Parkinson's Case Study - Nick Post-Treatment Assessment: Difference between revisions

(Created page with "<div class="editorbox"> '''Original Editor '''- Tarina van der Stockt '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} </di...")
 
No edit summary
Line 11: Line 11:
Baseline
Baseline
!'''Comments on Parkinsonian features of gait'''
!'''Comments on Parkinsonian features of gait'''
!'''Post Treatment'''
!'''Comments'''
|-
|-
!'''TUG'''
!'''TUG'''
Line 16: Line 18:
over cut off score (falls risk)
over cut off score (falls risk)
|Initiates gait immediately on standing; generally more flexed posture with reduced left arm swing and slow walk; watches for turning point; tremor both hands; six step for 180° turn (falls risk). Good step length and clearance of feet except on turn.
|Initiates gait immediately on standing; generally more flexed posture with reduced left arm swing and slow walk; watches for turning point; tremor both hands; six step for 180° turn (falls risk). Good step length and clearance of feet except on turn.
|'''16.46 secs'''
'''12.36 secs (below cut off, so safer walk)'''
|'''First attempt slow and conscious to maintain good long steps; forgot speed!'''
'''Second attempt able to stride out better; 4-step turn'''
|-
|-
!'''Motor on motor dual task'''
!'''Motor on motor dual task'''
|15.20 secs (not > 10% so the dual task does not increase falls risk)
|15.20 secs (not > 10% so the dual task does not increase falls risk)
|Pushes up from chair; pauses before initiating gait; passes turn point as looking up. 4 step turn
|Pushes up from chair; pauses before initiating gait; passes turn point as looking up. 4 step turn
|'''13.75 secs (> 10% of baseline so dual task increases falls risk when tired)'''
|'''Pushes up from chair on second attempt, as did not wait for ‘go’ command; straighter; 6-step pivot turn with adjustment steps.'''
'''Note he is becoming tired and his knee aches on right'''
|-
|-
!'''Cognitive on motor dual task'''
!'''Cognitive on motor dual task'''
|15.40 secs (not > 10%)
|15.40 secs (not > 10%)
|Even less arm swing; pauses before initiating gait; 5 step turn; less symmetry between steps
|Even less arm swing; pauses before initiating gait; 5 step turn; less symmetry between steps
|-
|'''14.39 secs'''
!'''Cognitive on motor dual task'''
'''(> 10% of baseline so dual task increases falls risk when tired)'''
|15.40 secs (not > 10%)
|
|Even less arm swing; pauses before initiating gait; 5 step turn; less symmetry between steps
|-
|-
!'''Steps forward 3m'''
!'''Steps forward 3m'''
|6 steps
|6 steps
|Confident, large steps
|Confident, large steps
|'''6 steps'''
|'''More upright'''
|-
|-
!'''Steps backwards 3m'''
!'''Steps backwards 3m'''
|8 steps
|8 steps
|Drags feet backwards – can hear the scuffing during all steps
|Drags feet backwards – can hear the scuffing during all steps
|'''6 steps'''
|'''More extension of trunk and right hip; only dragging right foot back. Nick stated he felt more even with his steps'''
|}
|}


== TUG ==
== TUG and Gait ==
To work out if dual tasking is of help or increases risk of falls, work out the 10% range either side of baseline i.e. for Nick’s baseline of 14.56 seconds, the range is 13.10 to 16.02 seconds. Adding the motor and cognitive task to baseline pretreatment was not outside the 10% baseline range, so does not increase the risk of falling with this test, but his combined transfer, walking pattern and turns take longer to complete than is deemed ‘safe’.  
The lack of extension from both buttocks is most noticeable in the backward stepping, but post-treatment his trunk posture is more upright, plus steps are larger and initiated from his buttock muscles, demonstrating better motor control and balance, so he equals the number of steps forwards on stepping back.


The TUG may not be a tool of choice to look at gait, but for example, using a tool such as the <a href="https://physio-pedia.com/Tinetti_Test">Tinneti gait scale</a>, you would record no hesitancy of gait initiation during the baseline walk, but hesitation when a second task is added, step length and height of feet are fine until he turns; symmetry affected but path and continuity of gait pattern fine, as is foot distance, but trunk is stiffer – this would give a score between 7 – 9/ 12 depending on the addition of a second task – again, demonstrating there are components that put Nick at moderate risk of a fall in the future.
The treatment session was effective in improving mechanical pressure and proprioceptive sensory feedback through Nick’s joints allowing better alignment of his body so (until he became tired), the treatment relieved his knee pain.
 
His TUG baseline post treatment was within the cut-off time as not only a better ability to recruit muscle fibres to power walking, but more confident to step out faster due to relieved pain. However, although all post treatment times were better, adding the second task when he was able to walk faster made the time >10% of baseline, meaning there was increased interference, and hence a falls risk by adding the second task.


==Tragus to wall test ==
==Tragus to wall test ==
Nick never fully extends either knees or hips during his walk (forwards or backwards) despite the good step size. Although his walk is purposeful, the stress through the anterior knee joint constantly flexed during joint loading when in stance could be a reason for his pain.  As I wanted to see whether the flexion was correctable, we performed a Tragus to wall test to understand the influence of forward pull on upright stance, and therefore gait.
{| class="wikitable"
{| class="wikitable"
!'''Test: Tragus to wall'''  
!'''Test: Tragus to wall'''  
Line 57: Line 73:
|-
|-
!'''Post treatment'''
!'''Post treatment'''
|16 cms – within optimal measure
|'''16 cms – within optimal measure'''
|18 cms – just within optimal measure
|'''18 cms – just within optimal measure'''
|}
|}


Revision as of 00:42, 15 July 2019

Original Editor - Tarina van der Stockt

Top Contributors - Kim Jackson, Tarina van der Stockt and Lauren Lopez

Assessment Results and Comments[edit | edit source]

Test Pretreatment

Baseline

Comments on Parkinsonian features of gait Post Treatment Comments
TUG 14.56 secs

over cut off score (falls risk)

Initiates gait immediately on standing; generally more flexed posture with reduced left arm swing and slow walk; watches for turning point; tremor both hands; six step for 180° turn (falls risk). Good step length and clearance of feet except on turn. 16.46 secs

12.36 secs (below cut off, so safer walk)

First attempt slow and conscious to maintain good long steps; forgot speed!

Second attempt able to stride out better; 4-step turn

Motor on motor dual task 15.20 secs (not > 10% so the dual task does not increase falls risk) Pushes up from chair; pauses before initiating gait; passes turn point as looking up. 4 step turn 13.75 secs (> 10% of baseline so dual task increases falls risk when tired) Pushes up from chair on second attempt, as did not wait for ‘go’ command; straighter; 6-step pivot turn with adjustment steps.

Note he is becoming tired and his knee aches on right

Cognitive on motor dual task 15.40 secs (not > 10%) Even less arm swing; pauses before initiating gait; 5 step turn; less symmetry between steps 14.39 secs

(> 10% of baseline so dual task increases falls risk when tired)

Steps forward 3m 6 steps Confident, large steps 6 steps More upright
Steps backwards 3m 8 steps Drags feet backwards – can hear the scuffing during all steps 6 steps More extension of trunk and right hip; only dragging right foot back. Nick stated he felt more even with his steps

TUG and Gait[edit | edit source]

The lack of extension from both buttocks is most noticeable in the backward stepping, but post-treatment his trunk posture is more upright, plus steps are larger and initiated from his buttock muscles, demonstrating better motor control and balance, so he equals the number of steps forwards on stepping back.

The treatment session was effective in improving mechanical pressure and proprioceptive sensory feedback through Nick’s joints allowing better alignment of his body so (until he became tired), the treatment relieved his knee pain.

His TUG baseline post treatment was within the cut-off time as not only a better ability to recruit muscle fibres to power walking, but more confident to step out faster due to relieved pain. However, although all post treatment times were better, adding the second task when he was able to walk faster made the time >10% of baseline, meaning there was increased interference, and hence a falls risk by adding the second task.

Tragus to wall test[edit | edit source]

Test: Tragus to wall

(Nick’s optimal is 15 cms +/- 3 cms)

Right Left
Pre treatment 26 cms – outside chest base 24 cms – outside chest base
Post treatment 16 cms – within optimal measure 18 cms – just within optimal measure

*This page forms part of the Parkinson's Disease Outcome Measures Case Study Course


Retrieved from "https://www.physio-pedia.com/index.php?title=Parkinson%27s_Case_Study_-_Nick_Post-Treatment_Assessment&oldid=215942"