1 / 32

Back Pain in a Person with Parkinson’s Disease

Back Pain in a Person with Parkinson’s Disease. Sharna Garrett DPT, ATC Performance Physical Therapy Hockessin, DE. Background info. February 2006 66 y/o male CC: back pain; also has pain in bilateral LEs What else do you want to know?. Subjective. Worse?

ena
Download Presentation

Back Pain in a Person with Parkinson’s Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Back Pain in a Person withParkinson’s Disease Sharna Garrett DPT, ATC Performance Physical Therapy Hockessin, DE

  2. Background info • February 2006 • 66 y/o male • CC: back pain; also has pain in bilateral LEs What else do you want to know?

  3. Subjective • Worse? • Quick movements, Sit→Stand (8/10) • Better? • Sitting (1/10) • Numbness/Tingling? • None

  4. Subjective • Weakness? • Both Legs, causes falls* • Bowel/Bladder Sx? • None • Occupation • Retired Organic Chemist *more about that later

  5. Medical History • Parkinson’s Disease • Diagnosed in 1991 • Medications: Amantadine, Mirapex, Sinemet (also supplements)

  6. Symptoms of PD • Resting tremor • Bradykinesia • Rigidity of limbs • Postural dysfunction/instability • Low voice volume (dysarthria) • Masked face (decreased facial expression) • Small handwriting (micrographia)

  7. Medical History • Hoehn and Yahr Staging • Stage 1 • Signs and symptoms on one side only and mild • Symptoms inconvenient but not disabling • Usually presents with tremor of one limb • Friends have noticed changes in posture, locomotion and facial expression • Stage 2 • Symptoms are bilateral • Minimal disability • Posture and gait affected

  8. Medical History • Stage 3 • Significant slowing of body movements • Early impairment of equilibrium on walking or standing • Stage 4 • Severe symptoms • Rigidity and bradykinesia • No longer able to live alone • Tremor may be less than earlier stages • Stage 5 • Cannot stand or walk • Requires constant nursing care

  9. Social Hx • Lives with wife • Ranch style home, with 1 step to enter • 14 steps to basement (pt goes down several times per week) • Ramps at outside doors, shower chair, toilet seat riser

  10. MRI Report • Multi-level advanced degenerative changes with scoliosis causes multi-level bilateral neuroforaminal impingement and moderate central canal stenosis. (T11-S1) • Abutment of the cord at T11/T12 and T12/L1 levels What do you want to test? What impairments do you expect to see?

  11. Physical Exam • Observations • Gait • ROM • Full ROM LEs and Lumbar spine (Muscular rigidity bilateral LE) • Increased right low back and R ant thigh pain with flexion, extension, and right SB

  12. Lower Quarter Screen • Strength (Bilateral) • Hip flex 4/5 Knee flex 3+/5 • Knee ext 4/5 PF NT • DF 5/5 • Reflexes • 1+ bilateral patellar and achilles • Dermatome Screen – Normal (Light Touch)

  13. Special Tests • SI joint tests → Negative • SLR → Negative • Sitting Root/Slump → Negative • FABER → Negative

  14. Impariments Pain ↓ flexibility Weakness ↓ endurance Gait dysfunction *PD symptoms Functional Limitations Falls Uses walker Limited use of stairs Unable to sit/stand without using UEs Needs assistance with mobility (especially after falling) Nagi Disablement Model

  15. Nagi Disablement Model • Disability/Handicap • Home most of the day • Limited time in the community • Needs to schedule appts in the morning only • Must have caregiver at all times

  16. Plan • Pelvic Traction • Sidelying opening mobs • Therapeutic Exercise

  17. Outcomes • After 7 treatment sessions • Back pain persists • LE pain worsens • Using wheelchair most of the day • Loss of bowel and bladder control Now what???

  18. The New Plan • Seen by PCP → would like Neuro eval • Patient cancelled remaining PT visits • Neurosurgeon appt in 3 weeks

  19. Almost Two Months Later… • Patient called to say lumbar decompression surgery scheduled for 1 week (this is 3 months after his last PT visit). • To continue PT at six weeks post-op

  20. Six Weeks Later… • Patient is 4 ½ weeks post-op (June 2006) • Multi-Level Decompression/Fusion T10-Sacrum • New Rx: Strengthening, Coordination, Balance, GT • CC: ↓ leg strength, ↓ balance. • Occasional LBP, but no LE pain

  21. Six Weeks Later…

  22. Physical Exam • Strength (Before Surgery) • Hip flex 4/5 Knee flex 3+/5 • Knee ext 4/5 PF NT • DF 5/5 • Strength (After Surgery) • Hip flex 5/5 Knee flex NT • Knee ext 4+/5 PF 5/5 • DF 5/5 Hip abd 4+/5

  23. Physical Exam • Reflexes (Before Surgery) • 1+ bilateral patellar and achilles • Reflexes (After Surgery) • 1+ bilateral patellar • 2+ bilateral achilles

  24. Physical Exam • Static Balance • SLS with UE support <5 seconds • Tandem stance with eyes open 10 seconds • Tandem stance with eyes closed 4 seconds

  25. Interventions • Therapeutic Exercise • Cardio Endurance (Stationary Bike) • Quad strength (Step up/down, Leg Press, Sit→Stand, Squat and pick up objects) • Balance (SLS on trampoline, Walk without rollator, Tandem walking, Turns) • Manual Stretching – Hamstrings, Hip Flexors

  26. Interventions • 4 weeks after Initial Evaluation • Cancelled appt due to repeated falls • Neurologist: Continue PT, sx not due to PD progression Would you change the Physical Therapy plan?

  27. New Plan (sort of) • New Emphasis on Transfers • Stand→Sit→Floor • Floor→Chair→Stand • Spent next two entire sessions practicing “just in case” techniques for falls

  28. Outcomes • Improved Balance • SLS >10 seconds • Side step and retro walk 25ft without assistance • Improved Endurance • 5/5 LE strength

  29. Outcomes • 2 weeks after D/C • Doing well with personal training • Falling less often, and is able to get up without several attempts • Slight change to medication (more Mirapex) • Using rollator only in public

  30. QUESTIONS???

  31. References • Fritz, Julie M, Delitto, Anthony, et al. “Lumbar Spinal Stenosis: A Review of Current Concepts in Evaluation, Management, and Outcome Measurements”. Arch Phys Med Rehab. Volume 79; June 1998. • Morris, Meg E. “Movement Disorders in People with Parkinson Disease: A Model for Physical Therapy”. Physical Therapy. Volume 80 (6); June 2000. • National Institutes of Health, National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov. • Parkinson’s Disease Foundation. www.pdf.org/aboutpd.

  32. Thank You!!! • John and Carole Adams • Performance Physical Therapy, Hockessin, DE • Professor Stacie Larkin, University of Delaware Physical Therapy Department

More Related