For Clinicians: Assessing Parkinson’s

For Clinicians: Assessing Parkinson’s

Photo credit: Glenn Carstens Peters

No one really enjoys being assessed. Typically if someone is being assessed by a rehab therapist it is because there is suspicion something might not be right (or perhaps they know for certain that something is wrong). Being under a therapeutic microscope can be a vulnerable part of a disease process. Evaluations are laced with a barrage of questions. The client is asked to share all of their medical baggage, surgery scars, list of medications, and are asked to complete tasks that are designed to highlight their deficits. Yikes.

In the world of “everything must be billable and skilled” it can be difficult as allied health professionals to navigate and juggle all the information that needs to be gathered and focus on all the rapport that needs to be established to accomplish that task. Here is some food for thought:

Provide the client with a brief outline and expectations before assessment day.
When scheduling the appointment, consider providing a short checklist of information. This list should prepare the client or family member to arrive at the assessment with information that will assist your evaluation. When it comes to assessing someone with Parkinson’s disease (PD) it can be helpful to know:

  1. Has the neurologist has a Hoehn & Yahr rating and what are the corresponding outcomes;
  2. Has a UPDRS (Unified Parkinson’s Disease Rating Scale) been completed and what are the corresponding outcomes;
  3. Which PD medications are being taken and at what times (you should always take this into consideration when scheduling your evaluation and treatment sessions);
  4. Reports from all previous therapies (not just your discipline) to identify what has/has not worked in the past.

 

Tell them what you do.
This may sound obvious. That’s ok. We all need this reminder. Give a brief summary of your role. It is common for people to be less familiar with your specific scope of practice or, to confuse your role with another discipline. Take the time to clear this up during assessments and send home a brief written description of what the client can expect to focus on when they come for therapy.

 

Ask them what they want.
Some evaluations require you to ask the patient about their goals, but remember that phrasing is key when attempting to get the client to express how their deficits impact their daily function. This information can help you create goals that are meaningful to them. Many clients and family members ask for a list of goals once the assessment is complete. Giving clients and family members goal lists can be a big asset to progress and carryover. When providing a list be brief, use layman’s terms, and use concrete language like this:

Therapy Goals

Walk twice the distance than you did during the assessment with big steps.
Eat meals without having any food left anywhere in your mouth after you swallow.
Lift items from the counter to the cabinet while keeping your balance.
Use a loud voice all of the time so others can hear you when you speak.

 

Assessments are just a snapshot.
An assessment is one small snapshot of who the client really is. As clinicians we can often quantify the client’s deficits so specifically that we may lose track of their skills and possibly the actual person. A few questions that can help you avoid this include:

  1. Would you characterize this as a good or bad day?
  2. When you are well rested, what do you enjoy doing most?
  3. What is your biggest struggle is in the morning and in the evening now that you have PD?
  4. In the last 3-6 months, what is one of the biggest changes you have noticed that you attribute to PD?

It can also be helpful to have a family member speak to some of these questions to get additional insight.

Overall, remember that PD cannot be treated for the symptoms only. Attempt to gather information about the whole person so you can provide collaborative care. If you are unfamiliar with PD, you should familiarize yourself with the symptoms, the way medication impacts those symptoms, and the best assessments to evaluate someone with PD.

Leave a comment if you have added insight for assessing someone with PD or have a favorite assessments in your discipline.


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