Shelley Clerke is a 72-year-old woman who has had Parkinson's disease for over 10 years. Initially the disorder presented with tremor on her right side. She has been managed by her family doctor and local neurologist. Over the years her medications have been adjusted and new medications added to control her symptoms. More recently, she is experiencing increasing difficulty with activities such as eating and signing her name due to the tremor. Two years ago she started using a rollator walker when her balance and overall mobility made it difficult for her to ambulate in the community with just a cane. Today she has an appointment with her neurologist. The neurologist notes the increase in tremor and her poor overall mobility compared to when he last reviewed her 6 months ago. Her Parkinson medications include: Levodopa/carbidopa 250/25 mg QID, entacapone 200 mg QID, ropinirole 3 mg QID, and amantidine 100 mg BID. On examination she has an obvious and severe right-sided resting tremor that does not completely stop when she raises her arms. She has difficulty getting out of the chair and on to the examination table.