Week 5 Day 23 Entry 3

This morning I took a particularly interesting time trial. Time trials are conducted on an interval basis to assess pt’s function and mobility to determine if their condition is being maintained or if the disease is progressing and require intervention. The time trial I took today was of a 61yo man who had been diagnosed with Pd for some time. During the subjective questioning, I asked the man if he was experiencing any writhing mvmt, or any uncontrolled excessive mvmts (called dyskinesia). To this the man relied that he often felt as though he had squirming under the skin as if maggots had infested his body and were crawling through his system. This raised a few alarm bells both for me and my supervisor. With additional questioning the pt also stated that he experienced frequent unprovoked and intense episodes of rage, anger, and urges of aggression. The pt stated that he had not yet acted on these feelings of anger but they were disrupting his socialisation and interaction in the community. The pt appeared to be isolating himself from those around him as a kind of protective mechanism. As a PT I understand that we do have a role in education and some degree or reassurance/counselling but I identified this as a case beyond the scope/skills of PT. My supervisor informed me that these symptoms maybe a result of certain medications &/or mental health conditions.

In this circumstance I suggested that the pt mention these feelings in his consultant r/v next week. I also suggested that if the pt felt as though his feelings were getting out of control, then he needed to seek immediate counselling, social work, or psychiatric help. The pt was quite open and responsive to these suggestions, and seemed motivated to want to change. In this respect I felt as though our response was appropriate and still within the role of PT intervention.

When the pt initially explained his symptoms he did mention a shaking feeling within his chest and trunk. With this description I assumed the pt was describing a Pd symptom of internal tremor. I should not have made this assumption, as with further prompting his symptoms did not correlate with Pd characteristics. I think I should not have been so hasty to assume all of this pt's problems were related to his Pd- as I found out later on in the session; there were clearly other cognitive/mental health issues on top of his Pd.

I felt very comfortable assessing this pt. As much as his symptoms of anger and aggression were alarming, the pt was a very pleasant person to work with, and did not present with any of these characteristics during the Rx session.

In the future I will continue to recognise my limitations in education and counselling when it comes too developed or complicated cognitive issues. There are many alternative avenues for these pts where there needs can be more appropriately met.

In general, today was a reasonable quiet day, as many of my pts cancelled unexpectedly due to poor health or transport issues. But I’m hoping this will not be the trend for the rest of the week!