Stroke Patient Case Study
I received a call from a desperate lady telling me that her 82-year-old father had just had a stroke. He was medically stable and recently discharged home. He was now lying on the bed and what should she do?
Due to COVID, I was reluctant to do an in-person session and did not have a lot of availability to travel 20 minutes to the home, do a 1-hour session and drive 35 minutes back to my home in peak-hour traffic. As an alternative, I suggested that we do a virtual session later the same day. She was surprised she could get an appointment so quickly. With virtual, things seem quicker, more convenient and accessible. So we scheduled a time that her teenage daughter would be home from school to help out with the session.
Initial Physiotherapy Session for Stroke Patient
Logging on to the virtual appointment was easy and uncomplicated. The assessment started with the client in bed. I found out that he had a history of smoking, diabetes and hypertension which are risk factors for stroke. The left side of his body was weak and uncoordinated. Lying in bed, he was afraid to move.
For the initial physical assessment, I taught his helpers (daughter and granddaughter) to test his strength, range of motion, ability to move in bed, sit up from lying and his sitting balance. His left side was floppy; he had difficulty controlling the limbs and trunk, so getting up from sitting and sitting still was difficult. From the strength test, I determined that his left leg was strong enough to stand up, so with a helper on each side of him, he stood up and took a few steps using a 2-wheeled walker. By the end of the session, he was tired and had to lie down again.
Home Treatment Program for Stroke
I discussed with his daughter the initial home exercise program:
1) encourage active and active assisted use of his left hand and arm for daily activities
2) bed exercises to help him move in bed like rolling, bridging (bending knees and lifting hips off the bed), side lying to sitting by propping on one elbow
3) Sitting practice – sitting without support, weight shifting and reaching for objects
4) Leg strengthening exercises in sitting – flexing up and pointing down his left foot , straightening and bending his left knee in sitting
5) Standing exercises – sit to stand, marching on the spot while holding his walker, short distance walking if able
Stroke Prevention Tips
It was strongly recommended that the client should stop smoking, and keep his diabetes and hypertension under control through medication and a strict diet. This is to prevent recurring strokes.
Progressive Treatment for Stroke Rehabilitation
The progress was rapid between the first and second virtual sessions. By the second session, he was walking around the town house 5 metres at a time with his walker under close supervision and his left arm and leg had gotten significantly stronger. As a result, the treatment and home exercise program were progressed quickly to include strengthening exercises, squats, lunges, longer duration sitting balance activities, weight shifts, standing balance and gait training.
In total, he had 3 virtual sessions and 1 in-person visit to ensure that the treatment program was being done correctly. By the time of the in-person visit, he was walking outside in the neighbourhood with a 4-wheeled walker and he was going to the washroom on his own using a cane. He could push and pull against mild resistance with his left arm. To challenge him further, we did some advanced balance and stabilization exercises using a large swiss ball.
There was still some left foot drop when walking so I recommended a ankle-foot splint to control this. I found out that the plan was for him to fly to his home country once he was fit enough and that would be next week.
Successful outcome for a stroke patient after 3 virtual and 1 in-person sessions
We were all surprised and impressed at the remarkable recovery he had made in a matter of slightly less than 3 weeks, from being bedridden to international air travel-ready. He would continue on with further rehab in his home country. I had given him and his daughter the education, guidance and tools needed to perform the treatments on their own. This was the key to his rapid recovery and successful outcome.