Parkinson's Case Study - Nick Clinical Reasoning

Original Editor - Tarina van der Stockt

Top Contributors - Tarina van der Stockt

Clinical Reasoning

The video clips of Nick walking and the tragus to wall test demonstrates how far forward Nick’s weight falls naturally when he is in standing. A body always held in a flexed position will generate altered soft tissue length over time, affecting correct alignment and proprioceptive feedback to the joints. For Nick, it is a likely cause of pain in his knee affecting his mobility. It led me to decide that the first thing to do was explore what effect releasing the tight tissue in Nick’s trunk and lower limbs would make.

Treatment Session

The treatment in this session was as follows:

  • Soft tissue and joint mobilisation and stretches to lower limbs and trunk, including rotation and elongation of trunk
  • Active (minimally assisted) extension exercises to facilitate concentric antigravity muscle recruitment at knee and hips, whilst encouraging eccentric release of flexor activity
  • Graded pelvic tilt work, alternating between abdominal control (anterior tilt), and low back/ gluteal control (bridging and posterior tilt) in crook lying

This session with Nick was 1 hour as it was part of a joint learning session between Dr Ramaswany and another physiotherapist who specialises in neurological treatments. The treatment time was purposely kept to 30 minutes. This is a more realistic timeframe to what we have in clinical reality

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