Case Study 6: Patient With Parkinson’s Disease

EXAMINATION

History

• Demographic Information:

  The patient is an 84-year-old man with a 9-year history of Parkinson’s disease.

• History of Present Illness:

  The patient has experienced a recent deterioration of balance, gait, endurance, and strength. He was hospitalized for 12 days to monitor the deterioration and adjust medications accordingly. The patient was then transferred to an inpatient rehabilitation facility for 2 weeks, has received home physical therapy for 4 weeks, and now has been referred for outpatient physical therapy.

• Medical History:

  Patient reports prostate cancer, left upper extremity (UE) adhesive capsulitis (status post trauma from a motor vehicle accident), and depression.

• Surgical History:

  Patient reports right total knee arthroplasty (status post 8 years), left total knee arthroplasty (status post 4 years), and left total hip arthroplasty (status post 3 years).

• Medications:

  Sinemet, Mirapex, Lexapro, iron, and Zocor.

• Social History:

  The patient is retired and lives with his wife. She is also retired and able to provide limited assistance during the day secondary to her history of cardiac disease. A recently hired aide provides 4 hours of assistance per day.

• Living Environment:

  The patient lives in an apartment with no steps. He has the following durable medical equipment: straight cane, tripod rollator, shower chair, commode, and two grab bars installed in the bathroom.

• General Health Status:

  Fair

• Prior Level of Function:

  Before last hospitalization, the patient ambulated independently with a straight cane.

• Current Level of Function:

  The patient ambulates using a straight cane at home for short distances and ambulates outside with a rollator and contact guard assistance secondary to imbalance and fall risk. The patient reports an average of three falls per month. He uses a motorized scooter when traveling farther than four blocks. He reports difficulty with rolling in bed in both directions, transferring from supine to sit and sit to stand, donning and doffing clothes, and eating.

Systems Review

• Cardiovascular/Pulmonary System:

  • Heart rate: 70 beats per minute

  • Respiratory rate: 24 breaths per minute

  • Blood pressure: 128/76 mm Hg

• Musculoskeletal System:

  • Height: 5 ft, 8 in. (1.7 m)

  • Weight: 185 lb (84 kg)

  • Gross symmetry: The patient presents with decreased lumbar lordosis, rounded shoulders, increased thoracic kyphosis, and forward head posture.

  • Gross range of motion (ROM): The patient presents with gross limitations in active ROM in both UEs and both lower extremities (LEs), with greater limitations in the left UE and LE.

  • Gross strength: The patient presents with gross limitations in the strength of both UEs and both LEs, with greater limitations in the left UE and LE.

• Neuromuscular System:

  • Motor function (motor control, motor learning): The patient’s impaired motor control is apparent; increased difficulty is noted during initiation of bed mobility, transfers, and ambulation. The patient presents with daily freezing episodes (inability to continue an activity). When he is asked to perform functional activities, including transfers, ambulation, and fine motor tasks with increased speed or with additional task ...