Parkinson’s Management: Management of a Patient to Maintain Mobility - Case Presentation of Jim

Original Editor - Merinda Rodseth based on the course by Bhanu Ramaswamy

Top Contributors - Merinda Rodseth and Tarina van der Stockt  

Background[edit | edit source]

Jim is a 70-year man who has been attending physiotherapy since mid 2018 after he volunteered as a model at a meeting for people with Parkinson’s. Dr Ramaswamy demonstrated how a physiotherapist might assess someone with the condition and he wanted to understand more about what he could do to keep himself fit and mobile.

Jim is a retired manager; his job role was stressful and mostly sedentary in an office. He is now active and independent, living in a house with his partner and leading a full social life. In terms of activity, Jim always did yoga and walked, but over the past two years has built a fitness regime that includes varied physical components.

Apart from a diagnosis of Parkinson’s made in 2016 affecting his left side more than the right, Jim has long standing low back arthritic changes, well-managed hypertension and chronic obstructive pulmonary disease.

Jim’s goal has always been to remain as fit and well as he can in order to stay mobile. Over time, Jim has had general assessments for gait, balance and transfers, but the focus has remained on components of his fitness.

The following aspects are however continually monitored:

  1. The Tragus-to-wall test to review ability to alter posture from his default position
  2. Jim monitors his own daily step count and walking speed during a 5 x week walk.

Due to the COVID-19 pandemic restrictions, Jim has chosen not to return to the clinic in person, but attends a weekly online exercise class run by Dr Ramaswamy. He also engages in a personalised 6-monthly appointment via a digital platform to monitor his progress.

In order to prevent progression of symptoms, it is essential that individuals with Parkinson’s engage in physical activity.[1][2][3] By imposing lock-down restrictions and limited healthcare, the COVID-19 pandemic has had a profound impact on the ability of individuals with Parkinson’s to stay active, leading to a loss of function and a decrease in quality of life.[4][5]  Digital platforms have opened up a whole new and enticing way to engage with patients, especially in a time where people are encouraged to isolate in order to curb the spread of the COVID-19 pandemic.[5][6] Where previously clinicians and patients might have been resistant to the use of digital platforms in healthcare, the pandemic has brought about a realisation of the significant potential of digital platforms.[5] This case study (Jim) illustrates how patients can be monitored and interventions can be implemented through the use of technology.

Resources[edit | edit source]

References[edit | edit source]

  1. Ellingson LD, Zaman A, Stegemöller EL. Sedentary Behavior and Quality of Life in Individuals with Parkinson’s Disease. Neurorehabilitation and neural repair. 2019 Aug;33(8):595-601. DOI:10.1177/1545968319856893
  2. von Rosen P, Hagströmer M, Franzén E, Leavy B. Physical activity profiles in Parkinson’s disease. BMC neurology. 2021 Dec;21(1):1-8. DOI: 10.1186/s12883-021-02101-2
  3. Urell C, Zetterberg L, Hellström K, Anens E. Factors explaining physical activity level in Parkinson's disease: A gender focus. Physiotherapy theory and practice. 2021 Apr 3;37(4):507-16. DOI:1080/09593985.2019.1630875
  4. Shalash A, Roushdy T, Essam M, Fathy M, Dawood NL, Abushady EM, Elrassas H, Helmi A, Hamid E. Mental Health, Physical Activity, and Quality of Life in Parkinson's Disease During COVID-19 Pandemic. Mov Disord. 2020 Jul 1;35(7):1097-9. DOI: 10.1002/mds.28134
  5. 5.0 5.1 5.2 Thomas S, Mancini F, Ebenezer L, Price J, Carta T, Cordasco J, Tedesco C, Gillett S. Parkinson's disease and the COVID-19 pandemic: responding to patient need with nurse-led telemedicine. British Journal of Neuroscience Nursing. 2020 Jun 2;16(3):131-3. DOI:10.12968/bjnn.2020.16.3.131
  6. Miele G, Straccia G, Moccia M, Leocani L, Tedeschi G, Bonavita S, Lavorgna L, Digital Technologies, Web and Social Media Study Group of the Italian Society of Neurology. Telemedicine in Parkinson's disease: how to ensure patient needs and continuity of care at the time of COVID-19 pandemic. Telemedicine and e-Health. 2020 Dec 1;26(12):1533-6. DOI: 10.1089/tmj.2020.0184