A process of dividing tasks and activities into small steps to make accomplishing them easier. This eases the anxiety people with Parkinson’s often feel about being unable to complete activities and helps to accommodate the motor limitations that develop as the disease progresses. Daily activities such as bathing, dressing, toileting, preparing meals, and even walking can be overwhelming to the person who struggles with dexterity, coordination, and balance, particularly in the middle to late stages of the disease. Although people tend to view everyday functions as single events, they actually are sequences of steps. cognitive impairment, even mild, and the disruptions to thought processes (drowsiness and difficulty concentrating or paying attention) that anti-parkinson’s medications often cause can affect a person’s ability to connect the steps into actions that once were commonplace. Family members and caregivers can make daily functions more efficient and less traumatic by helping to organize them into their component steps.
• Establish routines that break tasks into the smallest possible steps. Rather than looking at morning hygiene as a process of toileting, showering, brushing teeth, shaving, and combing hair, approach the process step by step. Toileting, for example, entails several actions: step into bathroom, turn on light, lift toilet lid, turn around, pull down pants, sit down.
• Allow enough time to carry out each step and maintain a consistent routine for this time allocation. Although some mornings the person with Parkinson’s may complete the steps of showering in 30 minutes, other mornings those steps may require an hour. It always is better to take each step without rushing and to finish ahead of schedule.
• Lay out items of personal hygiene, clothing, kitchen utensils whatever items the person needs to complete the task. Lay them out in the sequence in which they are used.
• When GAIT disturbances such as start hesitation and difficulty in changing direction become problems, encourage the person to think of each component of mobility separately. Sometimes it is overwhelming for the person with Parkinson’s to consider entering a room to sit down and watch television. Breaking down the actions into small units makes them less intimidating and gives the person a specific focus. This may involve establishing markers within the room, such as taking three steps to the coffee table.
The person’s needs will change over time as the Parkinson’s progresses. It is important to remain observant; if the person seems to struggle with what appear to be simple steps, look for ways to make the actions even more basic. Ask the person what would make them easier. Often solutions are possible but not obvious.