• Smaller, more frequent meals
• Avoid increased time in motionless positions
• Avoid warmer temperatures
• Avoid valsalva-provoking maneuvers
Compensatory strategies for self-feeding skills with tremor:
• Use of adaptive devices( adaptive utensils and plate guards)
• Nonskid mat( Dycem ®) to prevent the plate / bowl from sliding
• Arm position— anchor elbow on table, then lower arm down to plate / bowl to retrieve food and then back up to mouth( using the arm as a lever, never taking the elbow up / off of the table)
• Use deep spoons to assist with scooping
• Elevate the height of the dish bowl
Functional mobility in the home bedroom:
• Use a bedrail to assist with difficulty rolling
• Keep floors clutter free and walkways well lit
• Wear warmer pajamas and use fewer blankets to decrease likelihood of getting tangled up in bed
• Use a satin pillowcase / sheet under the bottom of the patient to assist with improving bed mobility
• Always sit as much as possible when dressing to help decrease risk of falls( hypotension)
• Always dress the most affected limb first
Functional mobility in the home bathroom:
• Grab bar / hand-held showerhead installation
• Remove glass partitions in the shower / tub to make transfers in / out easier and safer( sit and swing technique vs. step in)
• Use a shower bench / tub chair with a back to decrease risk of slipping, promote good posture and conserve energy
• Always sit as much as possible when bathing; eliminate all turning in the shower
• Avoid extremely hot showers to decrease dizziness / lightheadedness
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Functional mobility in the home kitchen:
• Never overreach; get as close as you can to the object that you are reaching for( e. g., in cabinets)
• Always support yourself with one hand when reaching( e. g., countertop)
• Always stand to the side of the dishwasher / oven / refrigerator when opening
• Make U-turns in open spaces around the house( swivel-wheeled rollators with brakes work well)
• Avoid pivot turns or crossing one foot over the other to turn; instead move right foot first to turn right, left to turn left
• Use a wide staggered stance when performing activities( this helps to reduce LOB and retropulsion)
• Side step when working at the counter-space or sink
Research Articles Jain S, Dawson J, Quinn NP, Playford ED. Occupational Therapy in multiple system atrophy: a pilot randomized controlled trial. Mov Disord. 2004 Nov; 19( 11): 1360-4.