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Terapia ocupaţională în boala Parkinson: intervenţia în sfera autoângrijirii

Rezumat Boala Parkinson este o afecţiune lent progresivă degenerativă a sistemului nervos central. Este caracterizată prin tremor când muşchii sunt în repaus (tremor de repaus), creşterea tonusului muscular (rigiditate), lentoarea mişcărilor voluntare şi dificultate în menţinerea echilibrului (instabilitate posturală). Semnele şi simpotomele acestei boli duc la desfăşurarea cu dificultate de către pacienţi a activităţilor de auto-îngrijire (îmbrăcat, mâncat, spălat, îngrijire personală), precum şi a activităţilor din afara casei (cumpărături), a celor de la locul de muncă şi a celor de timp liber şi agrement. Terapia ocupaţională ajută pacienţii cu Parkinson să-şi îmbunătăţească capacitatea de a îndeplini sarcinile lor zilnice. Intervenţia constă în asistarea pacienţilor în dezvoltarea unei rutine în autoîngrijire, ţinând cont de limitările mobilităţii funcţionale, încurajarea pacienţilor să menţină maximul funcţional în activităţile zilnice pentru cât mai mult timp posibil, învăţarea de tehnici adaptative pentru a reduce tremorul. Cuvinte cheie: boală Parkinson, terapie ocupaţională, activităţi de autoângrijire

Abstract Parkinson's disease is a slowly progressive degenerative disorder of the central nervous system. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone (rigidity), slowness of voluntary movements, and difficulty maintaining balance (postural instability). Signs and symptoms of this disease lead to difficult for patients to self-care activities (dressing, eating, bathing, personal care) and activities outside the home (shopping) for those at work and those leisure and entertainment. Occupational therapy helps Parkinson's patients to improve their ability to perform daily tasks. Intervention is to assist patients in developing self-care routines, taking account of functional mobility, encouraging patients to maintain maximum functional daily activities for as long as possible, adaptive learning techniques to reduce tremor. Key words: Parkinson's disease, occupational therapy, self-care activities Boala Parkinson este o afecţiune lent progresivă degenerativă a sistemului nervos central. Este caracterizată prin tremor când muşchii sunt în repaus (tremor de repaus), creşterea tonusului muscular (rigiditate), lentoarea mişcărilor voluntare şi dificultate în menţinerea echilibrului (instabilitate posturală). (2) Vârsta medie de debut a bolii Parkinson este între 35 şi 60 de ani. Este de remarcat, totuşi, că incidenţa acestei boli creşte odată cu vârsta (5), iar sexul masculin este afectat într.un procent mai mare decât sexul feminin. Semnele şi simptomele întâlnite in boala Parkinson sunt: slabiciune, apraxie (imposibilitatea de a efectua mişcarea în ciuda senzaţiei normale şi a înţelegerii de sarcini), demenţă, depresie, diplopie (vedere dublă), disfagie, mers cu paşi mici, pierdere în greutate, disfuncţii sexuale, tremor (în repaus, rar văzut în alte condiţii), absenţa balansului membrelor superioare în mers, hipokinezie, rigididate (rezistenţă sporită la mişcarea pasivă), postură aplecată, constipaţie, “mască facială”, afectarea vorbirii şi voce monotonă, micrografie (scris foarte mic). (3,4,6) Toate acestea duc la desfăşurarea cu dificultate de către pacienţii cu boală Parkinson a activităţilor de auto-îngrijire (îmbrăcat, mâncat, spălat, îngrijire personală), precum şi a activităţilor din afara casei (cumpărături), a celor de la locul de muncă şi a celor de timp liber şi agrement. Terapia ocupaţională ajută pacienţii cu Parkinson să-şi îmbunătăţească capacitatea de a îndeplini sarcinile lor zilnice. Intervenţia constă în asistarea pacienţilor în dezvoltarea unei rutine în autoîngrijire, ţinând cont de limitările mobilităţii funcţionale, încurajarea pacienţilor să menţină maximul funcţional în activităţile zilnice pentru cât mai mult timp posibil, învăţarea de tehnici adaptative pentru a reduce tremorul. Abilităţile funcţionale sunt îmbunătaţite o data ce prima doză de medicamente a fost absorbita.(1). De aceea este bine ca dupa administrarea medicamentelor să se înceapă activităţile, pacienţii raportând durata doar a îmbrăcatului între 30 min şi 2 ore. Este important de ştiut şi luat în considerare în procesul de evaluare a activităţilor de autoîngrijire că durata prea mare de timp a acestor activităţi poate cauza o oboseală mare pentru pacient, ce va duce la imposibilitatea efectuării ulterioare a activităţilor legate de muncă (sfera productivă) sau a celor de relaxare. Cu toate acestea unii pacienţi preferă să efectueze independent şi fără ajutoare aceste activităţi, în timp ce alţii acceptă introducerea de instrumente care să le faciliteze activităţile şi să le conserve energia.

* Îmbrăcatul – recomandări:

* efectuarea unor exerciţii simple înaintea începerii acestei activităţi, pentru încălzirea musculaturii * alocarea de suficient timp; grăbirea poate cauza stress şi frustrare şi poate încetini activitatea * concentrarea doar asupra acestei activităţi, evitând distragerea de sunete sau conversaţii (1) * poziţia recomandată este şezând pe un scaun, pentru a evita pierderea echilibrului şi căderea * pregătirea hainelor în ordinea în care vor fi îmbrăcate (1) * sunt indicate haine cu puţini nasturi sau fermoare dificil de închis (7) * sunt de preferat pantaloni cu bandă elastic, mai uşor de pus decât cei cu nasturi sau fermoar * folosirea unui instrument ajutător pentru punerea/scoaterea pantofilor şi şosetelor * utilizarea şosetelor antiderapante, pentru a preveni căderile * utilizarea pantofilor cu închidere elastic sau clape cu velcro (7)

* Alimentarea - recomandări: Activităţile sunt lente, persoanele fac dezordine şi aceste lucruri pot duce la pierderea interesului pacienţilor cu Parkinson de a participa la mese împreună cu familia şi retragerea din activităţile sociale care implică mâncat şi băut. * adoptarea unei poziţii commode, în şezând şi un iluminat adecvat * farfurii cu o margine ridicată, pentru ca mâncarea să nu iasă din farfurie * folosirea unei căni acoperite cu cioc, pentru evitarea vărsării conţinutului lichid datorită tremorului * paie lungi de plastic fixate pe cană sau pahar dacă pacientul nu poate ţine cana/paharul datorită slăbiciunii sau tremorului * pahare special, decupate, pentru cei cu limitare a mobilităţii gâtului * utilizarea unei furculiţe-cuţit, ca tacâm unic, pentru cei cu afectarea coordonării (1) * tacâmuri confecţionate din materiale mai grele sau folosirea unor suporturi mai grele şi îngroşate în care se introduc tacâmurile, pentru a creşte stabilitatea * folosirea unor dispozitive speciale pentru deschiderea borcanelor sau a cutiilor de conserve

* Toaleta personală - recomandări:

* existenţa unei lumini de supraveghere noaptea în baie, pentru a facilita accesul şi a evita căderile * cada sau cabina de duş ar trebui să aibă cel puţin două mânere de care persoana să se ţină când inră/iese de la duş * existenţa unei bănci de transfer în cadă sau a unui scaun cu spătar, ale cărui picioare sunt îmbrăcate în dopuri de cauciuc antiderapante, pe care să stea * să folosească un duş mobil cu furtun flexibil şi capăt cu mâner * săpunul solid poate fi introdus într-un ciorap de nylon şi legată partea cealaltă a ciorapului de bara de sprijin (7) * folosirea unor robinete cu manetă, mai uşor de manevrat ca cele cu filet * bureţii sau periile cu mâner lung sau încurbat îi ajută pe cei cu limitarea mobilităţii (7) * un cadru comod uşurează aşezatul şi ridicatul pe/de pe toaletă * când se spală pe dinţi, se bărbiereşte sau se piaptănă să o facă din poziţia şezând, pentru a evita riscul de cădere * sunt indicate periuţele de dinţi şi aparatele de ras electrice * paratul de ras sau periuţa de dinţi pot fi inserate în suporturi mai grele pentru stabilitate (7) Terapia ocupaţională nu vindecă boala Parkinson. Dar prin îmbunătăţirea abilităţilor pacienţilor, prin împărtăşirea unor noi modalităţi de a rezolva sarcinile, prin prescrierea unor echipamente adaptate, ajută pacienţii să-şi desfăşoare activităţile zilnice cu mai mare uşurinţă, contribuie la menţinerea independenţei funcţionale şi creşte satisfacţia şi stima de sine a acestor pacienţi.

Bibliografie 1. Aragon A., Kings J. (2010) – Occupational therapy for people with Parkinson’s: Best practice guidelines, College Of Occupational Therapists Ltd., 40-44 2. Beers M., Jones T., et al. (2000) - The Merk Manual of Geriatrics, 3rd Edition, 432 3. Bonder, B., & Wagner, M. (2001) - Functional performance in older adults, Philadelphia, PA: F.A. Davis Company 4. Duvoisin, R., Golbe, L., Mark, M., Sage, J., & Walters, A. (2001) - Parkinson’s disease handbook: A guide for patients and their families, Staten Island, NY: The American Parkinson Disease Association, Inc. 5. Melnick Me., (2001) – Basal ganglia disorders: metabolic, hereditary and genetic disoders in adults. In Umphred DA, ed: Neurological Rehabilitation,4th ed., St. Louis, 669-670 6. Neistadt, M., & Crepeau, E. (1998) - Willard and spackman’s occupational therapy. Philadelphia, PA: Lippincott 7. Reed K. (2000) – Quick Reference to Occupational Therapy, 2nd Edition, PRO-ED Incorporated, 327-329 8. www.aota.org/featured/area6/links/link02am.asp 9. www.ehow.com/about_6703293_occupational-therapy-parkinson_s-disease.html

--------------------------------------------
[ 1 ]. Asist. Univ. Drd., Medic specialist Radiologie şi Imagistică Medicală, FEFS, UV Timişoara
[ 2 ]. Lector Univ. Dr., Medic specialist MF, FEFS, UV Timişoara

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