Fay J. Tripp, MS, OTR/L, CDRS Department of Occupational Therapy and Physical Therapy Duke University Medical Center

1. Fay J. Tripp, MS, OTR/L, CDRS Department of Occupational Therapy and Physical Therapy Duke University Medical Center

2. Increase awareness of: • ways to save your energy to put you in control of what you do. • ways to reduce the effect of tremors during function. • adaptive devices and techniques to increase self-care and home responsibilities and safety. • possible visual changes that may occur. • driving safety issues related to movement and process delays.

3. Limit the amount of work you do • Plan ahead • Plan rest breaks • Be an efficiency expert • Organize your storage spaces • Use assistive devices to increase independence and safety

4. Stabilize your forearm or elbow • Wear wrist support braces • Use weighted utensils or weights • Hold items with a “fist” grip

5. Gently apply pressure to muscles • Gently move wrist side to side • When writing, print in large letters using lined paper with wrist brace • With computer work,use a forearm support system 5

6. Bathing • Tub seat or bench

7. Bathing • Grab bars • Adaptive devices

8. Bathroom Use and Hygiene • higher commode seats • grab bars • care aids

9. Dressing • Seated position • Adaptive devices

10. Grooming and Hygiene • Tremor control • Wrist brace • Forearm support • Adaptive devices • large, long handled devices • electric razor • nail care

11. Eating • Tremor reduction • wrist brace • forearm support • fist grip • Assistive devices • large handled, tubing • weighted utensils • rocker knives • long straws • no spill mugs

12. Cooking and Kitchen Work • Assistive devices • utensils • cutting boards • jar openers • can openers

13. “Personal domain” care • Home care tasks • Workshop needs

14. “Personal domain” care • Outdoor maintenance

15. Leisure Skills • Safety first • Alternate interests

16. Writing and Computer Work • Forearm stabilization • Forearm support • Micrographia • Begin good habits early • Used lined paper • Print in large letters • Incorporate strategies to reduce tremor

17. Vision Changes • Double Vision (Diplopia) • impaired movement control • eye muscle fatigue • decreased tracking together, alignment • Color perception • Contrast sensitivity 17

18. Vision Changes • Blurriness due to dry eyes • Decreased eye blink rate • Eye discomfort • Progressive pattern • Can impair motor functioning • Blepharospasm 18

19. Possible changes that may affect safety • Physical ability and reaction time • Response rate • Freezing • Attention • Multi-tasking ability • Judgment

20. Possible changes that may affect safety • Visual skills • Acuity • Depth perception • Peripheral vision • Perception

21. NC Department of Motor Vehicles • Medical Review Group • Physician Medical Form • Optometric Evaluation • Occupational Therapy Evaluation • Clinical evaluation: physical, visual, cognitive skills • Behind the wheel evaluation: licensed driver instructor • Referral to DMV Medical Review Group • At time of license renewal • Physician based • Motor vehicle incident occurrence 21

22. Questions?