Question

Choose two rehabilitation case scenarios and describe in detail the physical therapy process. Identify activities and exercise that should be prescribed during patient care that should improve patients range of motion.

Answer 1

CASE - 1

69 y.o. male with stroke with right sided hemiplegia with necrotizing fasciitis. Admitted to Rehab unit 3 weeks post surgery. Associated medical conditions included DM type 2 and history of stroke with resulting R hemiplegia and some cognitive impairment.
He previously worked as an accountant, but stopped working due to his stroke. Previously he was ambulating independently without an assistive device, independent for all his ADL’s, but was mostly housebound. He went out of the house only rarely when accompanied by family, mostly due to lack of motivation.

Intervention

This patient was provided with information on stump care and prosthetic. Initially elastic bandages were used for shaping of the stump, and shortly after a silicone shrinker sock was provided. The prosthetist casted his stump in order to fabricate a temporary prosthetic – total surface bearing with silicone liner.
He participated in daily ROM and strengthening exercises for both legs (notably, hip ext, knee ext, hip abd) and arms. Transfer training progressed from sliding board to standing pivot transfer with a walker. Sitting balance exercises were performed as well as core strengthening exercises with a medicine ball.
Pre-prosthetic standing exercises in the parallel bars included weight shifting, and standing balance. When the prosthetic was delivered, the patient and his spouse were educated on proper fit and care of the prosthetic, use of socks, inspection of skin on the stump. He practised weight shifting, standing balance and progressive gait in the parallel bars. Gait progressed to the use of a wheeled walker.

CASE-2

male 43 and has suffered a left meningioma operation that was followed by complications such as cerebral hemorrhage, left facial shingles, herpes encephalitis. Initial clinical examination revealed convergent strabismus, diplopia, difficulty for performing lateral eye movement for left eye), dissymmetry for heel-knee and index-nose coordination, walking with frame, difficulty in maintaining balance in upright position, insomnia, depression, anxiety and pain.

Intervention -

speech therapy, psychotherapy, occupational therapy, physical therapy, massage and MIRA therapy.

We followed the data statistics provided by the MIRA platform from which we emphasize those regarding Distance, Moving Time and Average Acceleration. Analysis of the data demonstrated that the motion becomes linear, with minimum distance and acceleration and a much more controlled and efficient movement for performing the required tasks. The distance performed with the upper limb towards the target is shorter, with minimum oscillating movements. Also, the patient is able to keep his eyes open for much longer (only 20-30 seconds initially) and there is an improvement in body posture.

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DR. PRADY