Parkinson's - Thomas P3

Question 1

What is the prognosis for Thomas?

Answer 1

mild progression of PD in 4 years
- bradykinesia > walking speed
- festination > doorways
- UL resting tremor > from hand to UL
- shoulder flexion ROM decrease by 15’
- reduced dexterity and fine motor skills in R hand > shirt buttons and coins
- dual tasking impaired > walking and talking
- no postural improvements > Lx pain
- forgets home exercise > frontal lobe executive dysfunction? > hinders improvements
- all outcome measures worsened

+ independently mobile > no walking aids
+ consistency in RLL ROM and power > better than deterioration
+ consistency in most R shoulder ROM and power

Question 2

Prioritised problem list

Answer 2

• all outcome measures worsened > progression
• bradykinesia > reduced walking speed
• increased step frequency
• posture > LBP > Lx lordosis > flexed UT
• R grip power > dexterity and fine motor
• dual tasking
• festination > turning and doorways
• RUL resting tremor
• rigidity in knee and DFs > DF ROM
• R shoulder flexion ROM and stiffness

Question 3

Short term goals

Answer 3

• full DF ROM and power in 4 weeks
• restore R shoulder flexion to 110 degrees in 6 weeks
• increase shoulder ROM by 10’ in 4 weeks
• increase grip and wrist/finger power to 4/5 in 6 weeks
• hold a three minute conversation while walking on the spot in 10 weeks
• improve TUG by 2s and 3 steps in 6 weeks
• improve BBT by 1 in 4 weeks
• decrease TTW by 1cms in 6 weeks

Question 4

Long term goals

Answer 4

• consistency in gym x2 weekly and PD exercise class
• increase walking routines
• restore posture extension
• maintain no walking aids if possible

Question 5

Possible treatment options

Answer 5

• ST mobilisation in biceps, scapular, knee and calf
• gait re-education > gait length and speed
• postural re-education > Lx and UT
• shoulder mobility and strengthening
• R DF strengthening and stretching > calf raises > resistance band stretch
• grip strength > ball squeezes > mobilisation and tactile stimulation preparing hand R2G > tip of finger to tip of thumb 5x3 daily > sheet of paper between finger and thumb pulling with other hand 30s ES daily x3 > fist and stretch 3x10 > hand palm stretch or link finger stretch
• dual tasking > walking on the spot and word game, catching ball
• daily walks 10 mins - preference
• S2S > 5x3 daily > focusing on smoothness > use mirror
• cervical and Lx spine mobilisation/stretching 5mins daily > knee rolls, head rolls, pencil
• deep core and ES > pelvis tilting and plank > standing super mans > LB rolls
• balance re-education > SL stands 3x30s ES