| Entry Type | Assessment |
|---|---|
| Client/Group | PFS-C001 |
| Entry Category | Intended Case Study |
| Select your mentor | Sarala Evans |
| Intake | |
| Assessment | |
| Proposed number of sessions | 10 |
| Location of sessions | Bellefonte, PA |
| Planned time per session | 90 minutes |
| Presenting Problem | Complications arising from progression of Parkinson’s disease (PD) since diagnosis 12 years ago. Side effects of deep brain stimulation surgery and medication are also contributing factors. |
| Physical | Some signs of micrographia are evidenced by the client’s intake form written responses. He presents with thoracic hyperkyphosis, limited arm swing while walking, a shortened stride, side sway, limited foot lift, and imbalance during turns. Tremor in his hands present as he walks. His range of motion (ROM) is limited in all planes of movement. He has a right lateral tilt of the cervical spine, the side with subcutaneous DBS wires. Shoulder joint movements are generally easeful within normal ROM except for flexion. He can lower down to the floor and rise up to standing from the floor without assistance. Transitioning from seating in a chair to standing is labored, using hands on chair seat to push of the seat. The client’s ability to translate verbal cues into action is challenged. He is experiencing pain in the neck and low back, in the SI joint area; possibly related to the hyperkyphosis. He also has pain in his hips, more so on the right side. Stress may be affecting the muscular tension the client describes. |
| Client/Group goals | Goals: 1. To stave off the effects of PD progression; 2. improve balance, posture, and ability to transition from seated to standing; 3. reduce stress. |
| Energetic | The client’s breathing is shallow, mainly in the chest. He has some sensory awareness of abdominal and thoracic movement with the breath. At times there is a distant, unfocused, vagueness in his eyes with flat affect. His speech is soft and slurred at times, likely dysarthria, a comorbidity of PD. His hearing loss and soft speech point to a weakened 5th chakra. Though he sleeps about nine hours a night and naps daily, he presents and describes himself as fatigued, indicating tamas. The medication he takes to help reduce restlessness while sleeping makes him groggy in the morning. His tremors quieted throughout guided relaxation, yet he remained mildly unsettled, a likely sign of rajasic mental energy. |
| Emotional | The client presents as pleased to engage in yoga therapy and somewhat forlorn. He expressed discouragement toward his perceived fate of illness progression, saying, “It’s not gonna get any better.” He seems attached to his prior abilities and saddened by loss with an aversion to studying his emotions. When the topic of emotions was broached, his orientation turned outward. When asked if he feels depressed, he answered, “No.” with a doubtful shrug. |
| Spiritual orientation and needs | The client did not indicate any interest in spirituality or mindfulness. He does find inspiration in “people who make the world a better place.” |
| Intellectual / Sense of self | The client was interested and engaged to start yoga therapy. His concentration waned in the later second hour. He has difficulty translating thoughts into the spoken word, expressing himself. Word retrieval and remembering proper nouns is slow. He ties his stress to having PD. When discussing stress he said “I’m a 70 year old man with Parkinson’s. There is no future.” He is identifying with the disease. He also ties his identity to the ability to work and make an income saying, “It (work) defines who you are.” Mistaking the non-self for the self, a component of avidya, is at play. |
| Yoga philosophy/wisdom research reference(s) | “My happiness grows in direct proportion to my acceptance, and in inverse proportion to my expectations.” Michael J. Fox |
| Scientific research reference(s), why chosen, how you plan to incorporate 1-3 | • To integrate physical and cognitive abilities, initiate controlled, fluid movement and improve proprioception; incorporate motor imagery, the mental practice of specific movement without physical movement, imagining movement; and action observation, basically observing a person demonstrating a task or movement. |
| Approval Notice | |
| Questions for Mentor | None at this time. Thank you Sue. |
| Care Plan | Outline should be a practice adapted to the needs of that client/group, including:
Your care plan proposal should be approved by the mentor before session 2 if possible, or 3 if approval is delayed by mentor. |
| Session | |
| Session Instructions (Not Mentoring) | Your session outline should be a practice adapted to the needs of that client, including:
Tools from each module should be used (not on each client – but overall) |
| Final Client/Group Report | After seeing your client/group (for at least 4 sessions including interactive intake) Please remember practicum is a learning experience. You’ll learn more from sharing what’s accurate than from what might “look good”. Things you did well, not so well, problems and questions are all valid and useful tools to teach you. We can’t serve you to become the best clinician you can be if you don’t share your challenges and mistakes. Success is anything from which you learn. You can continue to add Session entries after submitting this Final Client/Group Report. |
| Report briefly on each Kosha below | Progress toward wellness or worsening reported by the client/group or that you observed in the following areas |
| Additional Information | |
| Personal reflection from doing client/group. | |
| Notify Mentor? | Do not notify Mentor (choose if you wish to continue working on this entry later) |
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