Case Study: A 75- year old with Post Stroke Paralysis and Aphasia
Summary:
Mrs A, a retiree was living so full of life , experienced a stroke that left her with significant impairments in speech, daily living activities movements as well as her overall strength.
She also has a history of cardiac complications. Following acute medical intervention she was referred to the speech and occupational therapy team to regain her independence and improve her quality of life.
Embarking on the road to recovery, Mrs A, her family and our team made a bond rooted in trust and mutual respect. Together with our moments of laughter, tears and setbacks we began navigating the not so rectilinear path of post-stroke rehabilitation with courage and resilience.
Patient Info:
Name: Mrs. A
Age: 75 years old
Gender: Female
Diagnosis: Paralysis on left side with Aphasia
Assessment:
On initial assessment Mrs A presented with:
1. Paralysis (loss of complete motor movement) on her left side,
2. Difficulty with balance and coordination,
3. Loss of speech.
She was dependent on family for all Activities of Daily Living (ADL)
1. Bed bound side rolling and transfers.
2. Stiffness especially in her cervical , and hip joints.
We conducted a thorough assessment that helped us identify specific impairments, requirements and set realistic goals tailored to their needs and aspirations.
Recommendations
The recommendations for Occupational therapy intervention were to :
1. Improving the function and strength of upper and lower limbs.
2. Enhance balance and stability to facilitate more safe transfers and mobility.
3. Develop proper fatigue management and energy conservation strategies.
4. Use memory aid strategies to work on attention , memory ,etc
5. Using deep breathing and relaxation techniques to manage her anxiousness and early fatigue.
5. Assistive aid training of walkers or wheelchairs.
Other recommendations were to:
1. To continue speech therapy for assistance with expression and communication
2. Cognitive rehabilitation and mood management working in collaboration with other health professionals.
Goal Setting:
The family and the occupational therapy team worked primarily on these short term goals:
1. Coming to sit with minimum assistance.
2. Sustain sitting for 10 mins with minimum to no support.
3. Incorporating bilateral movements for motor initiation.
4. Improving the ROM for all joints as she experiences stiffness frequently.
Treatment and Intervention:
Assessment and treatment went hand in hand as we used functional tasks and repetitive practice of tasks as the main tool.
1. We started off with simple joint stabilization based exercises , gentle assisted active -assisted exercises which involved gripping and grasping of simple objects commonly found at home like perfume bottle, combs. Water bottle etc.
2. Occupational therapy also addressed her attention difficulties by using certain distractions in the environment , using spot the object or searching with gaze based activities.
3. Safe transfers with a tinge of core stabilization was implemented so that she could do bedside turning, come to sit with minimal assistance.
Before
After
We occupational therapists understand how mentally frustrating and challenging it is to perform even the simplest task post stroke as the brain has lost its usual sync and rhythm .
Hence, a careful graded approach for activities and gentle exercises were picked up to empathize with her condition .
This significantly helped us to reduce the negative demoralizing thoughts she would have due to her loss of independence post paralysis.
Outcome:
1. Our journey is a collection of so many small wins and big victories. From holding a bottle, shifting her weight on the bed to standing with help of a walker every achievement was testament of Mrs A and family’s unwavering spirit and our team's efforts.
2. Weeks turned into some months and today Mrs. A proudly is steady with a 40 minute exercise routine that comprises majorly of stretching and strengthening of extremity, simple cognitive based activities that helps her with her memory and attention, deep breathing and relaxation techniques that keeps the smile and calmness on her face despite her share of setbacks and tears.
3. She and her family continue to work with an Occupational therapist to manage her fatigue and work on her overall conditioning.
