How to manage seating discomfort in patients with Parkinson's disease?

Managing Seating Discomfort in Parkinson's Disease Patients

For patients with Parkinson's disease, optimal seating comfort should be achieved through proper postural alignment, appropriate seating support, and regular position changes, combined with physical activity that maintains mobility without causing fatigue. 1

Understanding Seating Challenges in Parkinson's Disease

Parkinson's disease (PD) patients face unique seating challenges due to:

• Rigidity and bradykinesia affecting posture
• Tremor causing discomfort in static positions
• Postural instability leading to poor alignment
• Dystonia causing abnormal postures and pain
• Fatigue from maintaining positions

Optimal Seating Strategies

Proper Postural Alignment

• Encourage even distribution of weight in sitting to normalize movement patterns and muscle activity 1
• Avoid postures that promote prolonged positioning of joints at the end of range (e.g., full hip, knee or ankle flexion while sitting) 1
• Support the affected limbs when at rest, using pillows or furniture to take the weight of limbs when sitting 1

Seating Support and Modifications

• Ensure adequate back support with proper lumbar support
• Use firm but cushioned seating surfaces that distribute pressure evenly
• Consider chairs with armrests to assist with transfers and provide upper body support
• Ensure proper seat height - feet should rest flat on the floor with knees at approximately 90 degrees
• Install handrails in seating areas, especially in bathrooms/shower areas 1

Movement and Position Changes

• Encourage regular position changes to prevent stiffness and discomfort
• Implement a schedule of position changes every 30-45 minutes
• Teach proper sit-to-stand techniques to reduce strain and discomfort
• Address unhelpful prejerk cognitions and movement (signs of anxiety, frustration) that may contribute to discomfort 1

Physical Activity Recommendations

Physical activity is beneficial for PD patients and should be incorporated into seating management:

• Encourage regular physical activity as long as it doesn't worsen the physical state of the patient 1
• Incorporate both endurance and resistance exercises which may slow disease progression and improve functionality and quality of life 1
• Teach relaxation techniques including diaphragmatic breathing or progressive muscular relaxation 1
• Consider "slow" movement activities such as yoga or tai chi to regain movement control 1

Environmental Modifications

• Ensure adequate lighting in seating areas 1
• Remove obstacles and clutter from pathways 1
• Use non-slip mats in areas where patients sit 1
• Consider adaptive equipment for improved comfort and function

Managing Associated Symptoms

For Dystonia

• Promote therapeutic resting postures and limb use 1
• Implement strategies to reduce muscle overactivity, pain and fatigue 1
• Address associated problems of pain and hypersensitivity 1

For Tremor

• Assist the person to relax muscles in the limb to prevent cocontraction 1
• Try to control tremor with the person at rest before moving to activity 1
• Discourage cocontraction or tensing of muscles as a method to suppress tremor 1

Practical Implementation Tips

• Perform regular assessments of seating comfort and function
• Involve occupational therapy for personalized seating recommendations
• Consider video recording interventions (with consent) to identify changes in symptoms and demonstrate successful strategies 1
• Be cautious with splinting as it may prevent restoration of normal movement and function 1

Common Pitfalls to Avoid

1. Using seating that's too soft, which can make transfers difficult
2. Neglecting to address both physical and psychological aspects of discomfort
3. Failing to regularly reassess seating needs as the disease progresses
4. Over-reliance on splinting which may increase attention to the affected area and exacerbate symptoms 1
5. Ignoring the need for regular position changes and movement breaks

By implementing these comprehensive seating strategies, PD patients can experience improved comfort, better posture, reduced pain, and enhanced quality of life despite the progressive nature of their condition.