Stroke - Brian P3

Question 1

What is the prognosis?

Answer 1

prognosis looks positive
+ performing ADL and becoming more functional
+ walking short distances outside with a stick and supervision
+ mobilise independently inside
+ addressed stairs

• gait hindering progress
• muscle imbalances hindering progress
• LUL needs further work

Question 2

Prioritised problem list

Answer 2

• slow gait > difficultly clearing toes in swing phase > hitches left hip > L initial contact is ball of foot > stance phase shorter L > stride length shorter L
• standing posture
• L grip strength > hand movements and grasping
• diminished pain threshold > spinal gate modulation > hypersensitivity?
• discriminative touch and stereognosis
• UL proprioception worse than LL
• LL remains effortful and slow for movements

Question 3

Short term goals

Answer 3

• reach towards an object independently in 2 weeks > implement grip and grasp activities into rehab programme
• increase L ankle DF to full range and 3/5 power in 2 weeks
• hip extension and knee flexion against gravity and with resistance (4/5) in 2 weeks
• 90 degree shoulder flexion and abduction in 3 weeks
• shoulder external rotation range to increase by 10 degrees and to 2/5 power
• increase wrist and finger e/f by one on oxford scale
• mobilise around house without sick, with supervision in 3 weeks
• walk the dog with stick and supervision in 1 month

Question 4

Long term goals

Answer 4

• walk dog independently with stick
• re-establish gait initial contact and normal stride lengths independently
• use stairs independently without hand rail or supervision

Question 5

Treatments for his outpatient programme

Answer 5

• gait re-education
• grip strengthening
• reach to grasp tasks > UL mobilisation and tactile stimulation rehab
• hip and knee flexors and extensors strengthening
• ankle stretches and strengthening
• shoulder muscle balancing and stretching > scapula-humeral rhythm re-education
• wrist soft tissue mobilisation
• pectoral massage and stretching