An interesting neural round at RPH

I wanted to share with you a very positive grand neural round experience. A 30 year old patient had a stroke secondary to violent dancing (and possibly connected with ½ an estacy pill). The exact cause of the stroke was not definite. The distribution of the stroke was vertebral basilar, first affecting the vertebral artery and moving rostrally to the basilar. Thus, her symptoms were initially Wallenberg syndrome (AKA lateral medullary syndrome) developed into locked-in syndrome (medial pontine syndrome). Personally, this is most scary condition I have ever heard of. Suffers are conscious and aware of their surroundings but can only respond by eye movement or blinking. The corticofugal, corticospinal and other extrapyramidal systems have been infracted. Their only response to the outside world is the cold binary language of affirmative or negative. The good news is that she started to slowly recover. It has been roughly 9 months post stroke and she is responding well to physiotherapy. Currently, she is able to transfer with 1X assist, and is mobile on an electric wheelchair. Our supervisor believes she will be able to walk independently one day. The patient attended the round and gave a stirring thank you speech. It was one of those moments I thought it was great to be a physio because we can make vast differences in people’s lives. The ability to have positive effects on others is inspiring. On a slightly negative note, the patient’s speech was cut short because she took too long to do it. One other person (surgeon I presume) made the comment to the presenting registrar that he was ‘speaking to those already converted and believed in rehab, and that promotion material was unnecessary and redundant. He believed time was better spent discussing the challenges of rehab. I was initially surprised and even somewhat disappointed with the comment. But after some thought, I felt there was much truth to what he spoke and that a grand round was perhaps not the best forum for ‘promotion’ of rehabilitation.