PESI Rehab provides continuing education for Speech and Language Pathologists, Occupational Therapists and Physical Therapists. PESI Rehab seminars are designed by expert clinicians with the needs of professional adult learners in mind. Their seminars are entertaining and engaging while providing practical hands-on skills, strategies and interventions that will improve the outcomes of the people you serve. In addition to their seminars, PESI Rehab provides continuing education to professionals and organizations through in house training, publications, audio and video home study, and on-demand trainings.
There are two seminars that might be of interest for Parkinson’s patients, support groups, and health care providers.
1. -Rehabilitation Strategies for Neuromuscular and Neurodegenerative Disorders Seminar, topics include:
Strategies to Overcome Rehab Challenges Due to Clinical Changes
- Tremors & Posture Changes
- Increased Rigidity
- Decreased Coordination and Increasingly Unsteady Gait
- Signs of Akinesia and Bradykinesia
Rehab Treatment Planning
- Safe Exercise Treatment Programs
- Speed and Amplitude in Movement
Techniques to Reach Rehab Goals
Whole Body Movements
2. -Current Management Strategies for Neuromuscular and Neurodegenerative Disorders, topics include:
Degeneration of Substantia Nigra
- Basal ganglia degeneration
- Deficiency of dopamine
Know the Symptoms “T-R-A-P”
- Medications – L-dopa Therapy, anticholinergics
- Neuroprotective agents
- Deep Brain Stimulation
See the PESI web site at http://www.pesirehab.com
- Ensure that you, as caregiver, have individual or joint signature authority over all bank and financial accounts. It is a tragic situation when the PD sufferer is the only one who can sign the check and for irrational reasons, will not sign it. Many situations can quickly deteriorate when expenditures are necessary yet cannot be made. Do not delay to resolve signature authority as soon as it becomes clear that you will be the caregiver and that cognitive deterioration is a possibility.
- Consider the roles of trustee. If there are trusts involved in the financial picture, at some point the care receiver will be unable to function as a trustee. As that time approaches and if the trust has such a provision, the care receiver should resign as a trustee so that an alternate trustee can be available to act if something happens to the caregiver who is co-trustee.
- Gain an understanding of the family financial picture. Develop an understanding of electronic banking and bill payment. Obtain all passwords to gain access to account information. Understand your investments and become involved with the investment advisor or broker. The caregiver will ultimately be responsible for the portfolio and must know and trust the individuals who manage the investment portfolio. Understand retirement plan arrangements, including identifying who is the beneficiary and determining whether that beneficiary is competent to make required decisions. Understand your insurance plans, including identifying the insurance agent, policies that are active, and what are the conditions of those policies.
The following discussion may help to ease some of the challenges of PD care-giving:
- Monitor care receiver tasks. Be cognizant of those duties the care receiver performs and watch for signs of inadequacy. Do not let bills go unpaid for months before stepping in. Collect and safeguard all tax documents. Understand the sequence of periodic car and home maintenance. Monitor medications closely to ensure that the care receiver does not decide to do something unsafe and be prepared to step in when they are no longer able to reliably self-medicate. Be organized so that any outside caregiver understands your routine. Be prepared to assume additional tasks to avoid unnecessary work later. But…
- Each task you assume is one more loss of independence and self-worth for the care receiver. Recognize that he or she may resent the intrusion or fight to retain responsibility. It may be helpful to start discussions early, while rational discussion is still possible, regarding your assuming tasks. You might ask the care receiver to show you how the task is accomplished to ease the transition. That tactic may not work, in which case you may simply take over the chore. It is imperative that the caregiver understands how to most effectively work with the care receiver to achieve the desired outcome. You must be strong when the outcome is important.
- Do not expect acknowledgment for your efforts as a caregiver. If words of appreciation come, savor them, but recognize that the care receiver will likely not acknowledge much of your caregiver efforts and sacrifices. Even if the care receiver recognizes and appreciates your efforts, the care receiver may not be able to express their appreciation.
- Keep children and siblings in the picture. It is important that those close to the PD sufferer remain aware of the changing condition of their loved one. Do not try to “protect” them from the reality of PD. Do not let them be surprised by “how mom/sis has changed” when they come for a visit after a long absence. By remaining aware of conditions they will be more able to accept the PD suffer as they are and much less likely to react poorly towards you or your care receiver. Also, as appropriate, keep them aware of your contingency plans, power of attorney arrangements, living will arrangements, etc. They may need to take action and foreknowledge will prepare them for the eventuality.
- Recognize that your job as caregiver for a PD sufferer will grow over time. While continuing all the responsibilities you previously shared, you will assume added tasks of caring for both the care receiver and you. It may be useful to list or catalog the tasks, particularly if the care receiver was independently responsible for many tasks. Moving forward, you will no longer be taken care of or told what to do and when to do the important tasks of life. It is a hard reality, but one best accepted sooner rather than later before you are compromised by possible anger or depression.
- Join and participate in a PD caregiver support group. Through group discussions and sharing you will realize that others are facing the same challenges and fears that you face. Many strategies and coping mechanisms will be discussed. Through the discussions, you will gain a better understanding of yourself, your fears, and the skills required to complete the tasks that make up your job of caregiver for a PD sufferer.
- Take care of yourself. Care giving is stressful, frustrating, time consuming and will cause sleep deprivation. You must remain strong for the long haul. Ask for help, exercise, focus on adequate sleep, and maintain joyful activities in your life, even if you must hire a caregiver to give you the time.
- And finally, remember the Serenity Prayer:
“God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference.”
More from Bill to follow…
The following discussion may help to ease some of the challenges of PD care-giving:
- Work to understand your care receiver. Determine what motivates him or her. Determine your actions that are most likely to obtain the desired response or outcome from your care receiver. Learn the words or inferences that lead to resistance or “rebellion”. Achieving the desired or necessary outcome is a key element of your job description as a caregiver (even if you never applied for the job!).
- Your independent world will decrease as your responsibilities to the care receiver increase. Recognize this reality and do not try to “do it all” by maintaining a job or other independent activities while concurrently assuming additional responsibilities on behalf of the care receiver. This shrinking of the caregiver’s world may cause significant sadness, bitterness and/or resentment unless the caregiver recognizes and accepts this situation. Maintaining some level of independence may be achieved by periodically utilizing a paid caregiver.
- Prioritize actions. Going to a medical appointment is important. Making a safe transition to the car is important. Going to lunch is not. Making the bed, doing the laundry today, or having a neat closet is not. If the care receiver wants to exert some authority regarding not going to lunch, let it go. It is not important that you be in control of that activity, so go in whatever direction the care receiver leads. Pick your battles carefully. If any outcome is O.K., follow the lead of the care receiver.
- Expand your tolerance for imperfection. Your care receiver may act in ways that, under normal situations, would not seem acceptable. When you consider an action or situation intolerable, your level of anger, stress, and anxiety will increase. Your care receiver will probably not understand your anger and may react poorly. Your anxiety and stress may intimidate your care receiver, and likely will not improve their actions or performance. Instead, match your expectations to the reality of your care receiver’s actions and abilities.
- Integrate the medical care of your care receiver. Your family doctor will likely not have the records, interest, or skills to assimilate inputs from the other specialists. You alone will need to maintain the “big picture” as integrator of conclusions from the various medical professionals such as the neurologist, orthopedic specialist, cardiologist, therapists etc. Various specialists will suggest different therapies. Keep notes from medical appointments and treatments including what works and what do not work for your particular care receiver. Be cognizant of treatment conflicts and evaluate their value for the care receiver. Only you will know all of the medications that are prescribed for your care receiver. It is your task to integrate all medical history and ensure that each provider knows what he or she needs to most effectively treat your care receiver.
More to follow…
The first and arguably the most important skill for success as a caregiver is to understand how to motivate and facilitate the care receiver and to understand your own reactions to care-giving. Just as the caregiver role expands, the role of the care receiver shrinks. Due to cognitive issues, they may not understand the reasons for the reduced role or willingly accept it. Also, due to cognitive decline, having a rational discussion regarding the shifting roles may not be productive or lead to the desired outcome. The PD sufferer becomes more and more childlike, yet unlike a child, will not mature over time. “I have to do more and more, I get more and more frustrated, and I dislike myself for it.” “I was so mean to _____ the other day and felt so badly after it was over. I know that ___ felt badly also.” How many caregivers have said these words or had these thoughts? These concerns may indicate that the caregiver is human and caring and/or does not yet understanding the scope and conditions of their care-giving job including the necessary tasks and skills. The following discussion may help to ease some of the challenges of PD care-giving:
- The care receiver is probably not being difficult on purpose. Accept that he or she simply cannot help how they react. Similar to a child, they may take actions or refuse to take actions in ways that make no sense or are aggravating. The caregiver must be the adult in each situation.
- Understand and accept the role reversal. If the caregiver is caring for a parent, the parent-child relationship is reversed, but the parent may not see or accept that. When the caregiver is a spouse, the roles of the marriage relationship may be reversed and evolve to a parent-child relationship. The care receiver may not see or accept this role change, but the caregiver must recognize his or her changing roles and responsibilities and act accordingly. “Business as usual” won’t work.
- All care receiver activities will take longer and can be frustrating. Allow additional time and expect delays in their getting up, getting dressed, eating, bathing, and getting ready to go out. Recognize that decisions regarding clothing or accessories may not make sense or may be redone several times. Don’t get frustrated and don’t expect the care receiver to hurry or feel your anxiety towards being late. They won’t—and your pressure and criticism will not help. It will only increase your level of stress.
More to follow…