In order to effectively discuss our Parkinson case without any difficulty, let use the ICF Classification as follows: body functions, body structures, activities and participation and environmental factors. First are body functions. Patient X is c/o right shoulder pain, muscle weakness, and difficulty walking. Along with the presentation of body functions are patient’s motor features: pill rolling tremor of the hands, bradykinesia, difficulty initiating movements, and postural instability; and non-motor features: dementia, depression, anxiety, hypersalivation, dysphagia and c/o constipation. Second, identifying patient’s body structures, we should be able to identify the structures of multiple body systems affected: mainly the nervous system, as Parkinson is mainly a disease characterized by the loss of dopamine-producing brain cells in the substantia nigra of the basal ganglia and specifically the autonomic system which controls the patient’s sensory, digestive, cardiovascular, respiratory, skeletal and muscular system. Further tests and examination of this patient have brought more impairment in body structures such as pt presenting with anosmia, “poker face” reaction (mask-like appearance), rigidity, indigestion, and constipation. Thus, patient’s activities and participation are limited as the following impairments hasten patient to effectively communicate with others, prevent patient to normal functioning in ADLs such as self-care, needing assistance in functional mobility such as feeding needing supervision as his pill rolling tremor of the hands affects the way he inserts food into his mouth causing spillage of food, toileting needing moderate assistance to clean himself up as he always have a hard time cleaning himself due to complaints of shoulder pain and pulling up his pants without losing his balance, functional transfers needing minimal assistance to rise from low chair, ambulation using his walker as he walks from his room to the crowded dining area and repeated falls reported on the last few weeks. Along with these are environmental factors such as “sense of belongingness” on the community of seniors in the facility, his family who visits him every weekend, supportive staff from nursing and especially the physical therapy and occupational therapy department who works hand in hand in providing the best quality of care, and the patient’s altitudes, view and insights regarding the disease process. 

After performing tests and assessments, I then gave my physical therapy diagnosis as follows:  difficulty walking, repeated falls, other lack of coordination and right shoulder pain. Difficulty walking is my primary physical therapy diagnosis as patient presents with difficulty initiating gait, with festinating pattern ambulating with small, frequent steps with narrow BOS; thus, the focus of treatment would be ambulation training using safe and effective techniques to improve gait pattern. Next is repeated falls which is caused by poor proprioception, impaired balance and displaced center of gravity anteriorly positioned. Another is lack of coordination of both upper and lower extremities affecting postural, equilibrium and anticipatory reactions in standing.  Lastly, is the right shoulder pain which is also addressed by the physical therapist, though patient is also receiving occupational therapy treatment, it is addressed as it primarily affects the activities of daily living including ambulation around facility.

Along with these, as the physical therapy-in-charge, I have constructed an individualized plan of care and ICF’s model had significantly helped me in identifying impairments on which areas to focus on. We started with manual treatment with Passive Joint Mobilization (PJM): Grade I distraction followed by Grade 3 oscillations towards posterior and inferior glides and gentle passive stretching and contract-relax technique on right shoulder flexors and abductors. Then neuromuscular re-education which focuses on holistic approach using the Proprioceptive Neuromuscular Facilitation (PNF) Bilateral Symmetrical D2 Extension to D2 Flexion on both upper extremities and Unilateral D1 Flexion to D1 Extension on both lower extremities, motor coordination exercises on both upper and lower extremities and Frenkel’s exercises incorporating deep diaphragmatic breathing exercises. Next are therapeutic exercises focusing on trunk exercises on transverse and coronal plane to work with patient’s trunk mobility, progressive strengthening exercises of hip flexors/ extensors and knee extensors to help with functional transfers: sit to stand and stand pivot. Therapeutic Activities are also addressed as safe and effective techniques, energy conservation, adaptation and compensatory techniques are incorporated in ADLs such as bed mobility, functional transfers, toileting, seated and standing activities, bathing, grooming, UE/LE dressing, and functional mobility using walker around and outside the facility. And lastly, gait re-training to work with normalizing gait pattern, improving base of support, increasing step length and foot clearance, daily graded ambulation training with sudden starts/stops, changes in velocity, maneuverability along obstacles and cardiopulmonary endurance training.

In general, using the ICF as guide in treating a patient with Parkinson’s disease had presented overall improvement in patient’s functional status. Identifying the ICF’s classification: body functions, body structures, activities and participation and environmental factors, has systematically addressed the above mentioned impairment thus had help me as a physical therapist to provide a strong and well-supported framework for an individualized plan of care. This then brought dramatic results, optimizing patient’s functional status, meeting short and long term goals and attaining patient’s maximum rehab potential. Truly, ICF is an essential component in today’s physical therapy practice, a tool that had enormously helped us in upgrading the standards, and greatly impacted our patients’ lives.