Stroke Physiotherapy and Speech Therapy

By Nightingales Jul 20, 2016

A 77 year old perfectly healthy housewife was making tea early morning when she spilled it all and was a little disoriented; her daughter did the FAST test on her and identified the symptoms to be suggestive of a Stroke/transient ischemic attack (TIA). She was taken to their family physician who informed that it was indeed a TIA. She was walking and speaking perfectly by evening-fully active. Next morning daughter noticed facial asymmetry and was taken to a Neurologist in a reputed Hospital a CT scan confirmed the stroke. She was started on blood thinners. Two days later she fell down from her bed, was conscious, disoriented, not able to recognize anyone, weakness in right side of her body, difficulty gripping objects, unable to walk/get up on her own. Able to speak few words not in sentences, skips few words while reading. She was admitted for 2-3 days and discharged.

She approached Stroke Rehabilitation at Nightingales mainly for Physiotherapy. Her main concern during the first assessment was: UNABLE TO STAND ON HER OWN/WALK WITHOUT SUPPORT, NOT VERY CLEAR WITH SPEECH SPEAKS SINGLE WORDS and WEAK RIGHT SIDE.

On assessment by the stroke rehabilitation team: She had weakness of all muscle groups in her upper and lower limb on the right side, but she had some movements preserved (not completely paralyzed). Her upper limb was weaker than her lower limbs. Face was like a mask with minimal expressions. Getting frustrated very soon and asking the therapists to leave. Could not understand commands or name familiar objects. Kept repeating the same words over and over.

Assessment of her daily activities revealed that she was able to walk using a walker and with additional support from her daughter, did her toileting activities. Severely impaired balance (in sitting and standing). Falling off on one side when made to stand. Turning was more difficult than walking straight. Not able to grasp any object of any size or weight. Cannot independently dress or undress, groom or do any activity without assistance. No history of hypertension, diabetes or cardiac problems. She was a very active individual prior to the stroke, went for regular long walks, did all her activities including cooking, handcrafts and was highly skilled in embroidery work.

She was started on a rehab program mainly focused on:

  1. Improving her balance: sitting, standing, walking.

  2. Training her to walk without her walker.

  3. Teaching her correct techniques to move in and out of bed and chair.

  4. Strengthening her limbs using all functional activities which she did not have difficulty understanding or replicating.

  5. Speech therapy mainly focused on improving object recognition, using compensatory techniques to help communicate. Improving her voice quality.

After a follow-up session where a re-assessment of her physical abilities was done and rehabilitation focused more on her daily and leisure activities:

  1. Stair training

  2. Training different grips and object handling.

  3. Doing very fine activities: threading a needle, chopping action using clay etc. with emphasis on correct movement pattern.

  4. Walking with a cane, outside the house.

6 weeks of consistent rehabilitation and she improved significantly able to do almost all her activities independently but a little slower than before, walked with a cane. Daughter does not have to stay home to supervise her and has returned to work part-time. Improvement in her behavior, no signs of frustration, laughs with others, recognizes and remembers everything, meets relatives spends time with them. Most important facilitator in her rehab program was her daughter, who was completely aware of the condition, progression and amount of support that had to be given, took part in the program was a constant motivator, co-operated and coordinated with the therapists.