“Timing is everything.” This is probably the most significant understatement in relationship to a Parkinson’s patient and rehabilitation services. When a patient with Parkinson’s disease enters a rehab center, issues and treatments need to be sequenced in correlation to each other. What does that mean?
When a patient is being assessed to determine their rehabilitation potential, it is vital that they are evaluated during “on time.” If they are experiencing freezing during the assessment, the therapist will not be able to accurately determine the patient’s potential. It may be inaccurately determined that the patient is unwilling to work with the therapist when in fact at that moment they were experiencing inadequate dopamine levels in their brain.
The first goal needs to establish as much “on time” as possible. Administering medications on an individual basis is required to promote mobility, fluent movement, and personal care ability to work with therapists. If a patient is experiencing “off time” during therapy, more days will be required for the patient to meet their therapy goals. This will increase healthcare costs. Additionally, a lack of progress may be prematurely diagnosed.
Examples of therapy challenges:
- Physical Therapy: If a patient is having difficulty rising from a chair or initiating their first step due to sub-therapeutic treatment of their Parkinson’s symptoms, gaining strength and practicing transfers will be nearly impossible. However, if a person receives therapy while their Parkinson’s symptoms are minimal, they will be better able to utilize therapy services.
- Speech Therapy: If someone is having swallowing or dexterity issues, working with a speech therapist will be compromised due to “off time.”
- Occupational Therapy: A person experiencing “on time” will be at their highest level of functioning. That is the time to determine how much personal assistance a patient actually needs.
Rest is also a component of regaining strength and stamina. If therapies are scheduled immediately after meals, fatigue may prohibit some patients from achieving their goals. However, other patients may feel the most energetic immediately after lunch because their medication is at peak levels. A challenge for a positive rehab stay is recognizing that no two patients will have the same schedule.
The components of care that must be scheduled specific to each individual include:
- Medication times.
- Meal times to not interfere with protein binding medications.
- All modalities of therapy during “on time.”
- Designated rest periods.
Nursing implications need to address the best interest of the patient. Advocate for the specific schedule individually established for each Parkinson’s patient. Always assure levodopa is given on an empty stomach at least one hour prior to meals. Be sure all multidisciplinary team members are aware of “on times” and “off times.” Fluent communication is essential.