The Priority Goals and Underlying Impairments Contributing to Goal-Related Problems of People with Parkinson’s Disease Receiving a Community-Based Rehabilitation Program

Table 1

DPA examples.

Example 1

Example 2

One participant’s goal was to improve their adherence to their PD home exercise program. They had purchased the program, had completed initial sessions with an exercise physiologist and were motivated to improve their frequency and consistency in completing the home program. The participant described organisational problems as the primary problem during guided discovery, whereby they intended to complete the home program each day but that other daily demands took precedence, and their exercises didn’t get done. The participant developed a strategy that involved pairing their home exercise program with another activity that occurred daily (eating lunch) and sharing digital tracking of their activity with family members (active minutes) to increase accountability. The strategy addressed planning and organisation problems and was effective in enabling task performance

One participant’s goal was to carry a tray of drinks, without spilling. They knew how to perform this activity and were adequately motivated for task performance. Observation of their performance, and discussions during guided discovery, indicated that tremor, anxiety and poor self-efficacy were contributing to ineffective performance. Several participant strategies were trialled during DPA including: Using melamine cups instead of porcelain cups and reducing the volume of liquid in cups to overcome anticipatory anxiety; and using nonslip matting on the tray to minimize cups slipping with tremor. The most effective strategy involved positioning of the participant’s thumb (bilateral interphalangeal extension), which reduced the intention tremor when carrying the tray