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A 70-year-old male was diagnosed with Parkinson's disease (PD) 8 years ago with a clinical presentation of a unilateral tremor in the right upper extremity. He now presents to outpatient physical therapy with reports of rigidity, postural instability, falls, and difficulty rising from a chair without falling backward. He requires minimal assistance for all transfers and bed mobility and ambulates within the home (50 ft) with a front-wheeled walker and contact guard assistance. He occasionally requires minimal assistance to limit forward momentum due to a festinating gait. He lives at home with his 65-year-old wife who is in good health and is the patient's primary caregiver. Over the last 3 months, the patient has begun falling regularly and has been unable to participate in weekly bridge games at his community clubhouse because of his decline in mobility. He is unable to get off the ground by himself and his wife has had to call 911 or neighbors to help him up; however, he has not suffered any serious injuries as a result of his falls. The patient presents with a masked face and hypophonia, making it difficult to communicate. He has also begun to experience dysphagia. This patient has been taking carbidopa/levodopa (Sinemet) for 8 years and has begun to experience decreased effectiveness with definitive on and off phases. The patient has just arrived for his first outpatient physical therapy evaluation.

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What are possible complications interfering with physical therapy?

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What are the most appropriate physical therapy outcome measures for functional mobility, balance, and gait?

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What examination signs may be associated with this diagnosis?

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  • DYSPHAGIA: Impaired swallowing; common in patients with PD due to rigidity and decreased mobility
  • FESTINATING GAIT: Gait pattern common in patients with PD that is characterized by progressively shortened stride lengths and increasing speed
  • HYPOPHONIA: Decreased voice production resulting in soft speech
  • MASKED FACE: Decreased facial expressions due to rigidity in patients with PD; also known as hypomimia
  • ON/OFF PHENOMENON: Transient improvement in symptoms after medication administration with a rapid decline in medication effectiveness; occurs frequently with long-term use of levodopa1
  • RIGIDITY: Increased muscle tone with resistance to passive elongation that is consistent throughout the range of motion, is present in both directions, and is not velocity dependent;1 there are two types of rigidity: “leadpipe” and “cogwheel”
  • TREMOR: Slow-frequency involuntary oscillation of a body part; in patients with PD, tremor occurs at rest, begins unilaterally, and often affects the hand

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  1. Describe the cardinal signs of PD.

  2. List direct and indirect impairments of PD.

  3. Describe how the progression of PD affects the patient's International Classification of Functioning, Disability and Health (ICF) related to body structure and functions, impairments, activity limitations and participation restrictions.

  4. Identify reliable and valid outcome measures for the assessment of activity limitations, and participation restrictions in individuals with PD.

  5. Identify potential adverse drug ...

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