This is a clinical case study of left sided hemiplegia and likely physical-therapy treatment approaches to cases like this, especially in clinical setting.
Note: Any depction of the case study below to real life individual or individuals is purely coincidental
Now, let proceed 👇
This is a case of a 54 year old man who is being managed for Lt sided hemiplegia secondary to Rt hemispheric ischaemic Cerebrovascular Accident.
The presenting complains:
Inability to use the left UL and LL.
Slurred speech
History: He a 54 year old construction worker. He was in his usual state of health until about 4/7 days ago when he was standing in the construction site with his colleague and noticed a sudden onset of left sided body weakness. This was first noticed when a construction helmet which he tried passing to his colleague dropped from his hand and he was later seen to have fallen to his left side.
Following the above incident of which his relatives were notified of, by his colleagues, there was associated slurred speech and facial deviation to the right. There was no Hx of vomiting, seizure, LOC, however there was a positive history of severe headache that predates the symptom, headache was described as generalized, throbbing, and was relieved by analgesic.
On account of the above incident he was initially taken to the hospital that same day before being admitted in another hospital for optimal management about 2 days ago.
On account of the above, he has been placed on Physiotherapy management.
Past Medical History:
He is not sickle-celled
He is a known hypertensive
He is not asthmatic
He is not diabetic
He is not epileptic
No known history of peptic ulcer disease
No History of epilpsy, seizure or convulsion
He is a known hypertensive, and claims to be compliant with medications, this was also confirmed by relatives.
There was a positive previous Hx of stroke which occurred 6 years ago
Past Surgical History : appendectomy
Surgical History: Nil
Past Drug History: Antihypertensives
Drug History: Atorvastatin, Mannitol, amlodipine, Lasix, PCM
Family and Social history: He is a 54 year old right handed construction worker. He is married (separated from his wife) and blessed with 6 children. He doesn't smoke or drink alcohol.
Observation and Examination: He was met in semi-fowler position in bed, IV- line and urinary catheter in-situ. He is on supplemental oxygen via intranasal oxygen ( 3.5L/min) . He is afebrile, acyanosed, aniteric, and not dehydrated
Facial deviation to the right and slurred speech
Vital Signs:
On admission
BP-155/85mmHg
PR- 98bpm
RR- 28cpm
SPO2- 97%
PCV - 52%
Recent
BP- 160/78mmHg
PR- 110bpm
RR- 36cpm
SPO2- 98%
GCS: 15/15:
EO- 4
BVR- 5
BMR- 6
This signifies that he is fully conscious and alert
SEGMENTAL EXAMINATION:
Head and Neck:
Thorax and Abdomen:
Poor chest excursion
Abd is Full and MWR
Upperlimbs:
-Muscle bulk: Preserved bilaterally at both left and right
-Muscle Tone: Right: Normotonia ; Left: hypotonia
LLs:
-Muscle bulk: Preserved bilaterally
-Muscle Tone: Rt-Normotonia ; Lt- Hypotonia
-Sensation: Intact bilaterally
-Spasticity: Absent bilaterally
-Gross Muscle power: Rt- 4/5 ; Lt- 0
-Active Range of Motion: Rt- Full and painfree ; Lt- could not initiate
-Passive Range of Motion: Full and painfree bilaterally
-Edema: Absent bilaterally
-Tendon achilles Tightness: Absent bilaterally
-Clonicity: Rt- absent ; Lt- present
-Deformity: Absent bilaterally
-Crepitation: Absent bilaterally
-Patella: Mobile bilaterally
-Pain: present at left thigh
-Skin: No discoloration or rashes
-Berbinski reflex- No response bilaterally
Functional assessment:
-Patient cannot sit independeny
-Patient cannot stand or walk
-Pt is maximally dependent in ADL.
Functional Independence Measure Score:
-Motor sub-score: 18/91
-Cognitive sub-score: 35/35
Total FIM score: 53/126
Now from the assessment what have we found out, the summary of finding from observation and assessment is highlighted in ANALYSIS OF FINDINGS 👇
Analysis of findings:
Radiological Findings
Cranial CT Scan:
Now the Analysis of findings should give us an idea of what intervention to be admitted for the successful rehabilitation of this Man. The aim of rehabilitation is to get him towards of not full, near full function and for this we would need an intervention plan . Here 👇
Intervention plan:
First to relieve pain at the left thigh and any places he might later complain of.
To improve facial symmetry
To improve muscle strength at the left upperlimb and lowerlimb
To preserve the physiological properties of the unaffected musculatures and improve the affected
To prevent other complications
To improve his functional status
To improve independence in activity of daily living (this here is ultimately the whole point of rehabilitation, and in this case it should be done early )
Now we have what we want to achieve and how we plan on intervention, the next is what exactly are the means to employ to achieve the goal for rehabilitation, Here: 👇
Passive movement to all joint of the left upperlimb and lower limb
Tactile stimulation to the left upper limb and left Lower limb
Soft tissue mobilization using analgesic gel
Facial massage for the facial deviation
Facila exercises for the Facial deviation also
Kineosiotaping to the face (you might want to check this up)
Bridging exercise for the weak trunk
Assisted and autoassisted Exercises to the left upper limb and Lower limb
Free active exercises and resisted active exercises as he improves
Weight bearing Exercise on the left upperlimb and lowerlimb
Standing and walking re-education as condition improves
Therapeutic positioning to prevent sores and other complications
That will be all from me, but note, intervention plan and intervention means is not limited to the above, there is a whole lot more in the arsenal of Physical-therapy that he would benefit from
https://www.physio-pedia.com/Stroke?veaction=edit
https://www.physio-pedia.com/Stroke:_The_Role_of_Physical_Activity
