8/8/2019 Case Study Stroke Rehabilitation

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Darin Trees, PT, DPT, CW

52 year-old male admitted to the ICU with right-sided weakness and diagnosed with a let hemorrhagic stroke. Patient was extubated and

deemed medically stable on day two. Physical and Occupational Therapy were consulted on day three. Patient was independent with allADLs prior to admission, working as a truck driver.

PT EvaluationGeneral:Patient was mentally alert and could ollow simple commands, but presented with expressive aphasia.

Strength:Let UE and LE: 4/5. Right UE 0/5 (accid). Right LE: 2/5 knee exors and extensors; 0/5 ankle musculature. Patient was

unable to isolate joint movements but able to ex and extend the right lower extremity in a synergistic pattern.

Bed Mobility, transfers:Moderate assistance to roll. Maximal assistance or supine-to-sit and sit-to-stand. When standing, patient

displayed a exed right lower extremity (LE) and did not weight-bear through the right LE.

Gait:Unable to stand without maximal assistance.Sitting balance:Able to sit on edge o bed unsupported in midline or 10 seconds, then required moderate assistance due to leaning to

the right. Patient required maximal assistance or dynamic sitting activities.

Standing balance: Maximal assistance required to stand upright.

TreatmentPatient education and exercise therapy included an in-bed exercise program, sitting balance activities, and unctional mobility training

(transers and standing activities) perormed every morning. In addition, the patient participated in a partial weight-bearing exercise

program using a dynamic tilt exercise platorm or weight-bearing strengthening, and LE orced-use every aternoon or 20-30 minutes.

The let unaected LE was positioned on a support pad which allowed exclusive weight-bearing on the right LE.

The frst treatment on the exercise platorm was three sets o eight mini-squats on the right leg at 10% body weight. The pattern o the

unilateral squat was non-uent. The patient displayed difculty with initial movement and required assistance to initiate right knee exion

and complete terminal extension. The patient needed verbal and tactile cues to keep the right knee in proper alignment. Without cueing,

the right knee tended to abduct and externally rotate during eccentric exion.

The exercise platorm was used or fve consecutive days in conjunction with unctional mobility training. At each session, the patient

perormed three sets o 15 mini-squats at progressively increasing inclines or body weight. Functional mobility training consisted o bed

mobility, transers, sitting balance, standing, and gait in the parallel bars.

On the sixth day after initial evaluation, three sets of 10 mini-squats on the exercise platform were performed at 40% body weight with

improved eccentric control, proper knee alignment, and independent knee extension. No tactile cues were required during the sessions.

Upon reassessment of mobility, the patient could transition from supine to sit and transfer from bed to wheelchair with minimal assistance.

He was able to ambulate 40 feet with a hemi-walker with standby assistance for safety. The patient transferred to the inpatient

rehabilitation facility on day seven where he daily continued with the LE forced-use program at progressive inclines on the exercise platform.

DischargeThe patient was discharged to home our weeks ater admission to ICU. The patient was independent with bed mobility and transers, and

could ambulate 350 eet using a hemi-walker at modifed independence.

Case Study Stroke Rehabilitation

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