Parkinson's Disease: Dyskinesias (Nursing)

00:00 So, let's take a look at the difficulty controlling movement.

00:03 You see we have an elderly patient here for you to see.

00:05 We'll talk about the dyskinesias.

00:08 They can have a tremor at rest.

00:10 So, even when a patient isn't moving, you'll notice that their hands are severely shaking.

00:15 Now, you might be familiar with an American actor named Michael J. Fox.

00:19 He's been diagnosed with Parkinson's.

00:21 Actually, several prominent and famous people have been diagnosed with Parkinson's.

00:26 Michael J Fox was on a TV show and he didn't want anyone to know at that point that he had been diagnosed with Parkinson's.

00:34 So there would be times when his tremors would get out of control, he didn't want people to see that.

00:40 So, if you watch the show that he's on, you'll see that he often has his hands in his pockets.

00:44 That's one way that he could control the tremors.

00:47 Now, when that was not good enough, he would just stay in his trailer and ask for a break.

00:52 Apparently, some people thought he was kind of a diva when, really, he wasn't.

00:57 He was just waiting for his medication to kick in for a diagnosis that the other actors were not aware that he had.

01:03 So, the tremor is very difficult for patients to deal with.

01:07 They feel like-- they feel self-conscious about it, it draws attention to them.

01:11 And then think about if you're trying to drink a cup of coffee or you're trying to write something, it makes very basic activities that we take for granted almost impossible, depending on how intense the tremor is.

01:23 Now, they also have postural instability.

01:26 That means there's an increased risk for falls.

01:29 We have to take special care with these patients to make sure walkways are clear.

01:33 There's nothing that they're going to trip over and know that they might need to use some assistive devices.

01:39 Now, on top of being posturally unstable, they can't respond like you normally can because they're very rigid.

01:47 And on top of that, they move slow.

01:49 So, they've got tremors. They're not very stable.

01:53 They're super stiff and they have these slow movements, so they cannot respond to changes in order to keep themselves as safe as they could before having Parkinson's.

02:03 So, what do we do to collaboratively care for patients with dyskinesias? Well, your best friend is going to be a physical therapist.

02:11 They can help you with assessing the patient and planning an individualized exercise program.

02:16 This type of program will help with functional needs and help the patient become able to work better on their balance, their strength, and to maintain as much functional ability as possible.

02:27 So, when we're talking about collaborative care, our physical therapist is going to play a vital role in helping our patient safely perform walking, sitting, standing, and other activities of daily life.

02:41 You may also work with an occupational therapist and a speech therapist.

02:44 Every level of care will be individualized.

02:47 But if we work with an occupational therapist and a physical therapist, now we can actually look at the safety evaluation and environmental risk for falls.

02:56 So not only in the hospital, that's usually a pretty clear environment, but as a healthcare team: occupational therapists, physical therapists, possibly a speech therapist, and the nurse, we're going to evaluate what their home environment is, because we want to know-- We want to be able to provide the most effective tools for this patient to use.

03:17 Now, there are lots of really cool things out there.

03:20 They've even got something for-- It's a spoon that will also-- that will also pulsate, and you can match it to the patient's tremors.

03:28 So, it kind of helps balance out or neutralize a tremor.

03:31 We've got a large handle, it's easy for the patient to hold.

03:34 The spoon itself actually moves, so that can neutralize the tremor and allow a patient to feed themselves.

03:41 Physical therapist, occupational therapist, speech therapist, they are very up-to-date on what the latest tools and accessories are that are out there to help this patient live as normal a life as possible which will help their quality of life and their overall mood and response.

03:59 So, use the advantage that you have on working at a team.

04:03 They can help you provide assistance to maintain the highest level of independence for your patient.

04:09 Now, the big one, minimizing falls risk.

04:13 See if you can remember for just a minute, what are the reasons that specifically put a Parkinson's patient at risk? Right, they're rigid.

04:23 They move slow, their postural instability.

04:26 So, that's going to be really difficult for them and make them a high risk for falls.

04:31 So, you want to make the patient and the family aware of, "Hey, here are some things that other patients have used." Now, downplay this, and I say that in a way like don't make this a big deal.

04:42 Whenever you fall, the first thing you do and you look-- when you get up as you look around to see who saw you do that, right? Because everyone feels kind of ridiculous when they fall.

04:52 Well, it's no different for a Parkinson's patient.

04:54 So, this is somewhat of a touchy subject.

04:58 You would want to re-emphasize with the patient.

05:01 "Hey, because Parkinson's gives you some extra challenges with walking, we know that this is not how things normally have worked for you and your body, so we just want you to be aware.

05:10 We absolutely want to help you minimize the risk of a fall.

05:14 So, these are things that other patients have told us were very effective." If you have loose throw rugs on the floor, you're going to need to move those.

05:22 Now, some people really tape them down with a special carpet tape, but it would really be the best if you have any loose throw rugs on the floor that might risk tripping if you just remove those from the house.

05:35 Make sure lighting is good.

05:37 You need adequate lighting.

05:39 The house needs to be well lit, so that the patient can see clearly where they're walking.

05:44 And think about the arrangement of your furniture.

05:47 Make sure there are clear and direct pathways for the patient to get to the key and most often visited places in the home, and make sure there's no clutter like cord running across the floor or in front of their path.

05:59 So, you just want to make sure the patient can adequately and clearly see their path, and then it's clear of any throw rugs, extension cords, or anything else that's in the path.

06:11 So, if shoes are normally kept by the door if you could move those to another area, those types of things.

06:16 You just want to look at the home environment with a new eye.

06:19 And we may work with physical therapy, occupational therapy, and speech therapy in the hospital, and then there's a home care team that can also work directly in the home.

06:31 So, what are some other tools that we can use, some other assistive devices, because we're still addressing this falls risk? So, the bathroom may need to be adapted, so we can either use like a grab bar and you can put that on the side by the toilet, so the patient can use that to help them stand up.

06:46 We might use a raised toilet seat, so the patient doesn't take as much effort to use the toilet.

06:52 So not sitting down a really long way, it makes it easier for them to get back up.

06:56 You might also consider a shower chair.

06:59 Nothing feels as good as being able to take your own shower and be clean.

07:04 So if you can just put maybe a shower chair in there where the patient can easily enter the shower and exit the shower, that would be really helpful.

07:13 Now, keep in mind, if the patient's shower is only in a bathtub, we need to look at a special seat that will let the patient sit and slide in, and then stand up in the shower.

07:25 It'd be very difficult for a Parkinson's patient to lift their leg over the side of a bathtub to stand in there to take a shower.

07:33 Now, you want them to have the right shoes.

07:36 It's really a good idea for a patient to have nice, supportive, and sturdy shoes.

07:41 You might just get a really good tennis shoe or depending on what the patient fits them the best.

07:47 Work with the physical therapist, see what the best option would be for the patient.

07:52 Now, rolling walkers are really good.

07:54 So, encourage the patient to utilize a rolling walker or a cane, but a rolling walker is going to be even safer if the patient is willing to use it.

08:03 I don't know if you've checked out any of these styles lately, but some of them are pretty cool.

08:07 They have wheels. They have brakes.

08:09 They even have a seat for the patient if they get tired.

08:12 And they sometimes have like basket attachments, so they can put important things in them.

08:16 So, rolling walkers have come a long way.

08:20 They're very useful.

08:21 But be patient, this might be a difficult thing for a patient to adjust to, because it feels like they're really losing some of their independence.

08:30 If you can help them see, "Hey, these are really effective.

08:33 You're gonna feel safer.

08:35 They make them small enough that you can move them in and out of restaurant areas.

08:39 You can get in and out of tight areas." So, this is really gonna be a benefit and will significantly minimize the risk of falls if a patient can use a walker.

08:49 Because that's what we want to do.

08:51 We want to encourage the patient to be independent.

08:54 We don't want them to become so down that they just kind of sit and want other people to take care of them.

09:00 That's not a normal and healthy outlook.

09:02 We want them to be independent.

09:04 So, we have to be extra patient.

09:08 And we have to help the family members recognize it.

09:10 Things are going to take longer.

09:12 You're not just going to get up, jump out of bed, and go somewhere.

09:15 It's going to take a little bit longer for a patient with Parkinson's to get moving in the morning and to get ready to go.

09:21 So, be prepared.

09:23 Allow extra time as a nurse for the patient to perform personal hygiene and help the patient understand and their family, it's going to take longer for your morning routine.

09:34 So, self-care activities and their activities of daily living are going to take a longer period of time, but that's okay.

09:42 That's normal. It's all right.

09:45 We just want you to stay as independent as possible.

09:48 Now, the occupational therapist, again, we talked about they're really good at helping you find adaptive tools for eating.

09:54 I talked about that spoon that kind of moves also, so it makes it easier to neutralize that tremor.

10:00 I think that is amazing.

10:02 There's all kinds of items for dressing whether working with the clothing that the patient has or there's designers that are now designing clothing for people that have difficulty with dressing themselves that you would never know.

10:16 They've got Velcro and not the traditional closures and types like that.

10:20 So, there's lots of things out there that are available.

10:24 So whether person needs to carry an object, dress themselves, feed themselves, there's probably a tool out there that can help them.

10:32 Now, if they're going to use a hot beverage or even a cold one, you want to make sure that the cup has a lid.

10:37 So, just get a cool travel mug that has the right kind of handle for the patient to hang on to, and keep moving.

10:45 This stuff isn't worth losing a lot of sleep over, or worry, or stress.

10:51 There's much bigger obstacles in life to deal with, so we just help them find the right adaptive tool for the basic functions of daily life.