Document Type

Case Report


Physical Therapy & Rehabilitation Science

Degree Name

DPT (Doctor of Physical Therapy)

Session and Year of Graduation

Fall 2019


Frey Law, Laura


Background: Rehabilitation research frequently focuses on single pathologies. However, it is relatively common for people to experience more than one impairment (i.e. orthopedic and neurological) that impacts physical therapy treatment. Case Description: A 72-year-old male presented to physical therapy 5 days after receiving a reverse total shoulder arthroplasty (RTSA). He also had a diagnosis of schizoaffective disorder and demonstrated several parkinsonian characteristics as side effects of antipsychotic medication including shuffling of gait, festinating, and poor movement initiation. Intervention: Following a thorough evaluation, we decided to treat the patient for both shoulder rehabilitation and movement related dysfunction. Shoulder rehabilitation followed his surgeon’s prescribed protocol and movement dysfunctions were treated with interventions appropriate for Parkinson’s Disease (PD). Outcome Measures: The patient was assessed using the Timed Up and Go (TUG), Tinetti Performance Oriented Mobility Assessment (POMA), Dynamic Gait Index (DGI), Berg Balance Assessment (BBA), 4 Square Step Test (4SST), and 6 Minute Walk Test (6MWT). Discussion: The patient progressed through Stage 1 and part of Stage 2 of his protocol, demonstrating significant improvements in passive range of motion during his plan of care. Impairments in coordination and movement amplitude remained, however. The PD intervention approach led to notable improvement in the POMA and 6MWT and near-clinically significant improvement was achieved in the BBS and the TUG. The patient’s gait endurance improved drastically, walking 230% further than at baseline without any safety concerns. This case report suggests that an individual with movement dysfunction can successfully rehabilitate both a common orthopedic procedure and objectively improve balance, gait, and coordination in the presence of other cognitive deficits. Furthermore, it supports the use of PD rehabilitation interventions to treat drug-induced parkinsonism.


Physical Therapy; rehabilitation; reverse total shoulder arthroplasty, drug-induced parkinsonism, schizoaffective disorder, orthopedics, neurology


16 pages


Copyright © 2019 Ryan Iverson