sudden involuntary movements

[hrhk]

Hi,Iam just comming across a peculiar syndrome where the elderly patient is very comfortable in bed, but the moment we attempt to get him out of bed he has panic attacks, even if we manage to get him out into a chair he doesnt even last for 2 minutes, he tends to extend his knees & slide down from chair and totally destabilses himself,Iam not sure if its is decorticate rigidity as i was taught decorticate rigidity would be quite sustained whereas this patient has this episode only when we attempt him to get out of bed.
Thanks in advance

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[Gawaine]

has there been any MRI or other study...?

i have a lot of old, scared, demented people who just flip when you try to get them out of bed... could be a number of things without knowing more of the medical history...

[Fyzzio]

Hi,
I have also seen a few of these people. Panic attack is exactly the right word. This behaviour is often caused by symptoms of neurological diseases, like severe lack of visuo-spatial awareness and proprioception, which might have occured after an otherwise unnoticed stroke, but could also be due to emotional trauma or comes from being in bed for too long. MRI/ CT is a good diagnostic tool.
We used to hoist them, rather than manually transfer/ mobilise them and sat them out in a tilt 'n space wheelchair. Start with 10 min periods (e.g. when changing the bedding) and slowly increase every 3 days. Good team work by the helpers, positive encouragement, heaps of praise and perceverance is the key.
That's not based on evidence based practise or any formalised guideline ... - .. just personal experience.
Good luck,
Fyzzio

[hrhk]

thanks for ur comments ,
the only presumed diagnosis was benign essential tremor.
doctors usually examine the patient in bed& the patient fully oriented and has no weakness in any of the muscles,as there were no significant focal neurological deficits an MRI would have been ruled out & the patient currently is for rehab in the view of returning to live on his own in a house. i did attempt to sit her on the edge of the bed with help of 2 ,he just lasted few seconds,I clearly agree with FIZZ that this should be related disturbance in visuo spatial awareness, however without a proper differential diagnosis tool, I am struggling to validate my stand for for diagnostic imaging. any help would be very much appreciated .
tnx in advance

[Fyzzio]

Hi,
if your observation isn't good enough for the doctors to start further investigations, or if your statement, that you cannot find a reasonable explanation for these symptoms occuring, isn't either, can you not get the doctors or one of them to watch your treatment, i.e. sitting the patient up?
Or else, do you know when the ward round is, you could just happen to be in the room just before they enter?
Or, do you have a Rehab Consultant or Specialist Geriatrician, who you could ask?
A benign essential tremor is not a diagnosis, but a symptom. I mean, Parkinsons' could be the underlying cause and then your stuffed with even the best Physio efforts!
So, you have got all reason to ask for thorough investigation.
Regards,
Fyzzio

[Gawaine]

since he seems to have an extensor pattern incorporated with fear (and it seems like this is not a neurologic-based issue), i would try getting him into a chair and then having him lean far forward with hips and knees flexed MORE Than 90 degrees, with the trunk flexed forward, and arms laying across a bedside table... REALLY take him to extreme flexion in sitting... this MAY help alleviate his fear of falling forward... it may be hard as hell to get him into this position, but i find it beneficial if you can put them there--- sometimes...
people just stay in bed too long and FREAK OUT over bringing their weight forward... such a common problem that i've never been able to fully fix very easily...

good luck...

[hrhk]

thanks for the contribution ,no diagnosis has been made , I made a conclusion that it could be postural tremors,thepatient extends his knee in such a force that ,we r unable to use an encore as he ends up with laceration in his shin.
still looking for answers.
thanks

[estherderu]

dear everybody,

a thought slipped into my mind reading these entries.....
could it be possible that the patient does not want to be moved ? and this is the only way the patient can " tell you". I have worked with the elderly and have seen such behaviour before. It means NO
Personally I would suggest talking about it together and deciding if physiotherapy is necessary. If the patient doesn´t want therapy.... who are we to force them???

As I said, just a thought.....


esther

[hrhk]

thanks for ur answers,MRI Showed- small vessel disease?