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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 physical therapist has completed the initial evaluation of this patient (Case 3) and is initiating the physical therapy plan of care.

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What precautions should be taken during physical therapy interventions?

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Based on the patient's diagnosis, what are appropriate physical therapy interventions?

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Describe a physical therapy plan of care based on this stage of the patient's disease.

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  1. Identify physical therapy interventions to address impairments, activity limitations, and participation restrictions in individuals with PD.

  2. Prescribe appropriate assistive devices for individuals with PD.

  3. Describe interventions to address postural instability and gait abnormalities that are common in individuals with PD.

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PT considerations during management of the individual with gait instability, balance difficulties, positive fall history, and decreased functional mobility due to PD:

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  • General physical therapy plan of care/goals: Improve transfer safety and independence; improve ability to rise from sitting without loss of balance posteriorly; improve household ambulation independence
  • Physical therapy interventions: Patient and family education regarding fall prevention; increase range of motion (ROM); gait training, balance exercises, transfer training; Lee Silverman Voice Treatment (LSVT) BIG training
  • Precautions during physical therapy interventions: Close guarding due to patient's high risk of falling; recognize potential ADRs and describe potential therapy solutions
  • Complications interfering with physical therapy: Orthostatic hypotension; timing of medication dosing

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The physical therapy plan of care for a patient with PD describes the planned interventions, frequency, and duration of treatment sessions. The plan of care should include measurable and time-specific therapy goals, expected outcomes, and the patient's discharge ...

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