Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. People with Parkinson’s disease (PD) without dementia often have cognitive deficits that impact daily function. This study explored functional cognition and its neural substrates in PD without dementia. We found dissociable relationships between aspects of daily cognitive function and functional connectivity of cognitive brain networks. This information may ultimately guide OT practice that will improve or maintain functional cognition in those with PD. Primary Author and Speaker: Anneliese Schlesinger Additional Authors and Speakers: Erin Foster

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The current guideline criteria for diagnosing people with Parkinson's disease with mild cognitive impairment include neuropsychological tests to assess cognitive functioning. Assessments that reflect real-life confrontations can identify functional cognitive decline. OTs can contribute in implementing evaluations and developing performance-based interventions to promote daily life performance and quality of life and prevent the onset of increased disability. Primary Author and Speaker: Sonya Meyer Additional Authors and Speakers: Sara Rosenblum Contributing Authors: Netta Gemerman, Ariella Richardson, Tal Nevo, and Sharon Hassin-Baer

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. We completed a pilot study of an 8-week Merging Yoga and Occupational Therapy for Parkinson's Disease program (MY-OT for PD). MY-OT for PD was a fall-risk self-management program that merged community-based yoga and group OT. Participants served as their own controls during the pilot study. During the intervention period (as compared with the control period), participants experienced reduced self-reported falls, improved fall management and prevention, and improved balance. Primary Author and Speaker: Laura A. Swink Contributing Authors: Brett Fling, Julia L. Sharp, Christine A. Fruhauf, Karen Atler, and Arlene Schmid

Date Presented 04/200/21 OT has a valuable role in promoting quality of life for individuals with PD in all aspects of daily life. The Canadian Occupational Performance Measure (COPM) enables practitioners to address the holistic needs of clients, rather than exclusively focusing on predetermined areas of disability. This study has shown that the full breadth of clients' needs are vast and varied and exist beyond those included in standardized assessment tools because only one-third of the items identified by the COPM were included in the Movement Disorder Society—Unified Parkinson's Disease Rating Scale. Primary Author and Speaker: Abdullah Alsaeed Additional Authors and Speakers: Kristen A. Pickett Contributing Authors: Maria Widmer

Date Presented 04/12/21 OT has been specifically called upon to improve the quality of care of people with Parkinson's disease (PD). This capstone project is a response to this call. A two-module online learning program was designed to address the gap between knowledge and current best practices in the treatment of mental health concerns associated with PD. The results suggest that high-quality online training is an effective way to teach OTs to better address the mental health needs of people with PD. Primary Author and Speaker: Sarah A. Zurawski; Contributing Authors: Wendy Coster, Gael Orsmond

Date Presented 04/8/21 People with Parkinson's disease (PD) experience nonmotor symptoms (NMS) such as cognitive impairment, depression, and fatigue, all of which impact daily function. Despite the prevalence and negative impact of NMS, there are limited interventions. Improvisational dance (ID) requires spontaneous integration of cognitive and motor skills in a playful and nonjudgmental environment. This study found improvements in NMS and daily function in people with PD after participating in an ID class. Primary Author and Speaker: Margaret R. Fleita Additional Authors and Speakers: Erika Fimple, Nicole Renae Roberts

Importance: People with Parkinson’s disease (PD) commonly experience difficulty in performing activities of daily living (ADLs), which affects their perceived quality of life. Objective: To examine the evidence for the effectiveness of interventions within the scope of occupational therapy to improve performance and participation in ADLs, rest, and sleep in adults with PD. Data Sources: Databases searched were MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane Collection. Included articles were published between January 2011 and December 2018. Study Selection and Data Collection: Articles describing Level 1b, 2b, and 3b studies that examined outcomes related to ADLs, rest, and sleep in people with PD were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Forty-five articles (10 Level 1b, 27 Level 2b, and 8 Level 3b) met the inclusion criteria. Conclusions and Relevance: Strong strength of evidence was found to support inpatient multidisciplinary intensive rehabilitation treatment (MIRT) to improve ADLs, and moderate strength of evidence that MIRT improves sleep performance. Low strength of evidence was present for outpatient occupational therapy to improve ADL and sleep outcomes. Low strength of evidence was found for resistance exercise programs to improve ADLs, but moderate strength of evidence indicates that multimodal exercise programs and targeted exercise programs can improve ADLs. Low to moderate strength of evidence suggested that alternative therapies and cognitive–behavioral therapy have a positive impact on ADLs and sleep. These results can be used to inform evidence-based occupational therapy practice. What This Article Adds: This article provides information for practitioners on the effectiveness of interventions within the scope of occupational therapy practice to improve ADLs and sleep.

Importance: Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson’s disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD. Objective: To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD. Data Sources: MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1–3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy–related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation. Conclusions and Relevance: Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome. What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions.

Importance: Caregivers play a critical role in facilitating the performance of people with Parkinson’s disease (PD). Knowledge on how occupational therapy practitioners can mitigate the negative effects of caregiving is needed to enable caregiver participation. Objective: To explore the effectiveness of interventions within the scope of occupational therapy practice for caregivers of people with PD to facilitate or maintain their participation in the caregiver role. Data Sources: We conducted a systematic review of the literature published in CINAHL, MEDLINE, PsycINFO, and OTseeker between 2011 and 2019. Article reference lists were also hand searched for additional articles. Study Selection and Data Collection: Articles were screened and evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The review was conducted in accordance with steps outlined by the American Occupational Therapy Association’s Evidence-Based Practice Project. Findings: Six articles met the inclusion criteria. Interventions in each article were distinct, prohibiting theme development. Overall, the strength of evidence was low, and the risk of bias was high. None of the studies included in this review were obtained from the occupational therapy literature. Conclusions and Relevance: Little evidence is available to support interventions within the scope of occupational therapy practice for caregivers of people with PD. Existing evidence suggests that interventions need to be flexible (e.g., in terms of time, cost, and delivery method) and tailored to the unique needs of this population. What This Article Adds: There is a continued need to develop occupational therapy interventions that support participation in the caregiving role for caregivers of people with PD.

OBJECTIVE. Our objective was to evaluate the effectiveness of four adapted feeding utensils with participants with essential tremor (ET) or tremor related to Parkinson’s disease (PD). METHOD. Participants performed a simulated feeding task under five conditions: (1) standard spoon (control condition), (2) weighted spoon with standard handle, (3) weighted spoon with built-up handle, (4) swivel spoon, and (5) Liftware Steady™ spoon, a product using active tremor cancellation technology. Participants rated each adapted utensil in comparison with the standard spoon regarding performance, ease of use, speed, neatness, and aesthetics. RESULTS. Participants preferred the Liftware Steady spoon and weighted spoon with standard handle. Friedman’s test did not reveal statistically significant differences in ratings between the two preferred utensils. CONCLUSION. Participants had varied reactions to the different adaptive utensils and gave different reasons for preferences. These findings support the need for people with tremor related to ET or PD to have access to trial use of all four devices assessed in this study.

If occupational therapy is to advance in conjunction with the health care system to achieve the triple aim, evidence must be used to pave the way to new roles and areas of practice.

The Centennial Vision articulated by the American Occupational Therapy Association includes moving the profession to being science driven and evidence based. The American Journal of Occupational Therapy contributes to this vision by publishing high-quality research. I reviewed research in the practice area of neurological rehabilitation published between May 2010 and October 2011. In particular, I reviewed effectiveness and efficacy studies, instrument development and testing, and basic research studies. Concerns emerging from the review were (1) few studies in neurological rehabilitation; (2) many disorders not represented; (3) exclusive use of impairment-level outcomes in some studies; and (4) high preponderance of case series designs in effectiveness studies. To achieve the Centennial Vision, the field needs to improve the volume and diversity of research in neurological rehabilitation. It is also important to modify academic and clinical practice to enable occupational therapists to spend more time in producing high-quality evidence to support the crucial role they play in neurological rehabilitation.

The ability to effectively communicate thoughts, feelings, and identity to others is an important aspect of occupational performance. The symptoms of Parkinson’s disease can impair a person’s ability to verbally and non-verbally communicate with others. In order to better understand issues of communication functioning for this population, research tools to describe expressive and communicative behavior during occupation and social interaction are needed. In this study, six persons with Parkinson’s disease participated in individual, videotaped interviews focused on problem solving during daily activities. Three trained graduate students viewed edited clips from the videotapes and completed a rating scale of expressive behavior designed by the authors. Data support the reliability and construct validity of the behavioral rating scale, suggesting that measures of expressive behavior of persons with Parkinson’s disease can be effectively derived using short segments of videotaped activity.

The medical treatment of idiopathic Parkinson’s disease has improved the quality of life and increased survival of patients with Parkinson’s disease. However, as the illness progresses, impairments in daily living activities occur. A clinical trial for a group rehabilitation program was initiated to maintain the functional status of these patients. The research protocol consisted of a pretreatment evaluation, random assignment to experimental or control groups, and posttreatment evaluations after therapy, at 6 months and at 1 year. The results showed that the subjects of the treated experimental group maintained their functional status after 1 year, demonstrated a significant decrease of bradykinesia, and perceived a significant improvement in their psychological well-being. This study confirms the value of an occupational therapy group approach and its benefits to the functional independence, to the improvement of physical and motor symptoms, and to the quality of life of persons with Parkinson’s disease.