Parkinson's Case Study - Nick

Basic Background About Nick[edit | edit source]

Nick is a 70 year old with Parkinson's, diagnosed 10 years ago, but onset noted several years before. It is secondary to encephalitis contracted after a work-related trip to Africa in the 1980’s (NB: secondary Parkinsonism following viral infections tends to occur several years after encephalitis[1]). Nick manages the condition on a combination of medication, exercise[2] and regular meditation.

He still works as an artist, but takes fewer commissions these days. He is an active family man, still driving, and lives in a house with his wife.

Nick considers himself healthy. As well as Parkinson's, he also has a diagnosis of Rheumatoid Arthritis. He had a pacemaker inserted over a decade ago for a third degree heart block. He has had no falls. Falls are considered a major determinant of quality of life, mobility, and life expectancy in people who have Parkinson's.[3]

Nick's Primary Complaint[edit | edit source]

Nick has been attending physiotherapy sessions through the National Health Service provision in an ad hoc manner (currently on review) since his diagnosis. Today, he requested we review his main problem to address pain in his right knee impacting on his walking. Pain is a common non-motor symptom of Parkinson’s, but it often goes underreported and treatment is often not optimal.[4][5]

Nick experiences his right knee pain once he has come into the stance phase of gait, when his right leg is loaded more. It manifested medially, and was sharp on initial movement. Although the pain is not always severe, it is painful enough to reduce his enjoyment of walking. Nick’s daily walks currently consists of about 20 minutes, instead of the couple of miles he used to enjoy throughout the day. He is also less confident to walk out in the fields near his countryside home, and sticks to pavements and regular pathways.

His pain is eased by rest, and the occasional analgesic he takes if he was on his feet for a long while during the day. To reduce knee pain, by default, Nick has taken to pushing up with his arms when coming to stand. No acute swelling or temperature increase. He has full knee flexion on the right with discomfort at end range and - 10° extension.

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

  1. Zhu YL, Guo XM, Qin ZB, Zhou ZJ, Can J, Wu JM et al. Reversible Parkinsonism caused by Influenza B-associated encephalitis affecting bilateral basal ganglia: A case report. CNS Neurosci Ther. 2020;26(3):396-8.
  2. Kim Y, Lai B, Mehta T, Thirumalai M, Padalabalanarayanan S, Rimmer JH et al. Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis. Am J Phys Med Rehabil. 2019;98(7):613-21.
  3. Fasano A, Canning CG, Hausdorff JM, Lord S, Rochester L. Falls in Parkinson's disease: A complex and evolving picture. Mov Disord. 2017;32(11):1524-36.
  4. Karnik V, Farcy N, Zamorano C, Bruno V. Current Status of Pain Management in Parkinson's Disease. Can J Neurol Sci. 2020;47(3):336-43.
  5. Buhidma Y, Rukavina K, Chaudhuri KR, Duty, S. Potential of animal models for advancing the understanding and treatment of pain in Parkinson’s disease. npj Parkinsons Dis. 2020;6(1).