Parkinson's Case Study - Nick
Basic Background about Nick
Nick is a 70 year old with Parkinsonism, 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. Nick manages the condition on a combination of medication, exercise 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 Parkinsonism, he has a diagnosis of Rheumatoid arthritis, and over a decade ago, had a pacemaker insertion for 3rd degree heart block. He has had no falls.
Nick's primary complaint
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.
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 Disease Outcome Measures Case Study Course