Monday, July 14, 2008
limitations: pathology?
I'm in my 3rd week of rural prac in a stroke centre and i have been treating this patient with cerebellar stroke for the past 3 weeks. He told me that he has had his stroke for 3 yrs and have always wanted to walk again. He has been going to therapy on an on and off basis. My supervisor told me that they have worked hard to treat this patient but thinks that he has plateaued in his recovery. He is still wheelchair bound. I assessed on his sitting balance and found that he doesn't have appropriate saving and equilibrium response and have difficulties coordinating his movements. He is able to sit to stand independently but needs close standby as he tend to overshoots his movements. I tried letting him walk along parallel bars and found that he needs +++ support and cues to slow down and control his movements. Further assessments revealed that he has poor trunk muscle strength and control and tend to slump all the time. From my limited knowledge on cerebellar stroke, i think that if this patient is going to walk again, he needs to be working really hard in therapy and if he is walking further down the track, he will still need atleast 1x min assist (at least, if not more). I don't really want to demotivate him from coming to therapy but at the same time, will he ever be able to walk again?.
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