Scenario: A 75-year-old male with a 7-year history of Parkinson disease (PD) was admitted to the hospital following a fall. He did not suffer any fractures, but reports pain in his back when he exerts himself. He has been admitted to in-patient rehabilitation for mobility retraining. He has a festinating gait pattern with poor disassociation in his trunk and no arm swing. He demonstrates bilateral upper-extremity (UE) tremors that increase in amplitude when he is under physical, mental, or emotional stress. He struggles both to initiate a movement and to control the movement once it is initiated. His wife reports that he walks better when he holds on to her arm and they walk together, but that walking seems more effortful for him over the past several months.

Question: Based on this presentation, what interventions should be prioritized to maximize this patient’s safety?

Potential answers:

A. Gait training, balance, and coordination activities

B. Gait training and flexibility activities

C. Strength training and PNF techniques

D. Relaxation and aquatic exercises

E. All of the above

Answer with rationale: E. All of the above

Gait training should be prioritized because maintaining safe ambulation is an important goal for most patients, and this patient has shown deteriorating walking skills over the pas few months. Gait training may include an assistive device, visual cues, and changes of direction practice.

Balance and coordination activities should be prioritized because they play such a large role in fall prevention and activities of daily living.

Flexibility activities can be prioritized as these maybe needed to increase step length. The patient may benefit from range of motion exercises to maintain current ranges.

Strength training can aid in maintaining functionality and independence in activities of daily living.

PNF activities can also aid in increasing functionality for activities of daily living.

Relaxation and aquatic exercises may assist with decreasing inattention deficits.

For more information see Chapter 97 in the Color Atlas of Physical Therapy