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Jack currently presents with short term memory deficits
- may develop executive, attentional, memory or visuospatial deficits (due to grey matter atrophy in frontal, temporal, and parietal lobes). Also PD dementia
- Cognitive decline may progress with disease, stay stable or in some cases even improve

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- COPD and PD
He may be higher risk for respiratory decline or complications such as pneumonia

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-       Changes in passive mechanical properties of joints, muscles and tendons

-       Enhancement of stretch reflexes from segmental spinal or supraspinal mechanisms

-       Abnormalities in peripheral sensory inputs that may influence response to spinal stretch

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It is due to the basal ganglia not reinforcing the cortical mechanisms that prepare and execute motor commands

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Leads to overstimulation of indirect pathway and underactivity of direct pathway

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Depletion of dopamine in striatum (particularly dorsolateral putamen

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Depletion of dopamine in striatum (particularly dorsolateral putamen

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Disturbance of dopaminergic pathway from substantia nigra to striatum

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Disturbance of dopaminergic pathway from substantia nigra to striatum

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It is as result of dopamine depletion in the basal ganglia, a hyperactive long loop reflex pathway and the cerebello-thalamo-cortical loop

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Decrease of dopaminergic cells in Substantia Nigra

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Decrease of dopaminergic cells in Substantia Nigra

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functionally linked to basal ganglia

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Physiotherapists prescribes cueing and cognitive strategies to break down task of handwriting

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Physiotherapists prescribing cueing and cognitive strategies to break down task of reaching and grasping objects

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Physiotherapist to write down all exercises or video Jack performing exercises to counteract decreased memory

Jack to keep track of exercises & activities by keeping a diary log

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Continue with social golf to increase upper limb muscle strength & flexibility.
Encourage aerobic exercise- treadmill walking/overground walking

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Stretch:  supine lying on a firm surface and stretching upper limb and upper trunk flexors by active raising and lowering of the arms- rolled up towel under arch of back to increase trunk extension (Carr & Shepherd, 2010)

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- Overground walking- could incorporate with social golf i.e. walking during and around golf course.
- Treadmill training with physiotherapist- practice starting and stopping abruptly, changing speed etc. Increase gait speed and stride length

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Fatigue during walking

COPD

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Handwriting deteriorates

Resting tremor in R arm

Slowing of rapid movements

Equivocal and varied reflexes

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Decreased gait performance- difficulty striding out during walking
Some hesitancy in initiation, small stride length, reduced R arm swing, slightly flexed head/trunk posture

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R arm resting tremor
Stiffness/Rigity in R UL
Knocking over objects he holds

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Parkinson's Disease- moderate; likely stage 3 on Hoehn & Yahr Scale