THE ROLE OF OCCUPATIONAL THERAPISTS
THE ROLE OF OCCUPATIONAL THERAPISTS
Cognitive / Psychosocial Strategies
• Break down tasks into smaller steps / keep instructions simple
• Reduce background noise / eliminate distractions
• Stress can increase symptoms; in stressful situations( e. g., out in the community) be sure to simplify tasks
Multiple System Atrophy( MSA)
Occupational therapy may improve functional abilities in patients with mild to moderate MSA.
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Signs and Symptoms
• Rigidity
• Action tremor, i. e., irregular, jerky, myoclonic
• Bradykinesia
• Freezing of gait / gait and limb ataxia
• Early postural instability and falls
• Orthostatic hypotension
• Erectile dysfunction
• Bladder dysfunction / constipation
• Speech and swallow difficulties; mixed dysarthria tends to emerge earlier in MSA than PD, is more severe and deteriorates more rapidly
• REM Behavioral Disorder( RBD)— acting out dreams while sleeping due to lack of atonia
• Nystagmus and jerky pursuit
• Antecollis
• Difficulty with thermoregulation
• Cognitive impairment is typically mild
Treatment Strategies
• No medications to slow disease progression
Patient and caregiver education about disease For bradykinesia and rigidity:
• Levodopa and dopamine agonists may help initially
• Avoid hand flexion / resistive exercise( e. g., Thera Putty ®/ foam squeezes).
• Encourage hand / wrist extension instead
For orthostatic hypotension:
• Fludrocortisone, midodrine
• Increase salt in diet
• Rising slowly and resting after position changes
• Support stockings
• Elevate head of bed