During my neuro placement i was assigned a pt who presented with Parkinsons but was diagnosed with a palsy that actually presented like PD. My pts PMH included lumbar spinal stenosis resulting in chronic LBP, a THR that had become fixated in external rotation and hip flexion, rheumatoid arthritis and heart issues. My treatment plan was developed in view of their PD, so treatment options to treat rigidity as well as assist with the bradykinesia and akinesia.
On applying this treatment plan i was met with a staunch refusal by my pt to participate in any activity that would aggravate their LBP. This contraindicated all my treatment options for their impairment of rigidity.
I attempted to retrain sit to stand, half way through encouraging leaning forward my pt stopped du eto the aggravation of pain in her LB.
In the end I decided to apply stretches for my pts LL joints in supine. Again this was short lived as it triggered their rheumatism.
My last resort was a gentle soft tissue mobilisation for my pts feet and calves to loosen it before mobilising. It was moderately successful with the only condition I do not touch the balls of their foot as that triggers their LBP.
My pt was very emotional about their limitations and became frustrated for not being able to be more mobile and 'treatable'.
What I learnt is that as much as we are in a position to help a pt to recovery from their illness sometimes even that is limited. Instead what we can offer is remedial support and ensure they are comfortable. I spent time to gently mobilise and massage my pts feet not just for a physio treatment but also as a therapeutic means to soothe my pt and make them more comfortable. I hope that others may see that when your physio treatment falls to bits we can still offer other options for the sake of pt comfort.
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