The negative effects of PD on the basal ganglia and supplementary motor area seem to cause the individual to utilize the premotor cortex to a greater degree to control movement (1). Both physical and occupational therapists utilize this concept to help break down activities into their component parts and instruct the patient to utilize cognitive strategies to control movement. Thus, working with a patient to get out of bed becomes a sequence of individual tasks such as roll to side, bend at knees and hip, move lower legs off edge of bed, pushup with elbow, bring body to upright position at edge of bed, lean upper body forward, and stand up to accomplish the end result of "getting out of bed." Occupational therapists would similarly break down fine motor self-care activities such as writing and feeding. With a combination of the adaptive equipment and aids, simple tasks such as opening jars, operation of small appliances, and shuffling cards can all be broken down into component parts that the patient can then work to control.
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