Referral to a multidisciplinary team

♦ Create a directory with contact information for various members of the team which is easily accessible to the PA/NP as well as other staff members.

♦ Physical therapy for gait and balance training, as well as stretching, range-of-motion exercises.

O Consider option of home physical therapy for house-bound PD patients. Identify agencies in the local area, which provide home services.

♦ Occupational therapy may help, particularly with activities requiring deftness. For example, a person with PD who played the clarinet found benefit from working with occupational therapy. O Make referrals for home occupational/physical therapy safety evaluation to assess the patient's home environment. Therapists can identify any hazards that could contribute to falls, such as throw rugs in doorways and hallways. Therapists also make recommendations for assistive devices, which may be of benefit to the person with PD, as well as the carer. O Assistive devices may include railings, lift chairs, shower chairs, canes, walkers, or wheelchairs.

♦ Speech and language therapist assessment for evaluation of speech as well as swallow, for patients with hypophonia, dysarthria, or dysphagia.

♦ Neuropsychology for baseline and annual neuro-psychological evaluation.

O Patients and family members may find reassurance from normal or minimal impairment. O Neuropsychological evaluation may also help with differentiating PD from parkinsonian syndromes.

O In cases where dementia or cognitive impairment is identified, behavioural and/or pharmacological therapy may be initiated.

Social services.

O The outpatient social worker can provide information regarding resources available in the community for respite care as well as home care.

O Information regarding financial assistance may also be available. O In cases where placement in an assisted living facility or nursing home may be indicated, the social worker can assist with placement issues, and may also be able to assist the family with obtaining financial assistance for long-term care. Psychologist.

O The person with PD may need assistance with coping with a diagnosis of PD and the impact of a progressive neurodegenerative disorder on his/her daily life. O The spouse of the PD patient may also be in need of the services of the psychologist, and at times couples' counselling may be indicated. Psychiatrist.

O Depression, anxiety, and panic attacks are a few of the nonmotor features of PD. Psychiatrists may be in the best position to assist with these particular aspects. Driver evaluation. Frequently family members will pose the question of whether the person with PD should be driving. Rehabilitation hospitals typically provide a driver evaluation programme, which includes examination of visual acuity, range of motion, and reaction time. While some programmes offer a driving simulator, others include a road test. The report is returned to the referring clinician as well as to the DMV (Department of Motor Vehicles) (USA) or DVLA (Driver and Vehicle Licensing Agency) (UK). O When requested, the DMV or DVLA may provide a list of driver evaluation programmes. Legal professional.

O Decisions regarding wills are best made when one is healthy. Encourage patients to consult with appropriate legal professionals to discuss will and testament issues, as well as healthcare surrogate and power of attorney. O Legal professionals may also assist with social security disability/medicare coverage issues as needed.

Registration personnel.

O Ensure that contact information for patient is correct.

O Update insurance information.

O Provide copies of living will/advance directives. The clinician should also encourage the patient to consider his/her choices for end-of-life issues and discuss them openly with family members.

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