Transcript PowerPoint presentation

The Occupational Therapist and
Huntington’s Disease
Clare Cook
MSc, Dip COT
Session Outline
• Introduction to occupational therapy in HD
• Development of practice guidelines
• Research
“The basic goals of occupational
therapy intervention for persons with
dementing illnesses are (a) to
maintain, restore or improve functional
capacity; (b) to promote participation in
activities that optimise physical and
mental health; and (c) to ease
caregiving activities.”
(American OT association,1994)
Where to find an OT
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Health and social care departments
Wheelchair services
Neurology clinics
Inpatient units (mental health/physical health)
Specialist teams
Community mental health teams
Palliative care teams
Why Have an OT in the Team?
• Trained in both mental health and physical
health
• OTs specialise in occupational performance
• Maintaining skills and independence
Interventions
Vary according to:
1.Particular difficulties experienced by the
service user
2.Which activities are meaningful and
purposeful to the individual
3.Social support
4.Resources available
Strategies
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Compensatory
Environmental
Cognitive/behavioural (care givers)
Case management/care coordination
Where’s the evidence?
Systematic Literature Review
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Medline
Embase
Cinahl
Amed
PsychInfo
Cochrane library
Internet search (Google scholar)
Search Terms
• Huntington’s disease, AND
• Occupational therapy / occupation /
independence / rehabilitation / activities of daily
living / adaptations / home adaptation /
equipment / leisure / work / employment /
feeding / posture / seating / wheelchairs /
splinting / sensory / multi-sensory / manual
handling.
Findings
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10 Articles
No RCTs
Pilot studies
Case studies
Effectiveness of physiotherapy,
occupational therapy and speech
pathology for people with Huntington’s
disease: A systematic review
(Bilney et al 2003)
• 3 articles on OT ’71,’81, ’91, no RCTs
• Small numbers of participants
• All in latter stages of disease in nursing
homes
• Showed no improvement in function but
unable to show if deterioration had been
prevented
• Need for further research
Community based OT for patients with
dementia and their caregivers:
randomised controlled trial. (Graff et al
2006)
• 135 participants
• 10 sessions of OT over 5 weeks compared
to a control group of no OT
• Outcome measures – AMPS, IDDD,SCQ
• Significant improvement in scores which
remained significant after 3 months
“occupational therapy will result
in less dependence on social
and healthcare resources and
less need for institutionalisation”
(Graff et al 2006)
Guidelines
Part 1
• Process of developing the
guide
• Background Information
Part 2
Strategies…
Physical Factors
Cognitive Factors
Behavioural Factors
Optimising activities
Mobility and falls prevention
Transfers and hoisting
Bed mobility and sleep safety
Postural management
Eating & drinking
Self care
Domestic skills
Fatigue
Supporting
Participation
Self Efficacy
Roles & relationships
Work
Social Recreational and
Leisure activities
Driving
Community living skills and
Outdoor mobility
End of life care
24 hour postural management
Manual handling and minimizing
risk
Alternative living arrangements
Current Challenges
• Evidencing statements
• Ratification
• Publication
Need for more research into
Huntington's disease and
occupational therapy
A Study to validate the
Assessment of Motor and
Process Skills (AMPS) for use
with people who have
Huntington’s disease
The Assessment of Motor and
Process Skills (AMPS)
• An observational assessment
• Used to measure the quality of ADL
performance
• Standardized on over 100,000 clients
worldwide
An AMPS Assessment
• Begins with an interview to determine the
tasks that are familiar and relevant to the
client
• There are 85 standardized AMPS tasks,
ranging from easy to hard
• Includes the observation of at least two
chosen ADL tasks
Research Study
• Test/retest
• Participant vs. control
• Relationship with similar scales
Hypotheses
• AMPS is a valid assessment to use with people
who have HD
• AMPS is a sensitive measure which can detect
change in performance skills
• AMPS could potentially be used to assess the
impact of disease modifying drugs on a
person’s ADL performance skills
Thank you for listening
[email protected]