35 year old patient w/ significant AIDS and some degree of underlying ataxia/balance problem, probably worsened by history of polysubstance abuse, AIDS dementia and/or side effects from antiretroviral drug protocol for her AIDS. All along, she's appeared to be embellishing her ataxia while in the therapy clinic - appears much more stable when not in therapy, widely erratic almost to the point of multiple personalities, has sudden "improvements" when it's time to retest her Berg Balance test to document improvement for continued therapy, always "falls" towards something she can catch, not in the direction of empty space etc.
I'm wondering if there is a way to test for ataxia that sorts out the reality from the embellishment? In other words, is it possible to fake ataxia convincingly and how would one confirm that in a professional, well documented way to separate out the underlying true deficits from the behaviorally influenced ones? She has numerous addiction issues. The facility currently providing her care (SNF) has a need to document her safety in various environments to facilitate appropriate discharge planning. I would like to assist where appropriate w/ her improvement but not get sucked into a complex agenda not really involving her underlying deficits. She's gained significant strength and weight since Rx initiated. I would like to discharge her when appropriate in a dignified and professional way, since she's likely to come back to me in the future, given her underlying health issues. Her AIDS MD feels that AIDS dementia is even more erratic than more typical dementias and some of her behavior can be explained by that.