Week 5 Day 22 Entry 2

Today I saw one of my more high function pts. This man is 60yo and was previously a very athletic and active person. The reason for him coming into the Parkinson’s clinic is to maintain his high level function by participating in some more disease specific balance and strengthening exercises. In addition to this, I identified during his assessment today that the patient was having some difficulty with bed mobility and complained of shoulder pain. After making these discoveries I aimed to progress my mobility assessment, give the pt some bed mobility strategies, and assess his shoulder pain.

I began by observing the pt's normal movement patterns for getting into bed, turning over in bed, and getting out of bed. I was able to then provide some simple tips such as bending his knees up more, pushing down into the bed with his heels, and reaching when turning onto his side. The pt noted that the turning strategies made moving on the bed much easier. Other than his turning, the pt had good technique moving in and out of bed, and did so with ease.

Next of all I assessed the pt's shoulder pain. I began by observing the pt's AROM and found that he experience a painful arch between ~80-120degrees of shoulder abduction. I was then able to reproduce the pt's pain by performing the Hawkins-Kennedy test where the pt experienced more pain when moved into lateral IR than medial IR. This indicated to me a sub-acromial impingement issue, in comparison to a sub-coracoid impingement. My supervisor then noted his very forward flexed posture. I then observed the pt's scapulo-humeral rhythm and found that the pt had very protracted shoulders both at rest and in dynamic movement. We then gave the pt a scapular setting exercise to pull the pt's scapular down and medially, and asked the pt to re-perform shoulder abduction with this scapular position. The pt noted straight away a decrease in his shoulder pain. I think a large part of the pt's problem maybe tight pectoral muscles which places the shoulder girdle in an abnormal position and prone to impingement problems. If I were to continue with this man's treatment I would have liked to further investigate the cause of his thoracic kyphosis and scapular protraction. There were many other factors that I think could have been contributing to the pt's symptoms that could be addressed.

During this Rx session I was a little unsure about my assessment of the man's shoulder. As I have been on a Parkinson's placement I haven't seen any other musculoskeletal cases, so I have not had the opportunity practice any assessment on real pts. In the end I think the assessment was a success and my supervisor and I were happy that we were able to identify one of the contributing factors to the pt's pain, and be able to address it to some extent.

In the future I would like to have planned out my assessment of his shoulder a bit more. As this problem is not a common presentation in the Parkinson's clinic I was not prepared for doing a musculoskeletal assessment. Nevertheless I still felt comfortable and confident with the procedure, having done PHTY221 this semester.

I learnt today to expect the unexpected. The Pd clinic can present with a great variety of pts with different function and ability and I should be prepared to be able to address a whole range of conditions. I think prac is going well, but I'm actually getting a bit sad about having to say goodbye to my pts. Over the 5wks it is very easy to develop quite a rapport and relationship with the people we see. I think I will find it difficult not being able to see how the pts progress, especially those new pts that I assessed and have worked with from the beginning.