Parkinson's - Thomas P1 Flashcards
1
Q
What is the prognosis for Thomas?
A
moderately positive prognosis
+ remains active > long walks and gym
+ no loss of balance or falls
+ no cognitive issues noted (informal)
+ dexterity - can undo buttons
+ normal tone in R hip and knee
+ LL and RUL full ROM and power bar R DF
- some signs of progression of disease
- R shoulder pain not improving > reduced ROM
- mild R hand tremor
- speech becoming quieter
- walking speed and distance reduced
- dual tasking reduced
2
Q
Prioritised problem list
A
- R shoulder pain and reduced ROM
- flexed upper trunk posture and unawareness plus head and neck flexion
- mild tremor
- reduced initial step length
- quieter speech (SALT team)
- dual tasking reduced
- worried and can become stressed w tasks
3
Q
Short term goals
A
- increase all shoulder ROM by 10 degrees in 3 weeks > add ST mobilisation to reduce stiffness
- R ankle DF 5/5 in 2 weeks
- recruit more trunk extension in sitting and standing in 3 weeks
- improve tragus to wall test by 2 degrees in 2 weeks
- integrate ball catches into dual task situations
- re educate heel strike and equal step length in R to L in 3 weeks
- increase walking speed by 1 second in 2 weeks > timed up and go - 1s
4
Q
Long term goals
A
- stay consistent with monthly long walks
- stay consistent with gym x3 per week
- restore walking speed and distances
5
Q
Possible treatment options
A
- posture re-education > upper trunk flexion > cervical flexion > gym ball exercises
- gait re-education > preparing for gait > improving initiation and heel strike
- R shoulder mobility and strengthen > rolling movements, isometric strength training, light weights
- coordination activities > alphabet names and ball catching > remain with established exercise as introducing a new one may induce stress
- posture and alignment > spinal mobility > core and erectus spinae strengthening > lats
- gripping and grasping > R hand ball squeezes
- maintain walks and gym
