Patient A presented at 28 years with a primary diagnosis of ChAc and was referred to the rehabilitation centre by her neurologist. The aim was to determine the level of disability and to explore ways to maintain independence. As the disease progressed her level of activity and participation declined. At early stages in the disease she exhibited mild executive function deficits related to basal ganglia damage. This reduced planning organisation, caused disinhibition, affected her perception of reality, and gave her difficulty with shifting tasks. All of these features affected communication .
Patient A presented with choreiform and stereotypic involuntary movements of her upper limbs, poor coordination and clumsiness of gait. She had classic lingual dystonia, expelling food from her mouth, with some dysfluency and tongue clicks. She had mild cognitive changes, specifically with visual memory. The MDT aimed to identify the problems for Patient A and what could be done though rehabilitation to reduce or compensate for these.
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