Parkinson's Case Study - Nick Post-Treatment Assessment

Original Editor - Tarina van der Stockt

Top Contributors - Tarina van der Stockt, Kim Jackson and Lauren Lopez

Assessment Results and Comments

Test Pre-Treatment

Baseline

Comments on Parkinsonian features of gait Post-Treatment Comments
TUG 14.56 secs

over cut off score (falls risk)

Initiates gait immediately on standing; generally more flexed posture with reduced left arm swing and slow walk; watches for turning point; tremor both hands; six step for 180° turn (falls risk). Good step length and clearance of feet except on turn. 16.46 secs

12.36 secs (below cut off, so safer walk)

First attempt slow and conscious to maintain good long steps; forgot speed!

Second attempt able to stride out better; 4-step turn

Motor on motor dual task 15.20 secs (not > 10% so the dual task does not increase falls risk) Pushes up from chair; pauses before initiating gait; passes turn point as looking up. 4 step turn 13.75 secs (> 10% of baseline so dual task increases falls risk when tired) Pushes up from chair on second attempt, as did not wait for ‘go’ command; straighter; 6-step pivot turn with adjustment steps.

Note he is becoming tired and his knee aches on right

Cognitive on motor dual task 15.40 secs (not > 10%) Even less arm swing; pauses before initiating gait; 5 step turn; less symmetry between steps 14.39 secs

(> 10% of baseline so dual task increases falls risk when tired)

Steps forward 3m 6 steps Confident, large steps 6 steps More upright
Steps backwards 3m 8 steps Drags feet backwards – can hear the scuffing during all steps 6 steps More extension of trunk and right hip; only dragging right foot back. Nick stated he felt more even with his steps

TUG and Gait

The lack of extension from both buttocks is most noticeable in the backward stepping, but post-treatment his trunk posture is more upright, plus steps are larger and initiated from his buttock muscles, demonstrating better motor control and balance, so he equals the number of steps forwards and decreased on stepping back (thus giving bigger steps).

The treatment session was effective in improving mechanical pressure and proprioceptive sensory feedback through Nick’s joints allowing better alignment of his body so (until he became tired), the treatment relieved his knee pain.

His TUG baseline post treatment was within the cut-off time as not only a better ability to recruit muscle fibres to power walking, but more confident to step out faster due to relieved pain. However, although all post treatment times were better, adding the second task when he was able to walk faster made the time >10% of baseline, meaning there was increased interference, and hence a falls risk by adding the second task.

Tragus to Wall Test

Test: Tragus to wall

(Nick’s optimal is 15 cms +/- 3 cms)

Right Left
Pre-treatment 26 cms – outside chest base 24 cms – outside chest base
Post-treatment 16 cms – within optimal measure 18 cms – just within optimal measure

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