Parkinson's - Thomas P2

Question 1

What is Thomas’s prognosis?

Answer 1

mild decreased prognosis aspects from last check up
- acute appendicitis > unable to do regular exercise due to illness
- right hand tremor worsened
- increased hypomimia > flat face
- R grip and wrist and finger strength decreased
- tiered and easily fatigued
- all outcome measures have worsened

+ smiles at times
+ no major changes in shoulder power and ROM > no noticeable progression > consistency is better than deterioration
+ independently correct standing posture > signs of awareness to posture
+ maintains active lifestyle where possible
+ joined Parkinson’s UK group class > support

Question 2

Prioritised problem list

Answer 2

• all outcome measures worsened
• easily fatigued
• R step length and heel strike reduced
• R hand grip strength and hand/wrist power
• worsened R hand tremor
• RUL rigidity > scapular and bicep
• R shoulder ROM and stiffness
• upper trunk flexion in standing
• excessive Lx lordosis compensation
• hypomimia

Question 3

Short term goals

Answer 3

• full R DF ROM and power in 3 weeks
• increase all shoulder ROM by 10 degrees in 3 weeks > maintaining power
• 4/5 power in supination, finger flexion and extension in 3 weeks
• increase grip strength to 4/5 in 3 weeks
• tragus to wall > decrease back to 23cms
• TUG > reduce back to 13 steps and to 12s in 4 weeks
• berg balance > RSL stance increase to 3/4 and tandem stand to 2/4 in 4 weeks

Question 4

Long term goals

Answer 4

• constant trunk extension in sitting and standing
• reduce general fatigue
• maintain current exercise routine > gym x2, 4 mile walks, exercise PD class, 20 min daily exercises

Question 5

Possible treatment options

Answer 5

• dorsiflexors stengthening > calf raises holding onto a chair > 3x10 daily
• ankle stretching > resistance band around foot > pull and hold for 6s 3x8 daily
• shoulder mobility > reduce stiffness increasing ROM > 10 mins daily
• grip strengthening > ball squeezes 3x10 daily ES
• finger strengthening > elastic band around fingers extending and relaxing > 3x10 daily ES
• Cx spine mobility > open up pecs > strengthen extensor spinae and deep core
• slalom waling 10m and back for 2 mins > count cones circled 2 sets 2x a week
• SL standing holding on to a chair 20s ES 3xdaily
• posture re-education with ball
• gait re-education > gait stride length, initiation and heel strike