rotation 2: 1st STARES: intervention

Situation:
I have been treating a 73 year old gentleman admitted for further investigations into his Parkinsonism and cognitive function. He is currently experiencing cog wheel rigidity and decreased functional use of his right upper limb especially his right hand function. He is under investigation for Parkinson’s disease and has undergone a dose response trial plus cognition tests as he has been displaying difficulties in thought process and storage of information.

Task:
To create a home exercise program in the interim to assess his deficits till he is seen by a specialized outpatient Parkinson’s clinic.

Action:
I assessed this patient’s deficits in proximal hip strength, lumbar/thoracic dissociation and excessive trunk tone. Then I established a home exercise program for him to address these deficits via pelvic rolling in sitting, trunk rotation in lying and sitting and hip extensor strengthening exercises. The exercise had to be broken down and explained simply due to his cognitive deficits.

Result:
The patient preformed the home exercises reasonably well; however there were times when he couldn’t understand how to perform the task. It took several explanations and demonstrations plus extra time for the patient to absorb the information given to him to perform the task. However eventually he was able to perform his exercises without prompting correctly.

Evaluation:
Due to this patient’s cognitive delays I had to change my approach to his intervention. This patient needed strategies and extra time to understand and reproduce the tasks I wanted him to do. I think I did this fairly well once I realized I needed to get him to focus on my demonstration of the task plus breaking down the task to allow him the time to learn the task. Prior to working out this strategy the patient was finding it very difficulty to perform the tasks and I was finding it increasingly frustrating with the whole process. But once I had worked out this strategy the treatment session ran very smoothly and both I and the patient were very happy with his home exercise program.

Strategies:
• Break down the task
• Demonstrate the task one step at a time
• Give the patient sufficient time to absorb and process the information given
• Remove distractions
• Focus on one action at a time