Primary Lateral Sclerosis (PLS): A Case Study

ABSTRACT

This fictional case study

INTRODUCTION

Is a very rare

CLIENT CHARACTERISTICS

Mr. Parker is a retired 56-year-old male, right-hand dominant, who presents with early-stage PLS. Until about three years ago (2019), he was an avid crossfitter, participated in leisure activities with his two grand-daughters, and worked part-time at his family-owned construction company. Previously, he would train at the gym 2-3 times per week and would go on 3-5 km runs twice a week. Mr. Parker first presented to his family physician three years ago with reports of weakness in his legs that had progressed over time to cause clumsiness and stiffness during his runs. He reported that he “had to stop running because of a fear of falling”. He was then diagnosed with ALS in 2019 through subjective history, physical examination and diagnostic tools (MRI and EMG). However, upon recent reassessment in 2022, the physician concluded that Mr. Parker has PLS as his symptoms did not progress to the LMNs - as concluded by a secondary physical examination and diagnostic tools. Mr. Parker’s physician initially referred him to physiotherapy in 2019 following his ALS diagnosis. However, he still recommends that Mr. Parker continues with his rehabilitation following his PLS diagnosis for maintenance purposes.

Since the initial diagnosis of ALS, Mr. Parker's health status has slowly deteriorated. Mr. Parker was prescribed a single point cane with a 2-point step-through pattern by his previous physiotherapist in 2019, which he uses on occasion.

In 2020, he was forced into an earlier retirement than planned as he was unable to keep up with the part-time hours and work duties at the construction company. Furthermore, he is now unable to participate in any recreational running or CrossFit training due to the severity and worsening of his symptoms. He has now adjusted his fitness regime and uses resistance bands to work out from time-to-time at home and tries to go for a 10-30 minute walk daily with his wife. His home activities have also been reduced due to decreased activity tolerance, decreased endurance and fatigue. Therefore, his wife has taken on more responsibilities at home.

Upon reassessment in 2022, Mr. Parker reports that he is starting to experience swallowing difficulties and painful spastic posturing in his left arm. Overall, his condition continues to remain relatively the same since initial onset but has since started to consistently take medication (Lexapro) for his concurrent depression. Additionally, his wife describes that he has been having intermittent, uncharacteristic behavioral outbursts as of two months ago.

PATIENT GOALS

Short-Term Goals (STG)

Body Structure/Function

Activity

Participation

Long-Term Goals (LTG)

Body Structure/Function

Activity

Participation