Stroke - Brian P1

Question 1

What is the prognosis for Brian?

Answer 1

• MCA is a large stroke meaning unlikely to regain full function
• rehabilitation will be a long term process
• can eat and drink independently > seems to have a safe swallow > SALT Ax > positive

Question 2

Problem list

Answer 2

• LUL weakness (1/5) > leading to shoulder subluxation
• standing with hoist AO2, hoist for all transfers > no independent mobilisation
• unable to maintain posture > using R arm to support himself
• reduced LL function in all movements > low tone
• only able to wash face

Question 3

Factors supporting diagnosis?

Answer 3

• symptoms of TIA 2 weeks prior
• clinical presentations matches Bamford stroke classification and imaging
• PMH > angina and TII diabetes > previous smoker > male and 62 years > increase risk

Question 4

Short term goals?

Answer 4

• 2/5 power in LLL ankle DF and PF in 2 weeks
• increase all LLL muscle power movements by 1 on the oxford scale in 2 weeks
• 2/5 shoulder shrug in 2 weeks
• full passive elbow extension in 2 weeks
• increase wrist extension by 10 degrees in 2 weeks
• sit unsupported in chair > introduce anterior pelvic tilt in posture > sit without support or R arm in 3 weeks
• stand from plinth only with AO2 > no hoist in 3 weeks
• AO2 for all transfers in 3 weeks

Question 5

Possible treatment and/or tests?

Answer 5

• standing a low tone patient
• light touch test > cotton wool ball and blind fold > arms supported > base line measures
• sitting posture