Parkinson's Disease: A Case Study

Abstract

This fictional case study is a 68 year old retired farmer (female) who has been diagnosed with early stage idiopathic Parkinson's Disease and received a referral for physiotherapy. The case study documents her intake assessment until 12 weeks follow up and a summary of the major outcomes.

Client Characters

Gail is a 68 year old female. She is a retired farmer who lives at home alone with her dog. Gail’s husband passed away 5 years ago. She experienced a minor fall after tripping over her dog and landed on an outstretched right hand, leading to wrist pain. She saw her family doctor regarding her wrist, but also complained of some recent trouble with balance and a small hand tremor. She was referred to a neurologist and diagnosed with early stage idiopathic Parkinson’s Disease. She received a referral for physiotherapy to perform a falls risk assessment, maintain her functional status, and address her concerns regarding the condition.

Examination Findings

The patient had their intake assessment on May 9th, 2020.

Subjective

• Patient Profile (PP): 68 y/o female
• History of Present Illness (HPI): Diagnosis of idiopathic Parkinson’s Disease 1 month ago, left hand tremor (~5 months), right hand dominant and decreased handwriting size (~5 months), decreased balance (~1 year)
• Past Medical History: Right wrist injury (~3 months ago, resolved), Depression
• Medications: Currently none, received prescription and education for Levadopa (doesn’t feel she needs it yet), advil for headaches when needed
• Health Habits: Non-smoker, no longer drinks alcohol (~3 years)
• Psychosocial: Patient describes feeling lonely, isolated, and frustrated with diagnosis. Showing signs of depression. She has avoided going to see her friend due to feeling unsteady, and fear of falling (~3 months). Daughter lives ~2 hours away, and visits 1-2 times/month.
• Home: Bungalow, lives with dog, 4 stairs into house with railing,10 stairs to basement with railing (laundry). Bathroom has large shower/bathtub with non-slip mat but no railing.
• Previous Functional Status:
  • Prior to onset of PD symptoms (decreased balance and tremor): able to walk about ~200m to her friends house, gardening, performed ADLs independently, driving often (grocery store, recreation centre)
  • Prior to husband passing (~5 years ago): attended dance classes, was very active with farm work
• Current Functional Status
  • Since onset of PD symptoms: Drives when necessary but less confidence with reaction time, less confident walking outside, no issues with dressing/bathing, no problems with stairs, no problems with bed mobility
• Imaging: MRI scheduled for next week to rule out other causes of symptoms.
• Precautions/Contraindications: Depression, lack of social support, right wrist injury (~3 months ago)

Objective

• General: Slight masked face, slight muscular deconditioning, mild dysarthria, mild left resting hand tremor which increased while discussing history of diagnosis
• Posture: Moderate kyphotic forward head posture
• Gait: Mild bradykinesia

AROM:

• U/E: Limited bilateral shoulder flexion and abduction L>R
• Trunk: Limited in bilateral rotation
• L/E: Limited in bilateral hip extension, bilateral dorsiflexion (non-WB) L>R
• All other ROM WNL

PROM:

• U/E: Limited bilateral shoulder flexion and abduction L>R
• L/E: limited in bilateral dorsiflexion (non-WB) L>R
• All other ROM WNL

**Some limits due to mild rigidity (cogwheel)

Strength:

• Grip strength: R hand 18kg, L hand 20kg
• Overall strength: R 4+/5, L 4/5
  • Apparent weakness in antigravity muscles (back and neck extensors, hip extensors, quads, hip flexors)

Sensation: U/E and L/E intact

Neurological testing (myotomes, dermatomes, UMN tests, reflexes): normal

Tone: normal

Intervention

Treatment Plan

	Frequency	Intensity	Time	Rationale
Education
Gait
Balance Training
Community Dance Program
Strengthening