“Somedays it takes me about 45 minutes to get on a pair of briefs”, said one of my patients with Parkinson’s Disease (PD).
As a physical therapist, I knew that we had to solve this problem. Spending 45 minutes of life donning clothing is no way to live.
If you are reading this and have PD, you may know what I am talking about. For those of you who are not as familiar with PD, this is a small window into the world of living with PD.
And when the problem of donning clothes reaches this level, it significantly reduces quality of life. It is not only the frustration that the patient with PD experiences, but the further drain on his or her already limited energy.
Without exception, the number one complaint I get from all of my patients with Parkinson’s Disease is fatigue. To those of us living outside of the PD world, we might think that the tremors and mobility impairments are the number one complaint—and they are a big deal. But the fatigue component trumps them all. Why? Because fatigue means that one can spend less time in life enjoying the company of others and engaging in activities that bring him or her joy and purpose.
Why can it be so hard to get briefs on when one has PD?
Stiffness and rigidity: PD causes stiffness and rigidity throughout the body, particularly in the spine and hips. This can make it difficult and/or painful to bend forward towards the feet or bring a knee up to lift a foot through the leg hole of a pair of briefs.
Motor initiation, planning, and sequencing: With PD, some of the tasks that one used to take for granted and didn’t even think about (i.e., putting on clothes, getting out of a chair) become very difficult. Sometimes getting the tasks started is the hardest part. And when a task involves a series of steps, such as putting on briefs (i.e., orienting the briefs properly, getting legs into the right holes), becomes very difficult.
Reduced amplitude of movement: Typically, once we learn how to do a motor tasks in our lives, we have an automatic program in our brain as to how much effort or force is needed to accomplish the task. For instance, getting into and out of a chair is easy because the brain “knows’ how much force should be put through the legs to rise from the chair. If the chair is exceptionally low, the brain knows that more force is needed through the legs vs. if the chair is a higher. With PD, people lose that sense of calibration and not enough effort/force is put into the movement and the task is not accomplished. Most of my patients come to physical therapy with complaints of falling back into a chair when they try to come to standing. Their brains have recalibrated the motor program for getting out of a chair. This recalibration occurs across all movements including fine motor skills, that are needed to handle a pair of briefs and orient them properly for donning.
Tremors: Tremors that are characteristic of PD obviously hinder motor tasks—especially fine motor tasks that take precise grip to open up and orient a pair of briefs for donning. And when a task becomes more difficult, people with PD often experience worsened tremors.
So what can a physical therapist do for a patient with PD who cannot get his briefs on? It depends on the individual’s characteristics, but what follows is an outline of the approach that I take:
- Determine the patient’s primary limitations in putting on briefs. Some people exhibit stiffness and rigidity as their primary issue. If this is the case, we spend time working on mobility and stretching to regain range of motion in the spine, hips and other lower extremity joints. We make sure the motions of putting on briefs are possible. For other people, they have the available range of motion needed to put on briefs, but they are not putting enough effort or force in to make the task possible. For example, they cannot lift their foot high enough to get it into the leg hole on the briefs. For other people, it’s the fine motor skills that are the biggest limiting factor. Sometimes getting the briefs opened up and properly positioned to facilitate donning is the biggest problem. And sometimes, it’s a combination of all of these issues.
- Design a rehab program that targets the biggest limitations and practices the skill of putting on briefs. More than likely, there is combination of limitations described above that need to be addressed. A comprehensive program might work on fine motor skills with one’s hands, mobility and flexibility and recalibration of force needed to accomplish the task of putting on briefs. For the latter, LSVT-BIG exercise is a well- researched exercise program that works very well for retraining the brain to initiate movements with greater force to make everyday tasks possible. LSVT-BIG is backed by over 25 years of U.S. National Institutes of Health research as being effective and can have long-lasting effects post physical therapy treatment. Weber Physical Therapy and Wellness is one of the only physical therapists in Southeast Idaho to offer LSVT-BIG treatment.
- Take comorbidities into consideration that complicate one’s life with PD. In the life of someone with PD, PD often takes center stage. However, other health issues layered on top, may make things even more difficult. To maximize the benefit from physical therapy, these other problems need to be taken into consideration. For instance, it is common for people with PD to struggle with dementia, visual deficits, other orthopedic injuries/pain that exacerbate the issues that they already stem from having PD.
The patient quoted at the top of this article had a unique presentation in that it was actually his comorbidities that were limiting his ability to don his briefs. He saw double up close and had dementia that caused him to hallucinate at times. He had some motor planning deficits that would get him “trapped” in a position, bent over with the brief only around the tips of his toes. And that is where he would stay for 35 minutes. And that was after the 10 minutes it would take him to fiddle with the briefs to open them up and find the leg holes—seeing double makes this very difficult. As a physical therapist, I cannot fix someone’s vision, but I can adapt a task so that it might get around some of the problem.
I built this patient a dressing aid that holds his briefs open for him so he can easily see the leg holes. And since the device holds the briefs open, he doesn’t have to hold onto them and can focus on just getting his legs into the leg holes. Once his feet are in place, he just has to grab the waist band and pull up. That’s it.
This device allows him to get his briefs on in 3 minutes or less. Saving him 42 minutes to do things that he loves and make his life full.
If this story sounds similar to your situation or that of someone you love, consider physical therapy. As a physical therapist I provide tailored, one-on-one services for patient driven success. You can ‘wear the pants’ again.
Carolyn F Weber, DPT, PhD is one of the only physical therapists in Southeast Idaho who is certified in LSVT-BIG treatment for Parkinson’s Disease. She provides one-on-one physical therapy and fitness programming for clients with Parkinson’s Disease in the comfort of their homes. Medicare of Idaho and Railroad Medicare insurances are accepted. You do not need a doctor’s referral to get started—just call or email Carolyn to set up your first appointment.
Phone: 505-412-8384 (call or text message)
Carolyn also leads an exercise group on Wednesday’s at 5 PM at the River of Life Church located at 1211 S 5th Ave, Pocatello, Idaho 83201. This class is FREE, but space is limited. Email Carolyn for more information or to her know that you want to reserve your space in the class.