A 58 year-old male presents to your clinic following a significant fall 2/52 ago that resulted in a R) Smith’s #. He reports multiple falls in the last 6/12, with his most recent incident being the worst. Although his R) UL is immobilised bc of the #, he states that he has been struggling recently with bilateral UL weakness and “clumsy” hands. You also notice that he occasionally slurs his speech. You decide to refer him to a neurologist for further testing, as his condition appears to be degenerating.
The neurology report confirms your initial suspicion, with a diagnosis of Motor Neurone Disease and life expectancy of 2-3 years. He currently lives at home with his wife, in a house with no modifications. PMHx includes: mild osteoarthritis R) knee, L) shoulder arthroplasty, GORD, otherwise well with no current medications.
O/E:
- Mobility: high steppage gait currently nil aids, decreased stride length, increased BOS, decreased heel strike bilaterally
- Full ROM of LL’s, bilateral atrophy of tibialis anterior with DF mm’s G4 strength
- Noticeable atrophy of R) & L) biceps with fasciculations L) triceps
- Decreased bilateral shoulder AROM L>R
- Significant reduction in grip strength bilaterally
