Rehab

Gait Training

This is an 89 Yrs male who had Hypertension (high blood pressure -controlled) and presented with progressive difficulty in walking. He had moderately normal cognitive skills, a bit depressed and no problems in micturition. He did had had once a kidney problem, years before, had to be operated but details not known. At present he had no incontinence, hesitancy or urgency related to micturition. On examination, he was not having features classical of Parkinson disease except that his gait was slow and had gross imbalance. Neurological examination was not suggestive of any remarkable issue. MRI of brain showed a shrunken brain (common for his age) and multiple small lacunar infarcts, related to his hypertension. This sort of patients are very commonly seen and unfortunately subjected to treatment for Parkinson. However all what they need is rehab and control of their hypertension.

Here we sat, myself and the neuro-physiotherapist and first few sessions were to make him take out of his loneliness(his wife passed away 10 years back and children were busy out of station with their families. He was only under the care of 2 nurses. We first made him realise for few days that his life was not over and discussed about his past life (banker) and could play football in his youth. Then we started him on emphasising on activities he could do in past stressing on his football skills.

Gradually made him realise that the stick was not needed, gave the chairs to improve his standing posture, did away with his stooping posture, which automatically develops by using stick and initially he could not kick the ball at targets given but finally could and now he is cheerful, goes for morning walks, (no stick) talks to people, and enjoys his balancing exercises.

Giving eg of this case simply means that it needs time from the doctor and trained neuro-physiotherapist and many times that’s enough to make even a man nearly 90 walk straight and unnecessarily can avoid a bundle of medications.