Parkinson's Case Study - Nick Post-Treatment Assessment

Original Editor - Tarina van der Stockt

Top Contributors - Kim Jackson, Tarina van der Stockt 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