STROKE CASE STUDY 1

Mr Mahender Singh, an 80 year old male living with his son in Burari Delhi was admitted to Jaipur Golden Hospital on 12th July 2015 with sudden onset of left sided weakness. After clinically stable he was discharged from hospital. Dr KK Jindal Neurologist referred Mr. Mahender to GRTC for Rehabilitation

Diagnosis (Left Hemiparesis)
A CT scan has shown a right Middle Cerebral Artery haemorrhagic infarct, involving right basal ganglia and internal capsule.
Clinical problems presented with:
  • Weakness on the left half of the body
  • Decreased L-sided strength
  • Lack of normal mobility and inability to perform functional Activities of Daily Living
  • Fluctuating high blood pressure and episodes of dizziness during past treatment sessions
  • Dependant on family members for transfers from bed to wheel chair and movement for basic activities
  • Inattention of the left side there by no movement of the body
  • Mild cognitive impairment

Past Medical History:

  1. Hypertension
  2. Diabetes
  3. BPH (Prostate)
  4. B/L Osteoarthritis Knee

Social history: Patient is married and 80 years. His wife is in good health and will be able to help at home. He has two sons, two grandsons and one granddaughter. He is dependent on his sons for all basic needs.

Findings of Clinical Evaluation:

Tone: Minimal tone in Left Upper/Lower Extremity (flaccid), Right upper and lower extremity are normal.
ROM: PROM L shoulder is 0-110 degrees of flexion and 0-90 degrees abduction; R UE and LE are Normal
Strength: Left upper extremity strength is 1/5 and left lower extremity strength is 2/5.
Function: sitting at the edge of the bed requires moderate support; elimination of support results in leaning to Left. Dynamic sitting balance results in balance loss to Left side and posterior requiring max assistance to recover. Head control in sitting is good.
Transfers and bed mobility: spine <-> stand: Moderate assist of 1. Bed mobility requires minimal assist of 1 and ongoing verbal cues
Ambulation: Stands with moderate assist x1. Unable to maintain dynamic standing balance for gait without max assist
Left sided neglect – requires verbal cues to locate Left Upper Extremity/Lower Extremity.
Due to his decreased mobility, he has been identified as having functional incontinence.
Patient Goals:

Resume walking
Resume Activity of daily living and gain independence
Walk Up and down the Stairs for arrangement of granddaughter’s wedding in 3 months
Plan of Care:

Therapeutic exercises, including activities to increase Left shoulder ROM; strengthening of L side
Functional training to improve bed mobility; posture transitions, and gait
Balance activities in all postures
Patient/caregiver education on home preparation and exercise
Progress
Mahender Singh has now been receiving rehabilitation for 6 weeks and daily treatment of more than 4 hrs. He is progressing well and gained ability to walk, perform activities of daily living with minimal assistance.
Integrated approach of treatment by GRTC made patient gain improvement in six weeks and will be recovering within the next six weeks. GRTC has been providing him free treatment and free transportation so that he is able to get treatment on a daily basis.