Parkinson’s disease: Physical Impairments and Work Retention
The assignment is to write a work retention plan for the individual in your chosen case, including:
- Background on the impairment
- How the impairment generally impacts work retention
- How this impairment would/could impact this individual in his/her workplace
- Whom you would contact for what additional information
- Proposed work retention plan, including any accommodations, assistive devices, and/or prevention measures
to reduce the risk of exacerbation or recurrence, if appropriate.
Case 1: Dr. Carl Rabinovich
(adapted from Schultz-Krohn, Foti, & Glogoski, 2006)
Dr. Carl Rabinovich is a 60-year-old professor of modern history, specializing in World War II and the holocaust, at a mid-size liberal arts college. He was diagnosed with Parkinson’s Disease at age 57. He is married, with two adult children who are both married with children, and who each live within a two-hour drive away. His wife held an administrative position at the same college, but she retired two years ago and is now a full-time homemaker. They live in a one-story home about a mile from the campus. Dr. Rabinovich’s leisure activities include travelling, painting, reading, and attending concerts of classical music.
Dr. Rabinovich is considering early retirement, although he really enjoys his work and would like to continue. His essential job duties include academic writing (he is working on another book), teaching and marking, and committee work. However, he reports increasing tremors in both hands, which makes typing and marking essays (typically he makes handwritten comments in the margins of the students' papers) difficult. He also reports some problems with decreased endurance due to stiffness. He is also unsure whether he should continue driving, due to his hand tremors.
Dr. Raninovich is independent for self-care, although he is finding it increasingly difficult to tie his shoes and tie and fasten small buttons. He is on medication but finds it "wears off" between doses. He is discussing long-acting alternatives with his specialist.
Dr. Rabinovich denies depression but admits he is not as enthusiastic about things he used to enjoy, such as concerts and vacationing with his children and grandchildren. He has stopped painting because of his tremors.
Develop a proposed work retention plan for Dr. Rabinovich according to the assignment outline.
Schultz-Krohn, W., Foti, D., & Glogoski, C. (2006). Degenerative diseases of the central nervous system. In H.M. Pendleton & W. Schultz-Krohn (Eds.), Occupational therapy: Practice skills for physical dysfunction (6th ed., pp. 873-902). St. Louis, MO: Mosby Elsevier.
Other effective resources:
https://www(dot)parkinson(dot)ca/glossary/
https://www(dot)parkinson(dot)ca/
Parkinson’s Disease and Work Retention
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Parkinson’s disease
Parkinson’s disease (sometimes called Parkinson disease) is a general, progressive neurological disorder that affects almost 1% of the population (Forwell, Hugos, Copperman, & Ghahari, 2014). It affects men approximately 5 times more often than women, and the incidence increases steeply with age, although 10% of those with the disease are under 45 years old (Lees, Hardy, & Revesz, 2009). Never smokers are twice as likely to exhibit Parkinson's disease as smokers; and men and postmenopausal women who are not taking hormone replacement, who take no or very low quantities of daily caffeine, seem to be at increased (about 25% more) risk. These findings are controversial, however, with some studies refuting or contradicting them. The findings might be related to dopamine's role in reward pathways and premorbid novelty-seeking personality traits, rather than to any neuroprotective effect of tobacco smoke, nicotine, or caffeine (Lees et al., 2009). Unstable associations between Parkinson’s disease and head injury, rural living, middle-age obesity, lack of exercise, well-water ingestion, and herbicide and insecticide exposure have also been reported. Environmental toxins can produce a uniform, but not identical, clinical picture (Lees et al., 2009). When it comes to the number of people with chronic progressive neurodegenerative diseases, Parkinson’s is inferior only to Alzheimer’s (Christensen & Steen, 2012).
Young-onset Parkinson's disease, attack between ages 21 and 40, represents between 3 and 6% of all people with Parkinson's (Klepac et al., 2013). These individuals with young-onset are more likely to have a positive family biography for the condition and are more likely to have one of the several genes that have been associated with the disease (Sawle, 2004). Genetic studies have shown that several mutations in seven genes are linked with L-dopa-responsive parkinsonism, and hereditary risk for some of these mutations is more common among North African Arabs, Ashkenazi Jews, and Portuguese people (Lees et al., 2009).
Fatigue is a popular symptom in all chronic diseases, and it is especially prevalent in neurological disorders. Fatigue alters 33 - 70% of people with Parkinson's disease. One-third of those with Parkinson's rate fatigue as their single worst symptom and 58% rank it among their three most disabling symptoms, including motor dysfunction. People with Parkinson's disease describe their fatigue as "distinct" from the fatigue they encountered before developing the condition, using words like feeling "drained" or "exhausted", and it is reported to be more destructive to the quality of life than motor dysfunction. Fatigue usually develops shortly and, once developed, usually remains, although worsening over time. Fatigue does not, in broad, correlate with motor accuracy but is more common in those who are depressed. The exact mechanism of fatigue in Parkinson's is not clarified, and there has been a slight study on the adequate treatment of this debilitating symptom (Friedman, Abrantes, & Sweet, 2011).
Symptoms/Potential Activity Limitations
• Tremors
• Lessen or loss of sense of smell
• Reduced facial expression
• Bradykinesia
• Rigidity or stiffness of muscles
• Impaired posture
• Problems with balance (falls)
• Gait disorders
• Loss of automatic movements
• Changes in speech- slowed or slurred
• Changes in writing- small writing
• Prominent dysautonomia (bladder/bowel incontinence, constipation)
• Cognitive problems
• Depression/emotional changes
• Swallowing/chewing/eating problems
• Sleep disturbance
• Erectile dysfunction in men
Parkinson's disease commonly presents with a gradual onset of impaired dexterity that is often overlooked or misinterpreted for some time. Fatigue and stiffness are common but non-specific groans. Family members, friends, and colleagues often are the first to mark symptoms such as reduced facial expression, flexion of one arm with lack of swing, monotonous quality of speech, and an outermost slowing down, but these are often misjudged as old age, depression, or arthritis.
The hallmark symptom of Parkinson's disease is bradykinesia, a reduction in speed and amplitude of repetitive movements, for sample, finger, or foot-tapping (Sawle, 2004). Other common symptoms include rigidity throughout the class of movement that does not vary with the speed of movement; resting tremor of the limbs or chin, the most common being "pill-rolling" tremor between thumb and index finger; symmetrical presentation of symptoms; and as the condition progresses, loss of postural reflexes. These reflexes help you retrieve your balance, so the loss of them may lead to mutability when walking and then lead to falls (Sawle, 2004).
Dysautonomia is a disorder of the autonomic nervous system characterized by lack of reflexes, abnormal sweating, defective lacrimation and sense perceptions, emotional instability, and motor incoordination.
Work Retention
Employee retention is a phenomenon where employees prefer to remain with their current company and don’t actively search for other job prospects. The contrary of retention is turnover, where employees vacate the company for a variety of reasons.
Retention is defined as the process by which a company ensures that its employees don’t quit their jobs. Every company and industry has a varying retention value, which indicates the percentage of employees who stayed with the organization during a fixed period (BasuMallik, 2020).
Parkinson's Disease Impact on Work Retention
A frequent antagonism that many people with Parkinson’s disease (PD) encounter is navigating their continued employment. This is a burdened issue for many and, like most issues affecting people with Parkinson’s disease, is highly variable depending on each person’s rare circumstances.
Depression is vulgar in Parkinson’s disease. It is due not only to the presence of a disabling condition but also related to neurochemical changes. People with Parkinson’s disease may draw various other symptoms. Handwriting that becomes smaller (micrographia), even throughout a single line or word (Swale, 2004), and a festinating gait are typical as the disease progresses. Festinating gait is one with stooped posture, small steps, and increasing speed. People with Parkinson's disease also have episodes of freezing, when they cannot initiate gait. These gait abnormalities can contribute to falls (Forwell et al., 2014). In later stages, speech becomes very soft, swallowing difficulties, sleep disturbances, and constipation may arise (Forwell et al., 2014). Urinary frequency and urgency have also been reported (Schultz-Krohn, 2006).
Parkinson’s disease also has social implications. The “mask-like face” typical of Parkinson’s may lead others to think the person is depressed, uninterested, unfriendly, or even angry. Many individuals are embarrassed by their tremors and other symptoms and stop engaging socially. Further, communication can be hindered by micrographia, lack of vocal intonation or facial expression, reduced gestures, and dysarthria (Forwell et al., 2014).
The hazard of unemployment and early retirement is aggravated in those with Parkinson's disease (Murphy, Tubridy, Kevelighan, & O’Riordan, 2013). In studies of those with Parkinson’s disease, 37-58% reported withdrawing early due to Parkinson’s disease, and they retired 6 to 7.8 years earlier than peers (Martikainen, Luukkaala, & Marttila, 2006; Schrag & Banks, 2006). The median time from diagnosis to loss of work was 6-7 years (Martikainen et al., 2006; Murphy et al., 2013; Schrag & Banks, 2006). This has a marked financial impact, particularly on those with younger age of onset. The symptom reported as most negatively affecting work was fatigue (Birleson, 2013), but slowness and tremor were also announced as challenging (Murphy et al., 2013). Part-time work authorized employees with Parkinson's to act an average of 4.3 years longer (Martikainen et al., 2006). Young individuals with Parkinson's had higher levels of perceived stigma about their impairment and its impact on work, which was demonstrated in a reluctance to seek help and request for accommodations at work (Murphy et al., 2013), and in fact, most were uninformed of their employment rights (Birleson, 2013). Barriers to continued employment included having to trade with customers or speak in public, and employers who were not flexible (Birleson, 2013). However, in their vindication, emplo...