremor is very difficult
for patients to deal with.
01:07
They feel like--
they feel self-conscious about it,
it draws attention to them.
01:11
And then think about
if you're trying to drink a cup of coffee
or you're trying to write something,
it makes very basic activities
that we take for granted
almost impossible,
depending on how intense
the tremor is.
01:23
Now, they also have postural instability.
01:26
That means there's an increased
risk for falls.
01:29
We have to take special care
with these patients
to make sure walkways are clear.
01:33
There's nothing
that they're going to trip over
and know that they might need
to use some assistive devices.
01:39
Now, on top of being
posturally unstable,
they can't respond
like you normally can
because they're very rigid.
01:47
And on top of that,
they move slow.
01:49
So, they've got tremors.
They're not very stable.
01:53
They're super stiff
and they have these slow movements,
so they cannot respond to changes
in order to keep themselves
as safe as they could
before having Parkinson's.
02:03
So, what do we do
to collaboratively care
for patients with dyskinesias?
Well, your best friend
is going to be a physical therapist.
02:11
They can help you
with assessing the patient
and planning an individualized
exercise program.
02:16
This type of program will help
with functional needs
and help the patient become
able to work better on their balance,
their strength, and to maintain
as much functional ability as possible.
02:27
So, when we're talking
about collaborative care,
our physical therapist
is going to play a vital role
in helping our patient safely perform
walking, sitting, standing,
and other activities of daily life.
02:41
You may also work
with an occupational therapist
and a speech therapist.
02:44
Every level of care
will be individualized.
02:47
But if we work
with an occupational therapist
and a physical therapist,
now we can actually look
at the safety evaluation
and environmental risk for falls.
02:56
So not only in the hospital,
that's usually a pretty clear environment,
but as a healthcare team:
occupational therapists,
physical therapists,
possibly a speech therapist,
and the nurse,
we're going to evaluate
what their home environment is,
because we want to know--
We want to be able to provide
the most effective tools
for this patient to use.
03:17
Now, there are lots
of really cool things out there.
03:20
They've even got something for--
It's a spoon that will also--
that will also pulsate,
and you can match it
to the patient's tremors.
03:28
So, it kind of helps balance out
or neutralize a tremor.
03:31
We've got a large handle,
it's easy for the patient to hold.
03:34
The spoon itself actually moves,
so that can neutralize the tremor
and allow a patient
to feed themselves.
03:41
Physical therapist,
occupational therapist,
speech therapist,
they are very up-to-date
on what the latest tools
and accessories are
that are out there
to help this patient live
as normal a life as possible
which will help their quality of life
and their overall mood and response.
03:59
So, use the advantage that you have
on working at a team.
04:03
They can help you provide assistance
to maintain the highest level
of independence
for your patient.
04:09
Now, the big one,
minimizing falls risk.
04:13
See if you can remember
for just a minute,
what are the reasons that specifically put
a Parkinson's patient at risk?
Right, they're rigid.
04:23
They move slow,
their postural instability.
04:26
So, that's going to be
really difficult for them
and make them a high risk for falls.
04:31
So, you want to make the patient
and the family aware of,
"Hey, here are some things
that other patients have used."
Now, downplay this,
and I say that in a way
like don't make this a big deal.
04:42
Whenever you fall,
the first thing you do and you look--
when you get up
as you look around to see
who saw you do that, right?
Because everyone feels
kind of ridiculous when they fall.
04:52
Well, it's no different
for a Parkinson's patient.
04:54
So, this is somewhat
of a touchy subject.
04:58
You would want to re-emphasize
with the patient.
05:01
"Hey, because Parkinson's gives you
some extra challenges with walking,
we know that this is not how things
normally have worked for you and your body,
so we just want you to be aware.
05:10
We absolutely want to help you
minimize the risk of a fall.
05:14
So, these are things that other patients
have told us were very effective."
If you have loose throw rugs
on the floor,
you're going to need to move those.
05:22
Now, some people really tape them down
with a special carpet tape,
but it would really be the best
if you have any loose throw rugs
on the floor
that might risk tripping
if you just remove those
from the house.
05:35
Make sure lighting is good.
05:37
You need adequate lighting.
05:39
The house needs to be well lit,
so that the patient can see clearly
where they're walking.
05:44
And think about the arrangement
of your furniture.
05:47
Make sure there are clear
and direct pathways
for the patient to get to the key
and most often visited places
in the home,
and make sure there's no clutter
like cord running across the floor
or in front of their path.
05:59
So, you just want to make sure
the patient can adequately
and clearly see their path,
and then it's clear of any throw rugs,
extension cords,
or anything else that's in the path.
06:11
So, if shoes are normally kept by the door
if you could move those to another area,
those types of things.
06:16
You just want to look
at the home environment with a new eye.
06:19
And we may work with physical therapy,
occupational therapy,
and speech therapy in the hospital,
and then there's a home care team
that can also work directly in the home.
06:31
So, what are some other tools
that we can use,
some other assistive devices,
because we're still addressing
this falls risk?
So, the bathroom
may need to be adapted,
so we can either use like a grab bar
and you can put that
on the side by the toilet,
so the patient can use that
to help them stand up.
06:46
We might use a raised toilet seat,
so the patient doesn't take
as much effort to use the toilet.
06:52
So not sitting down a really long way,
it makes it easier for them to get back up.
06:56
You might also consider
a shower chair.
06:59
Nothing feels as good
as being able to take your own shower
and be clean.
07:04
So if you can just put
maybe a shower chair in there
where the patient can easily
enter the shower and exit the shower,
that would be really helpful.
07:13
Now, keep in mind,
if the patient's shower
is only in a bathtub,
we need to look at a special seat
that will let the patient sit and slide in,
and then stand up in the shower.
07:25
It'd be very difficult
for a Parkinson's patient
to lift their leg
over the side of a bathtub
to stand in there to take a shower.
07:33
Now, you want them
to have the right shoes.
07:36
It's really a good idea for a patient
to have nice, supportive, and sturdy shoes.
07:41
You might just get
a really good tennis shoe
or depending on what the patient
fits them the best.
07:47
Work with the physical therapist,
see what the best option
would be for the patient.
07:52
Now, rolling walkers are really good.
07:54
So, encourage the patient
to utilize a rolling walker or a cane,
but a rolling walker
is going to be even safer
if the patient is willing to use it.
08:03
I don't know if you've checked out
any of these styles lately,
but some of them are pretty cool.
08:07
They have wheels.
They have brakes.
08:09
They even have a seat for the patient
if they get tired.
08:12
And they sometimes have
like basket attachments,
so they can put important things in them.
08:16
So, rolling walkers
have come a long way.
08:20
They're very useful.
08:21
But be patient,
this might be a difficult thing
for a patient to adjust to,
because it feels like
they're really losing
some of their independence.
08:30
If you can help them see,
"Hey, these are really effective.
08:33
You're gonna feel safer.
08:35
They make them small enough
that you can move them
in and out of restaurant areas.
08:39
You can get in and out of tight areas."
So, this is really gonna be a benefit
and will significantly minimize
the risk of falls
if a patient can use a walker.
08:49
Because that's what we want to do.
08:51
We want to encourage the patient
to be independent.
08:54
We don't want them
to become so down
that they just kind of sit
and want other people
to take care of them.
09:00
That's not a normal
and healthy outlook.
09:02
We want them to be independent.
09:04
So, we have to be extra patient.
09:08
And we have to help
the family members recognize it.
09:10
Things are going to take longer.
09:12
You're not just going to get up,
jump out of bed, and go somewhere.
09:15
It's going to take a little bit longer
for a patient with Parkinson's
to get moving in the morning
and to get ready to go.
09:21
So, be prepared.
09:23
Allow extra time as a nurse
for the patient to perform personal hygiene
and help the patient understand
and their family,
it's going to take longer
for your morning routine.
09:34
So, self-care activities
and their activities of daily living
are going to take
a longer period of time,
but that's okay.
09:42
That's normal.
It's all right.
09:45
We just want you to stay
as independent as possible.
09:48
Now, the occupational therapist,
again, we talked
about they're really good
at helping you find
adaptive tools for eating.
09:54
I talked about that spoon
that kind of moves also,
so it makes it easier
to neutralize that tremor.
10:00
I think that is amazing.
10:02
There's all kinds of items
for dressing
whether working with the clothing
that the patient has
or there's designers
that are now designing clothing
for people that have difficulty
with dressing themselves
that you would never know.
10:16
They've got Velcro
and not the traditional closures
and types like that.
10:20
So, there's lots of things out there
that are available.
10:24
So whether person needs
to carry an object, dress themselves,
feed themselves,
there's probably a tool out there
that can help them.
10:32
Now, if they're going to use
a hot beverage or even a cold one,
you want to make sure
that the cup has a lid.
10:37
So, just get a cool travel mug
that has the right kind of handle
for the patient to hang on to,
and keep moving.
10:45
This stuff isn't worth losing
a lot of sleep over,
or worry, or stress.
10:51
There's much bigger obstacles
in life to deal with,
so we just help them find
the right adaptive tool
for the basic functions of daily life.