I am currently taking neuro placement at the Royal Perth Hospital Shenton Park Campus.
The first patient I saw was a lady who had LMCA stroke and was attending the neuro outpatient department for ongoing rehabilitation. Reading her transfer summary I have noticed that previous physiotherapist was working mainly on this ladies UL function. When I met the lady for the first time I observed that she had quite and advanced pregnancy and her gait was very compensated to the point that I thought that she is quite unsteady and at risk of falling.
During my subjective examination, I asked her what were her main concerns were.
She pointed out to me to her R UL, as she couldn’t talk due to receptive aphasia. All the questions had to be with answers being yes or no. So my first treatment consisted mainly with the exercises of her R UL as she requested and also I followed what was in her transfer summary of her exercise program. On her second visit I decided to do an assessment to revaluate her impairments and prioritise the problem list for her ongoing rehabilitation.
During the assessment of the ladies gait I noticed that she had inadequate weight shift on the affected side and she looked very unsteady. My instant thought was that I needed to change her program in terms of working more on postural control and improving her gait pattern, rather that just working on her R UL function.
My dilemma was how would I tell this lady to change her program as she was quite determined what she wanted, that is to improve her UL function. Seeing her for the second time I wanted first to gain the patients trust and build a better rapport to gain her compliance of the rehabilitation.
I decided to explain the reason for my decision. First, by doing the Berg Balance reassessment and 10 min walk test would show her and me a good outcome measure, that is results probably indicating that she hasn’t improved since her last assessment. Secondly explaining how balance changes with pregnancy in normal people and that being affected by the stroke balance will be affected even more puts her at risk of losing balance, which may harm her and the babie. This may increase her awareness and therefore compliance.
What do you think colleagues of my plan when dealing with this patient?
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2 comments:
Vaidas,
I think your plan is good....the pt needs to be aware of changes throughout pregnancy which surely the medical team would have at least partially addressed with her. It is a priority that gait be addressed as it is not only for her and her mobility, independence and safety, but also for the baby's health.
The only other thing I can think of is that she may view pregnancy as a transient state - therefore she's just got to get through it, and she may be concerned regarding her UL function due to care of the baby - an ongoing issue, and once the baby comes she may have less time for rehab and may want to make more gains with the UL function now.
Mads
hi Viadas,
she sounds like an interesting case. its hard to imagion having suffered a stroke at a young age, let alone having the stress of a pregnancy on top. I totally agree with Mads on her point about pregenancy being transient, i can imagion this women would be scared to death at the prospect she might not be fully able to care for her child. another thing you may come across once the baby is born, is that she, like most mothers, will most probably put the babys needs/wants before her own. this could could effect her compliance with rehab once she has the baby to care for aswell. i guess educating her that the babys health will indirectly mimic hers may help this potential seneario...
Jess
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