Carl is a 62-year old college professor diagnosed with PD at the age of 57.

He is married and lives in a small one-story home with his wife. He has two adult children, who live in another state. Carl reports that he enjoys travelling, reading, painting and attending concerts. As a therapist, what areas will you assess: a. ADL b. IADL c. WORK d. LEISURE e. PLAY f. SCHOOL g. SOCIAL PARTICIPATION h. SLEEP Answers: ADL, IADL (Community mobility), Work, Leisure, Social Participation Incorrect: Play and School (for Pedia), Sleep (not indicated in the case) Part II: Carl recently considered taking early retirement because of the increase in tremors in both his hands, which made correcting papers difficult. He also reports some problems with endurance as a result of stiffness. Carl indicates that he is no longer able to paint because of the tremors in his hands. He also reports that he is unsure whether he should continue driving because of these tremors. When asked about his personal goals, Carl replies, I guess Ill have more time to read now. What formal and informal assessment and evaluation tools will you use: a. Interview b. Driving simulators c. Dynamometer d. Pinch meter e. FIM f. Aesthesiometer g. Beck Depression Inventory h. MMT i. COPM Answers: A. interview. During evaluation, it is important to interview both the client and the caregiver to obtain a clear occupational profile of the client. B. it is indicated in the case that he is unsure if he would still be unwilling to drive thus we should assess this area to identify appropriate recommendation (if he needs to stop driving) or goal (for continuation/modification) for this activity. E. FIM: since the patient lives with his wife, it is necessary to assess ADL skills to identify patients independence in this area. G: Beck Depression Inventory: it may not be directly indicated that the patient has depression but since he may lose his job and is currently having difficulty performing his leisure activities, depression may already be a developing problem for the patient. i. COPM: for leisure assessment Incorrect: C. D. F. H. not related to the case. Part III: Results of the OT evaluation indicate that Carl is cooperative and motivated for therapy. Although he does not indicate that he is depressed, his wife reports features of depression, such as a decreased interest in going to concerts and planning summer vacations to see their adult children and

grandchildren. His wife also reports that Carl seems depressed about his possible early retirement and loss of status as a college professor. What possible intervention could the OT provide? 1. Assess for computer access 2. Remove throw rugs and obstacles in walkways 3. Provide a tub seat and shower extension hose 4. Provide a raised toilet seat 5. Provide a cushion on dining room chairs 6. Instruct daily active ROM exercise program 7. Instruct in energy conservation, urging him to take frequent breaks and schedule activities during on phase of medications 8. Provide modifications to his easel, using forearm supports to allow him to continue to paint 9. Trunk extension and rotation exercises 10. Bilateral upper extremity exercise 11. Use of music during exercise program 12. Provide information regarding community-based Parkinsons disease support groups Answer: The following answers directly address problems in the work setting and leisure area. Assess work setting for modifications 1. Assess for computer access 7. Instruct in energy conservation, urging him to take frequent breaks and schedule activities during on phase of medications Investigate leisure pursuits 8. Provide modifications to his easel, using forearm supports to allow him to continue to paint 12. Provide information regarding community-based Parkinsons disease support groups Part IV: Carl is able to complete most personal ADLs independently but has difficulties stepping into and out of the tub and shower. His wife reports that she is afraid he will fall and that she often assists him in getting into and out of the shower. Carl also has difficulty tying his tie and buttoning his shirt. Tremors are noted bilaterally in his hands, and slight rigidity is present during PROM. Dynamic balance is slightly compromised on uneven surfaces and stairs. What possible ADL performance activities could you suggest? 1. Instruct use of a buttonhook 2. Remove throw rugs and obstacles in walkways 3. Provide a tub seat and shower extension hose 4. Provide a cushion on dining room chairs 5. Make suggestions regarding clothing modifications such as clip=on ties and slip-on shoes 6. Provide a raised toilet seat 7. Instruct in use of momentum to initiate movement, such as rocking back and forth to rise from a chair. 8. Assess for computer access 9. Instruct in energy conservation, urging him to take frequent breaks and schedule activities during on phase of medications Answer: The following answers consist of ADL performance activities. OT was initiated to accomplish the following: Improve ADL performance. 1. Instruct use of a buttonhook 5. Make suggestions regarding clothing modifications such as clip=on ties and slip-on shoes 7. Instruct in use of momentum to initiate movement, such as rocking back and forth to rise from a chair. Incorrect: the rest of the answers do not target ADL performance. Some include modification of home environment and assessing work setting for modification.

a. Modify home environment Result of Intervention: Carl responded well to OT intervention. Although he was able to complete the academic school year, he decided to retire afterwards. He stopped driving, but his wide began to drive them to concerts and art exhibits. He was able to complete personal ADLs safely with the use of adapted equipment and home modifications. He resumed painting during the on periods of his medication schedule, using the forearm supports attached to an angled table. He attended a Parkinsons support group two times a week and began to socialize with members from that group. Carl reported that the daily exercises seemed to decrease his stiffness, and he and his wife took frequent strolls in the park when weather permitted. He and his wife also joined a book club.