Question

Geriatrics case

Mr. Ahmed is a right-handed, married, 83-year-old retired military personnel. Currently, he takes care of his farm in Al Dhaid and stays with his wife, 79 year old Shaikha in their farm house. Both can speak Arabic fluently. They have two children who live and work in Dubai and Abudhabi.

Their home is a recently made wheelchair accessible, two-storey house. There are two bedrooms on the second floor, a bath on the second floor, a small bathroom on the ground floor , an outdoor kitchen attached to the back of the house, and a ground floor living room that has been converted into a bedroom for Mr. Ahmed He often uses a portable commode that is stored in a hall closet on the main floor when he feels he is unable to get to the ground floor bathroom.

Mr. Ahmed enjoys watching television and visiting with friends and neighbours who drop by the house. They are community people and have good neighbours since they have been living there since 20 years. They have a house boy who helps with making meals, cleaning the house, and doing the laundry.

Mr. Ahmed has a history of chronic idiopathic Parkinson's disease, severe bilateral hand deformities as a result of rheumatoid arthritis, and recently diagnosed with bilateral cataracts which contribute to his extremely poor vision. His medications include Sinemet (for Parkinson's disease), and Voltaren and Prednisone (both anti-inflammatory medications) and Paracetamol (analgesic) for acute bouts of swelling and pain. He suffers both feeding and swallowing problems since three months.

His wife, Ms. Shaikha has a history of cardiac problems as a result of essential hypertension and congestive heart failure.

Currently there are difficulties in understanding Mr. Ahmeds speech further complicated by his mask like face. Ms. Shaikha reports increased feelings of isolation and frustration as a result of his speech production problems, the inevitable decline in his speech skills with disease progression, and his increasing reliance on others for help with his ADLs. Mr. Ahmed is using gestures, but writing is limited due to rheumatoid arthritis

Ms. Shaikha is concerned about recent changes in her husband's personality and memory skills. In particular, she notes that her husband exhibits frequent outbursts of anger that appear to be unprovoked and often forgets what he and his wife talked about earlier in the day. She is also feeling care giver burnout and frustration.

Mr. Ahmed expresses a strong desire to stay home, with his wife continuing to care for him.

Functional status:

Mr. Ahmed requires extensive assistance for most activities of daily living. With cuing and set-up he is able to wash his face and hands, but this is very slow. He is otherwise independent to wash and dress. He is very slow to feed, Help is required to transfer him out of bed.

Physical status:

Mr. Ahmed has elevated extensor tone in the neck and trunk, which makes wheelchair positioning and transfers difficult. He can sit unsupported with fair trunk balance. He has rigidity in all limbs and all movements are slow and awkward. Joint range is generally restricted, especially in hip and knee extension. He has marked deformities in both hands - Swan Neck in both ring fingers and left little finger, plus ulnar drift and metacarpal-phalangeal (MCP) subluxation. He reports pain in hands, hips, and knees bilaterally. He displays a "mask-like" facial expression. He fatigues easily, requiring several hours of bed rest during the day. His walking is limited to small steps to the bathroom only.

Psychosocial Status

Mr. Ahmed is oriented to person, but not time or place. Recent memory appeared more impaired than remote. He is unable to read due to visual problems. Although he is hard of hearing, he appears to understand simple verbal communication. His speech is very difficult to hear and understand, especially when he is tired. His hand writing is barely legible and reportedly painful.

PT Evaluation

Mr. Ahmed suffers from a moderate level of physical impairment related to Parkinson's disease. He has limited mobility with transfers also difficult at this stage. Joint movement is limited and awkward due to tremor of the limbs; he also is slow to initiate muscular effort. Hand deformities and discomfort (pain and stiffness) arising from the rheumatoid arthritis also are interfering with his use of the wheelchair and other upper limb functions.

As his treating physiotherapist:

1. What assessments might you suggest for the following? scales

• mobility
• strength
• flexibility
• balance
• posture
• sensation
• pain
• other issues

2. Develop and evaluate prioritized therapeutic strategies consistent with the individual's rehabilitation goals for physical function.
3. Recommend physical aids as necessary.
4. Identify communication and or cognitive issues which might influence interactions with the individual or relevant caregivers.
5. Identify community-based resources for the individual and caregivers (are there any in the UAE)?

Answer 1

ANDA The the Assesments I will suggest for this case will be Mobility Assement • Strength Assesment flexibility Assement • Balance Assesment •Posture Assesment Pair Assement Eye Assement therapeutic Strategies Consistent with Induidud Rehabilitation goals for physical function aus L-doba (1-2 tablets TID] Praus postale [ 0.125 mg TID] Ropinirole [o.2sung TID] Selegiline Sug BD Rasegiline 0.5mg/day Amantadine Prihexiphenidyl Recomanded Physical-aids as Necessary are. Exercises recomended – Solo breath each sich I timefday Mountain Voss upward Salute Leprove belance and faulty becture Toward Bond - • Warrior I lose Tronk circles Neck side bends

Interactions with Communication or cognitive Lesues which Inflwence Individual as relevant caregivers are Emotional changes in patient Showing and Eating problems in patient Thinking Difficulties in botient • Depression and Emotional changes in patient • Sleep Disorder of polient Swellowing problems in patient Community based Resoures for these type of Pobients and Caregivers in United - Arc Enisates are Parkinson support Dubai group • Moverment Mantra these group help to Alleviate the Syreptons of Parkinson Disease by Music therly and by Dancing process. They also and people physically and teach them various breathing Gercises.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.