Case Study: Parkinson’s Disease – 75-Year-Old Male

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Clinical Setting- (2010-2012)

Subjective:

A 75-year-old male presented to the clinic accompanied by his wife with a diagnosis of Parkinson’s disease. Due to the passage of time, full medical history is not available, but the patient exhibited classic symptoms including bradykinesia, gait instability, and postural changes. The wife reported increased difficulty with mobility, frequent imbalance, and reduced confidence in walking independently. The patient had not previously undergone structured physiotherapy.

Objective:

• Observation: Stooped posture, shuffling gait, reduced arm swing, and masked facial expression.

• Gait Assessment: Shortened stride length, reduced foot clearance, and episodes of freezing.

• Motor Assessment: Bradykinesia, mild resting tremor, rigidity in upper limbs, particularly during passive movement.

• Balance: Impaired dynamic balance and postural instability noted.

• Outcome Measures :

  1. Unified Parkinson’s Disease Rating Scale (UPDRS) – for motor symptom severity.
  2. Timed Up and Go (TUG) Test – to assess functional mobility.
  3. Berg Balance Scale (BBS) – to evaluate balance and fall risk.
  4. 10-Meter Walk Test – for gait speed monitoring.

Assessment:

A diagnosis of moderate-stage idiopathic Parkinson’s disease with impaired balance, coordination, and mobility. The patient showed limited functional independence and a high risk of falls. His wife was the primary caregiver and played an essential role in assisting with home activities.

Plan:

Treatment Techniques Implemented 

1. Gait Training:

  • Overground gait training with visual and auditory cues (e.g., lines on the floor, clapping/metronome for rhythm).
  • Emphasis on increasing stride length and arm swing.
  • Cueing techniques to overcome freezing episodes.
  • Walking with walker support initially, progressing to supervised walking.

2. Balance and Coordination Exercises:

  • Static and dynamic balance training using parallel bars, balance boards, and single-leg stance.
  • Weight shifting and stepping strategies to enhance postural responses.
  • Heel-to-toe walking and obstacle navigation for coordination.

3. Flexibility and Strengthening Exercises:

  • Stretching of cervical and thoracolumbar spine, hamstrings, and calf muscles.
  • Strengthening of lower limb muscles (especially quadriceps and hip extensors).
  • Functional strengthening through sit-to-stand, stair climbing.

4. Breathing and Relaxation:

  • Diaphragmatic breathing and upper chest expansion to improve respiratory function.
  • Relaxation techniques to reduce rigidity and tremor, including guided imagery and gentle rhythmic movements.

5. Caregiver Education and Home Program:

  • Education for the wife on safe transfers, fall prevention, and support strategies.
  • A customized home exercise plan with visual cues and daily walking routine.

Frequency: 

3 sessions per week for approximately 8–10 weeks, with periodic reassessments.

Outcome:

• Improved gait quality and walking speed as measured by the 10-Meter Walk Test.

• TUG time reduced, indicating better functional mobility.

• BBS score increased, showing reduced fall risk.

• UPDRS motor score reflected modest but meaningful improvement.

• Patient gained confidence in mobility and performed daily activities with minimal assistance.

• The caregiver reported improved quality of life for both herself and the patient.


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