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Parkinson’s Disease (PD) is not only a motor disorder characterized by rigidity, bradykinesia, and postural instability (Hermanns et al. 2015). According to Ferraz et al. (2018), it also affects cognitive, sleep, behavior, physical, sensory and social functioning. The patient suffered from impaired attention, impaired visuospatial function, and deficits in memory. The rigidity and tremor are correlated with worsening postural changes like camptocormia and akinesia as well as worsening manual dexterity. Moreover, postural instability and gait alteration increase the risk of falls. Therefore, proper physical therapy is very important for health improvement in PD patients. The aerobic training may improve strength, muscle tropism, and mobility. The issues of difficulty swallowing and speech inefficiency are also very common among PD patients (Petersen et al. 2017).
According to Hermanns et al. (2015), the cognitive function includes all those activities in which brain-based skills are required like decision making, problem-solving, memory, or thinking. Physical functioning includes maintaining body balances, walking, jogging, and other related activities. An individual with PD faces issues in performing his/her daily normal cognitive and physical functioning. The sensory functioning includes hearing, vision, pain feelings through the skin, taste sensing issues, and others. Social functioning includes the individual’s interaction with its environments like relationships with friends, partners, or family. Such an individual does not involve much in social activities or volunteering. A patient with PD faces problems with sensory functioning and social functioning as well (Bramley et al. 2005). As they cannot see things, cannot walk properly, cannot maintain proper communication with others, all these factors impact the life of an individual who has PD.
The case study of Frank tells that he did not respond to door knocking, he needed help while bathing, he feels like stale urine, walks slowly and his kitchen was also dirty. All these showed that his physical, sensory, social, cognitive functioning got affected like those in PD patients. Such individuals are provided care and assessments by the care workers. Therefore, for PD patients the role of a care worker especially in aged patients is very crucial in providing proper health care. The role of such care workers includes organizing social activities, providing companionship, accompanying the patient during daily activities, assisting in dressing, and many others (Petersen et al. 2017).
According to Petersen et al. (2017), for physical functioning assessments of all components of gait like step length, symmetry, initiation of walking, rhythm, coordination, and posture is done. Various assessments are done by measurement of lower limb strength, balance and ankle strength, and many other assessments. For sensory assessments, the care worker provides the patient with blinds or shades to reduce glare, conduct eyesight testing by involving ophthalmologists or optometrists, and hearing aids. According to Ferraz et al. (2018), for social functioning assessment, the care worker encourages the patient for participating in voluntary and social activities and helps the patient to establish/maintain good relationships with peers, family, or neighbors. Moreover, for cognitive functioning assessments, the care worker develops a clock-watching test – in this the candidate watch clock and make hand positions accordingly on the paper or mini-mental state examination. A mini-mental state examination is a test consisting of 30 points questionnaire that measures the candidate’s motor skills, orientation, language, and attention. A care worker plays a very important role by assisting and assesses the functioning of a PD person to track his progress and provide complete, patient-centered, and comprehensive care. If a care worker does not provide proper assessments for functioning then it becomes difficult for a PD patient to live a quality life (Bramley et al. 2005).
Frank did not respond to the door knocking by his friend at his house, he looked in a strange and ill situation as he looked dishelleved, and it appeared as he had lost weight. His pajama top and bottom were not matching, he smelt like stale urine with stains on his dressing gown, and his friend found that he looked a bit confused with a photo frame in his hand which he was carrying everywhere with him. He was also murmuring few incomplete phrases about his sister lucky like ‘would be 70’, Frank also did not respond to his friend’s questions in a normal manner and he also needed more assistance than before while bathing as his balance and physical functioning looked disturbed. His kitchen looked dirty and in a bad manner which was not observed ever before. All these factors about Frank in the scenario were of major concern. According to McGregor and Nelson (2019), the slowness of movement/bradykinesia is a condition in which the individual’s physical activities are slower than a normal rate. The everyday tasks become difficult to perform and result in a shuffling walk with very small steps and a distinctive slow. The muscle stiffness (rigidity) is a condition in which the individual develops tension and stiffness in the muscles, these result in difficulty in facial expressions and difficulty to move around and can result in painful muscle cramps. According to Mueller et al. (2018), if an individual develops symptoms like personality changes, more severe memory problems, or seeing things that are not there, then it can lead to dementia, which is an associated problem with PD. Moreover, the individual also has depression and anxiety problems affecting his quality of life.
The working hypothesis with underlying issues is - Frank might be having Parkinson's disease or might develop the same in the future. Such an individual might show slow movement, loss of balance, and stiffness; these are the symptoms of a patient suffering from PD. Such a patient also suffers from difficulty in - standing, walking, involuntary movements, problems with coordination, or difficulty in speech. Other symptoms observed in a PD patient are leaking to urine or weight loss. Similar symptoms are also observed in Frank so it can be hypothesized that he might develop PD. According to Zham et al. (2017), PD has 5 stages: stage 1 with mild less severe symptoms, stage 2 with moderate symptoms and facial modifications, and stage 3 in which progression of the disease is observed. Stage 4 where drastic changes are observed and stage 5 with advanced and aggressive symptoms.
The rationale is – Frank might have a disease whose symptoms are similar to that of Parkinson’s disease. So more specific tests and assessments should be done at the hospital by the doctors or health care professionals to detect if he is developing another similar disease or not. Frank shows to develop stage 1 only according to his mild and less severe symptoms. If at early stages detection is done and treatment is provided to the patient then the chances of becoming/entering into a worse stage of the disease can be prevented. These early stages can be treated with medications to get relief from the symptoms. Currently, no cure has been developed for the disease but symptoms can be cured at early stages with the use of pharmacological or non-pharmacological therapies (McGregor and Nelson 2019).
A person showing the signs and symptoms of PD should be immediately provided with care by a care worker. The immediate and follow up actions to be done include being patient with the individual, help him feel normal, assist him in bathing, dressing, cleaning his body, and other daily activities. Other actions might include preparing meals, giving medications, conducting exercises or yoga for the patient, and give full attention to him. It is seen that Parkinson develops with old age and progress with time becoming worse if left unattended, so it is required to look for worsening symptoms regularly (Ferraz et al. 2018). A regular assessment is of great importance in the case of PD. As a care worker, planning activities ahead of time for the diseased patient will help provide complete and comprehensive patient-centered care to him. Various assessments should be used to track the individual’s progress reports like visual assessments, hearing, socio-cultural activities involvements, or encouraging the individual to develop self-confidence and making him involved in various activities to provide him quality life (Petersen et al. 2017).
As in this case, Frank need assistance or various daily activities, being a care worker complete care will be provided to him and also with an assurance that he is not facing any difficulty. If the same is observed then the cause will be assessed and measures will be taken immediately. Moreover, it will be ensured that he gets involved with his neighbors, peers, friends, and family members as well to get relief from depression signs and feelings of loneliness. If the daily tasks are simplified with realistic goals then Frank will get encouraged to achieve his daily goals like several steps to be covered a day or yoga or exercise resulting in him in better health.
Bramley, N. and Eatough, V. 2005. The experience of living with Parkinson's disease: An interpretative phenomenological analysis case study. Psychology & Health, vol. 20, no. 2, pp. 223-235. https://doi.org/10.1080/08870440412331296053
Ferraz, D. D., Trippo, K.V., Duarte, G. P., Neto, M. G., Santos, K. O. B., and Oliveira Filho, J. 2018. The effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly patients with Parkinson disease: a pilot randomized controlled single-blinded trial. Archives Of Physical Medicine And Rehabilitation, vol. 99, no. 5, pp. 826-833. https://doi.org/10.1016/j.apmr.2017.12.014
Hegland, K. W., Troche, M, and Brandimore, A. 2019. Relationship between respiratory sensory perception, speech, and swallow in Parkinson's disease. Movement Disorders Clinical Practice, vol. 6, no. 3, pp. 243-249. https://doi.org/10.1002/mdc3.12732
Hermanns, M., Greer, D. B. and Cooper, C., 2015. Visions of living with Parkinson’s disease: A photovoice study. The Qualitative Report, vol. 20, no. 3, pp. 336-355. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.817.8284&rep=rep1&type=pdf
McGregor, M. M,. and Nelson, A. B. 2019. Circuit mechanisms of Parkinson’s disease. Neuron, vol. 101, no. 6, pp. 1042-1056. https://doi.org/10.1016/j.neuron.2019.03.004
Mueller, C., Rajkumar, A. P., Wan, Y. M., Velayudhan, L., Chaudhuri, K. R., and Aarsland, D. 2018. Assessment and management of neuropsychiatric symptoms in Parkinson’s disease. CNS Drugs, vol. 32, no. 7, pp. 621-635. https://doi.org/10.1007/s40263-018-0540-6
Petersen, C., Steffen, T., Paly, E., Dvorak, L, and Nelson, R. 2017. Reliability and minimal detectable change for sit-to-stand tests and the functional gait assessment for individuals with Parkinson disease. Journal Of Geriatric Physical Therapy, vol. 40, no. 4, pp. 223-226. https://doi.org/10.1519/JPT.0000000000000102
Zham, P., Kumar, D.K., Dabnichki, P., Poosapadi Arjunan, S., and Raghav, S. 2017. Distinguishing different stages of Parkinson’s disease using composite index of speed and pen-pressure of sketching a spiral. Frontiers in Neurology, vol. 8, p. 435. https://doi.org/10.3389/fneur.2017.00435
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