Date of Award

2019

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Kristin Johnson Thomanschefsky

Keywords

Acoustic Stimulation; Music therapy; Physical Therapy Modalities; Quality of Life; Parkinson Disease -- rehabilitation; Case Reports

Abstract

Background and Purpose: Parkinson's Disease is a chronic and progressive neurological disorder that causes motor dysfunction leading to dyskinesia, bradykinesia, muscular rigidity, resting tremors, postural impairments, and gait impairments. These impairments can have a tremendous negative impact on a person's everyday life. This case study demonstrates the collaboration of physical therapy and music therapy interventions and its effects on a female with Parkinson's Disease.

Case Description: The patient is a 72-year old female diagnosed with Parkinson's Disease around 2010. Her primary reason for seeking treatment is due to an increase in freezing of gait and overall decrease in mobility that affects her activities of daily living. She presents with a hand tremor, dyskinesia, freezing of gait, shuffling steps, muscle stiffness, difficulty maneuvering in small spaces, difficulty maintaining balance or taking a step when reaching, decreased endurance, and a history of falls. She ambulates with a single end cane and hand hold assist from her husband when ambulating in the community.

Interventions: A combination of physical therapy and music therapy interventions were utilized to improve weight shifting, gait, balance, and address patient concerns such as bed mobility. Music therapy interventions included metronome pacing, guitar pacing, guitar strumming for initiation cues, clarinet cuing, paddle drums, and singing. A combination of auditory and visual cues were incorporated to improve the patient's symptoms and promote patient safety.

Outcomes: The patient improved her score on the Parkinson's Disease Questionaire- 39, Freezing of Gait Questionnaire, Berg Balance Scale, Timed Up and Go. The patient had improved step length bilaterally for several of the gait activities including fast paced walking and walking with a metronome.

Discussion: In this case study there was an overall improvement in balance and quality of life that was considered significant based on minimal detectable change. Although other measures did not produce significant changes, outcomes of this case study showed that the patient had an increased safety awareness, balance, gait, and confidence improved based on clinical observation and judgement. Due to the complexity and variability of PD, weekly interventions varied based on the patient's ability and the patient could improve over the course of treatment sessions with proper cues. Videos, pictures, and increased detail on documentation would be beneficial in future case studies for increase accuracy in measuring outcomes.

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