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a Healthcare Plan Developed for
Health Fusion 2019 - Meet the Team!
Jane - Speech and Language Therapy
Megan - Occupational Therapy
Lauren - Dietetics
Dominyka - Psychology
Getting to know James
WHO?
James in the context of CAMM-UL & ICF framework
Addressing primary Goals of James, ROSEMARY and MDT
TREATMENT PLAN
6-month review & looking ahead
WHO?
Understanding social supports and barriers, diagnosis, prognosis, current functioning levels, Assessment
WHAT?
SMART goals for intervention, client-centred practice and prioritisation
HOW?
Treatment approaches (MDT, key workers, etc.)
EFFECT?
Measuring change & establishing outcome expectations
WHERE NEXT?
Review and reassess goals, plan for future & long-term management
Franklin, S, Kearns, A, Kearns, T, ,McCurtin, A, Murphy, C.A & Wright, A (2015)
Health condition
Parkinson's disease (PD)
ICF
participation (RESTRICTIONS)
INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY & HEALTH
ACTIVITY (LIMITATIONS)
BODY STRUCTURES AND FUNCTIONS
personal factors
environmental factors
(World Health Organization, 2013)
OT and psychologist to meet James first, get informed consent, and build rapport with James and Rosemary; talk through THEIR goals with them to ensure client-centered care
Activities and
Participation
Body Structure and Functions
Environmental Factors
+
Ethical Practice
Personal Factors
"I know Rosemary wants us to go out more, and I'd like to, but my voice is just too quiet. I'm afraid that no one will be able to hear me me .. I used to be a loud enough when I was out you know! "
INFORMING GOAL: assessment
Dysarthria
Dysphagia
fRENCHAY DYSARTHRIA ASSESSMENT (FDA-2)- SEVERITY + IMPACT ON QOL
high incidence of changes in swallow IN PD
(LEOPOLD AND KAGEL, 1996)
EVALUATION OF SPONTANEOUS SPEECH
OROFACIAL EXAMINATION ,
SENSORY ASSESSMENT REFLEXES,
DRY SWALLOW, SWALLOW TRIALS
REFERRAL FOR VIDEOfluoroscopY
ASSESSING COMMON SPEECH FEATURES: BREATHING, PHONATION, RESONANCE , PROSODY
Intensive, High Effort Therapy
how?
(Dysarthria
+
dysphagia)
Dosage: 4 consecutive days a week for 4 weeks
Rosemary as co-therapist (Kalf et al.)
Training as conversational partner
Motivating for James
"Think loud"
Improvements in motor speech + swallowing (El Sharkawi et al. 2002)
Energy requirements:
High energy/protein diet
Henry Oxford Equation to calculate:
Exercise - daily walk: benefit from socialisation and fresh air
Closely monitor TMD with SLT and community nurse
Aim for a healthy diet:
Sample foods for James following swallow assessment
"I wish I weren't so tired all the time - it makes it hard to want to do things."
There could be a number of reasons why James is having many symptoms despite being prescribed medication: medical adherence, taking medications on an empty stomach (causing nausea) which would result in medication not being absorbed, taking medication after a high protein meal or the medication is no longer effective (L-dopa effectiveness may decrease after prolonged use)
Prolonged use of Levodopa can result in nausea, vomiting and hypotension as well as James being prescribed anti-hypertensives.
It is likely he could come off the blood pressure medication and manage it with diet and lifestyle changes, a decarboxylase inhibitor, can be combined with levodopa to minimise these side effects otherwise.
Timing of L-dopa medications around mealtimes to ensure that dietary protein does not interfere with the absorption of the L-dopa across the blood-brain barrier. It has been suggested that there should be a 40-minute delay between taking L-dopa and eating a meal.
Dyskinesia
Nausea and vomiting
Heart failure & anemia
Anxiety, mania, depression
hypokalemia & hyponatremia
pheochromocytoma
Lupus-like syndrome
"James is finding it hard to leave the house and face old friends, and I don't feel right leaving him so we haven't been going out much."
Gradually build confidence & motivation to engage in local community again
Impact and Outcomes
Increased vocal loudness, improved articulation, vocal quality and intonation (Fox et al. 2011)
Post 1mth LSVT oral transit time, pharyngeal transit time, and vallecular residue decreased (Sharwaki et al. 2002)
EFFECT?
He will maintain his weight status
where next?
Ability to manage own routine with less fatigue, take meds, complete tasks of daily living safely, and become more motivated to complete activities
James feels comfortable moving around, and him and Rosemary start getting out and about again, building up support & social networks
for 6 month review
Goal 1
Goal 2
Goal 3
Goal 4
Re-administer Frenchay Dysarthria Assessment to ensure improvement has generalised
Thick and easy may need to be ordered for dysphagia
Weighted cutlery for tremor
Monitor weight
Gradually build on exercise program & expose couple to increased opportunities for peer support.
Continue to monitor ADL performance (driving, incontinence, transfers) and need for AT.
Perform COPM again to track areas of progress/setbacks.
Consider sleep & gauge for mental health problems.
THANK YOU!
BC Cancer Agency (2015). Easy to Chew, Easy to Swallow Food Ideas. Oncology Nutrition. [online] Vancouver: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/nutrition-site/Documents/Patient%20Education/EasyToChewEasyToSwallowFoodIdeas%20-%202015.pdf [Accessed 24 Feb. 2019].
Drugs.com. (2019). Levodopa Side Effects in Detail - Drugs.com. [online] Available at: https://www.drugs.com/sfx/levodopa-side-effects.html [Accessed 9 Feb. 2019].
Duffy, Joseph R. (2013) Motor speech disorders : substrates, differential diagnosis, and management . Third edition. St. Louis, Mo: Elsevier Mosby.
Fox, C et al. (2012) LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinsons Disease. [Online] 2012 (2012), 391946.
Indi.ie. (2019). Eating Well With Parkinson's Disease - INDI. [online] Available at: https://www.indi.ie/resources/fact-sheets/515-eating-well-with-parkinson-s-disease.html [Accessed 12 Feb. 2019].
Parkinsons.org.uk. (2019). Homepage Parkinson's UK. [online] Available at: https://www.parkinsons.org.uk [Accessed 14 Feb. 2019].
Seidl, S., Santiago, J., Bilyk, H. and Potashkin, J. (2014). The emerging role of nutrition in Parkinson's disease. Frontiers in Aging Neuroscience, [online] 6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945400/ [Accessed 12 Feb. 2019].