Page 8 P H Y S I O T Assesment of the Effects of L-Dopa on Parkinson's Disease. J. W R IG H T , D .O .T . Senior Occupational Therapist, K arl Bremer Hospital, Bellville. Since the end o f February, 1970, when the N eurologist at K arl Bremer H ospital started his research project using L-dopa in th e treatm ent o f Parkinsonism , a testing routine has been followed with each patient used in the project in order to assess th e effects o f the drug. T here is nothing new o r startling ab o u t the assessment either in technique or its basic form but the reason for, and the result of, th e assessment are very exciting an d new. Because o f the very prom inent an d incapaciting symptoms o f muscle rigidity an d trem or in P arkinson’s Disease, its insidious onset a n d erratic progress, the assessment is most meaningful when perform ed in terms o f functional ability. F o r this reason all patients were adm itted as in-patients at comm encement o f their course o f treatm ent and were im mediately referred to th e O ccupational T herapy d epart­ m ent in order to perform the functional testing to establish their degree o f independence, mobility an d ability to socialize and cope w ith their circumstances psychologically. T he program m e which is then necessary in order to facilitate th e p atien t’s independence and full use o f his anticipated progress is planned according to results o f th e testing and graduated according to progress. A SSESSM E N T Initially, the basic A .D .L . (Activities o f D aily Living) assessment tests are used. These cover m obility, personal hygiene, eating an d dressing, com m unication and for the w omen basic household tasks. F o r the research project itself 12 specific functional activities have been selected which are timed an d tested at regular intervals. D uring the testing, the patient is closely observed in contact with his fellow patients a n d therapists and his attitude tow ards the tests is noted. Functional Tests 1. G ait — time taken to walk 29 ft. 2. T urning 180° to R . an d then to L. 3. M icroswitch — num ber o f contacts per 60 seconds. 4. T urning over o f playing cards — num ber per 60 seconds. 5. W riting nam e, address and date. 6. Screwing o n an d off o f Balls ja r lid. 7. U ndoing a n d doing up o f button. 8. Tying up o f shoe laces. 9. Opening and closing o f safety pin. 10. Opening up and folding back o f new spaper page. 11. Rising from sitting position. 12. C utting out. By using the above tests we assess the following: 1. Bradykinesia o f the hands (a) By recording the length o f time it takes a patient to write his full nam e an d address an d the date. (b) By recording the tim e it takes to u ndo an d do up a button. (c) By the num ber o f playing cards which can be turned over in 60 seconds. 2. Rigidity (Very evident in neck and shoulders) This is m easured by: (a) F olding a new spaper back on itself. (b) Unscrewing th e lid o f the Balls jar, setting it dow n and screwing it back on again. H E R A P Y MARCH, 1971 (c) T h e finer movem ent o f opening and closing a safety pin is timed. {d) C utting out a hexagonal shape with a pair o f scissors is also timed. 3. Posture T his is only assessed through observation but it affects m ost o f the tests, particularly if it has deteriorated to a m arked degree, because th e joints go in to flexion. T he hands are affected particularly badly. 4. Upper extremity swing T his becomes lost when walking and is noted when the p atien t’s gait is tested. 5. Gait (а) T he time when the patient takes to w alk a set distance o f 29 feet is recorded. (б ) M obility in gait is further tested by timing his turning 180° to the right an d 180° to th e left. T he degree o f blocking may be observed, an d also whether he is walking w ith a heel-toe gait o r only on his toes. 6. Tremor T rem or is partly m easured by taking the num ber o f times per 60 seconds th a t contact is recorded when the patient touches a microswitch by flexing an d extending his forefinger a t the m .p. jo in t. Unless purposeful m ovem ent is made contact is not recorded. T rem or is also dem onstrated very well in different ways in the handw riting test, the screwing on and off o f the lid o f the Balls ja r, tying the shoe laces, opening the newspaper, opening an d closing the pin, and the cutting ou t of hexagonal shape. 7. F ades T his is mainly recordable if drooling interferes w ith the time taken to perform a test. 8. Speech This is often badly affected but is n o t assessed empirically although a no tatio n is m ade on th e assessment form. (Speech therapy is prescribed for these patients.) 9. Self-care Self-care is assessed in the following tests an d recorded o n the A .D .L . assessment fo rm s: (a) D oing u p o f buttons. (b) Tying o f shoe laces. (c) Rising from the chair. W hile the patients are in hospital, the testing is done continuously. O n discharge it is done at one week intervals, lengthening to tw o weeks and eventually to three weeks when a plateau is reached and the side effects o f the drug have adjusted themselves. T he regular testing enables the p atient’s reaction to the drug to be established from one visit to the clinic to the next visit and the dosage is adjusted accordingly. We have found th a t a very good rap p o rt is built u p between the patient and therapist through this routine contact, and once the patient is acquainted w ith the tests he does no t feel threatened by them (which does effect his perform ance to begin with); instead he accepts the testing as a challenge, and it is the therapist an d patient against last week’s results. Very good social contact is built up between the patients themselves through the com m on bond, each going through th e sam e routine testing while visiting the clinic and this has gone a long way tow ards establishing better social reactions in these patients. In the beginning they all ju st sat! G raphs have been plotted against dosage, an d the results are very dram atic. In time we hope to com pare these per­ formances w ith those o f norm al people o f com parable age and background. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )