Intellectual Disability Case Study Subjective Mr. RK is a 45 yr old male who has a mild intellectual disability (ID) and also Down syndrome (DS) and early stage Alzheimer’s disease.

Question

Intellectual Disability Case Study  Subjective  Mr. RK is a 45 yr old male who has a mild intellectual disability (ID) and also Down syndrome (DS) and early stage Alzheimer’s disease. He lives in a community group home with 24 h support and assistance. He works 6 h per day at a local fast food restaurant. His favorite activity is to watch TV, and he enjoys eating popcorn while watching movies.  He does not have any history of heart disease or other serious medical conditions. His case worker has noted that over the past year he has experienced increased shortness of breath when walking up the stairs to his bedroom. However, at his last physical examination there was no note on any suggested pulmonary problems. He has started to display the early stage of Alzheimer’s disease and medical record notes abnormal laxity of the left knee. Mr. RK cannot walk or jog for any extended period of time without pain.  Both his physician and case worker have encouraged him to become more physically active, but at present he performs no physical activity outside of work. He is not currently taking any medications. He is referred by his physician with a request that he be provided assistance with beginning a mild exercise regimen.  Objective and Laboratory Data  He is 5 ft 6 in. (168 cm) and 240 lb (109 kg), with a BMI of 38.8 kg · m–2. Recent laboratory data indicates his total cholesterol is 240 mg · dL–1, with high-density lipoprotein (HDL) cholesterol of 35 mg · dL–1. There is no information on triglycerides or low-density lipoprotein (LDL) cholesterol. His blood pressure was 110/70 mmHg. Other findings on the physical examination were unremarkable.  A graded exercise test was ordered and completed. Mr. AK completed 4 min on a standard Bruce treadmill protocol. His maximal heart rate was 148 beats · min–1 (85% of predicted), and his maximal work capacity was predicted from treadmill time to be 4 METs. Oxygen uptake was not measured. His maximal blood pressure was 150/80 mmHg. He exhibited no ECG abnormalities, and the test was interpreted as negative for exercise-induced myocardial ischemia; but it was noted that maximal effort may not have been reached as evidenced by the low maximal heart rate achieved.  Assessment and Plan  Mr. RK has a mild ID with DS and early stage of Alzheimer’s disease. He is obese and presents with several cardiovascular disease risk factors.  A supervised exercise plan is established. Since Mr. RK has a problem with knee instability and knee pain, he was prescribed a stationary cycling program.  Case Study Discussion Questions  Provide a more specific exercise program. Include your recommendations for intensity, duration, frequency, as well as how you would progress the exercise. What measures might you use to evaluate progress and outcomes? Explain your rationale for your choices.