This paper focuses on the case of Sheila, a 75-year old woman diagnosed with Parkinson’s disease. Using this case, I explored the five domains of the OT Practice Framework, including occupation, client factors, performance skills, performance patterns, and context and environment. Each of the domains has a list of aspects, some of which I described in more detail in this paper. These included instrumental activities of daily living, beliefs, motor and praxis skills, rituals, and personal context. I also explained how each of the aspects would manifest itself in the case of Sheila. Next, the paper includes three organizations that the client could use to manage her condition. These included Parkinson’s Foundation, the American Parkinson Disease Association (APDA), and The Michael J. Fox Foundation for Parkinson’s Research. All three organizations have user-friendly websites offering information and support to people with Parkinson’s disease. The paper ends with an “elevator speech” defining occupational therapy.
Keywords: occupational therapy, Parkinson’s disease, OT Practice Framework.
Practice Domain: Geriatrics
My case study relates to the geriatrics field. I selected the case of Sheila, a 75-year old retiree diagnosed with Parkinson’s disease. In would start by collecting client-specific data on areas of occupation, which include activities of daily living (ADLs), instrumental ADLs, rest and sleep patterns, education, leisure, and social participation (Vroman & Stewart, 2013). I would specifically focus on instrumental ADLs such as care of others, care of pets, and home management, as there are the main activities in which older women engage most of the time. For example, Sheila may share how she takes care of her grandchildren on the weekends and how she takes care of her two cats. Such meaningful activities bring her a sense of purpose and many positive emotions. She may tell me about her home activities such as cleaning, washing up, ironing, etc. and the way her tremor affects her efficiency. Issues of confidence and independence may emerge when discussing this aspect of the domain.
When assessing client factors, I would focus on collecting data about Sheila’s specific capacities, characteristics, and beliefs (Hinojosa et al., 2017). I will ask her about body functions, values, and spirituality to create a fuller picture of the client and her physical and spiritual needs. For example, Sheila may share her beliefs about health and wellbeing and state that she needs to continue doing her activities because she wants to knit fine clothes for her small grandchildren and wants to feel valued. She may also share some information about her religion and how going to the church every Sunday helps her connect with God and maintain social connections. Sheila may also dwell on how she perceives health at her age and how her health beliefs affect her physical activity and diet.
Next, I would assess performance skills, which include motor and praxis skills, cognitive skills, communication and social skills, sensory-perceptual skills, and emotional regulation skills (Vroman & Stewart, 2013). Given the fact that Sheila tremors consistently, I would focus on the former aspect of the domain, that is, motor and praxis skills. The client may explain whether she faces any difficulties holding, grabbing, and using things (e.g., a kitchen knife), how she adapts to her condition, etc. Any fine object manipulation may be challenging for people with Parkinson’s disease (Norman & Héroux, 2013). Sheila may share her concerns regarding knitting and sewing and confide that she struggles with engaging in these activities as much as she did before the onset of the disease. In addition, Sheila may experience movement slowness, which may pose a challenge in terms of house management.
Furthermore, I would focus on performance patterns, which include habits, roles, routines, rituals, etc. (Vroman & Stewart, 2013). For example, I will ask Sheila why knitting her important to her, and she may respond that it is associated with a very important ritual in her family’s life. Every year, she knits soft sweaters to her children and grandchildren and presents them on the Christmas eve when they all gather for family dinner. Sheila believes that this ritual has a deep spiritual and emotional meaning for her because it is nice to know that she can do something good for the family and make them feel special and loved. As knitting becomes more challenging, Sheila is afraid that she will not be able to continue this family tradition any longer. Sheila may also tell that she has always had a morning ritual as she likes to sit on the porch with a cup of hot tea. Now that she has a tremor, she cannot bring a cup on the porch with her because she is afraid of spilling the hot water. Sheila may add that such small changes in rituals make her feel depressed.
Finally, I would assess the last OT Practice Framework domain called context and environment, which includes cultural, personal, social, temporal, and virtual aspects (AOTA, 2014). In the case of Sheila, I would want to focus more on the personal context, that is, the way her age, gender, family status, socioeconomic status, educational level, and religion affect her experiences. Learning more about Sheila’s literacy level and financial situation is particularly important in terms of planning appropriate OT interventions. Moreover, since Sheila lives alone now, OT may require more focus on independent living and self-management.
The first organization that I would recommend to Sheila as a useful source of information about her condition is Parkinson’s Foundation. Its website contains much useful information about managing the disease, legal and financial/insurance matters, resources and support, and so on. It also can help locate expert PD centers in the Sheila’s area, which may include support groups, education programs, exercise and wellness classes, and so on. I recommend this organization because, throughout its long history, it accumulated knowledge and expertise needed to provide evidence-based support to people with Parkinson’s disease. Its website is easy to navigate and user friendly, so Sheila may find it particularly useful for expanding her knowledge about the disease and seeking help.
The second organization that I think may help Sheila manage her disease is the American Parkinson Disease Association (APDA). This reputable organization offers support, education, and research to people diagnosed with this debilitating condition. APDA website helps find APDA resources in one’s community, which may be particularly valuable for Sheila. The organization provides support and exercise groups, which improve the quality of life and expand social networks of people diagnosed with Parkinson’s disease. APDA’s website is also easy to use, so Sheila would not have to ask her family to help her. Sheila may also contribute to research on Parkinson’s disease by participating in the survey on the website.
The third organization that I would recommend to Sheila is The Michael J. Fox Foundation for Parkinson’s Research. Established by Michael J. Fox, a famous actor and advocate, this organization seeks to find a cure to Parkinson’s disease. While research is its primary focus, it also helps people by providing valuable information about the causes of this disease, symptoms, medication and treatment, etc. Similar to the other two organizations, this one also offers some social support and inspiration through its website. I would recommend it to Sheila to learn more about how she could manage her condition effectively and minimize its effects on her daily life. In addition, the organization’s website offers an opportunity to advocate for changes by inviting users to contact policymakers and learn more about how one can participate in advocacy. Although this last feature may be difficult for Sheila to navigate, her family members could use it to affect healthcare policies.
Briefly speaking, I define OT as the therapy using everyday life activities to enhance patients’ participation in their normal roles, routines, and habits in home, work, school, and other settings. It seeks to improve body functions, body structures, skills, and spiritual dimensions (beliefs, values) to help clients return to independent, healthy living (AOTA, 2014). OT recognizes clients’ uniqueness, as well as the dynamic nature and diversity of each patient’s situation and condition. OT provides a framework in which occupational therapists can address each client’s physical and mental needs in the context of their day-to-day circumstances (Duncan, 2020).