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case presentation of stroke.pptx
- 1. CASE PRESENTATION PRESENTED BY- Mrigakshi Talukdar MPT , 2nd Semester
- 2. 1. DEMOGRAPHIC DATA Name : Mrs. Sabita Saha Age : 70 years Sex : Female Address : Goalpara, Assam. Occupation : High school teacher Hand dominance : Right Date of examination : 3rd April 2023
- 3. 2. SUBJECTIVE ASSESSMENT Chiefcomplain: patient complaints of pain in the left side of the hip joint, weakness in left hand and unable to stand and walk since 7 years. History of Present illness : The patient was apparently alright 7 years before, after that one day while going to the bathroom she started feeling dizziness and fell down. She was immediately admitted to the Shillong hospital for some days, there she was diagnosed with stroke. After that she had weakness on the left side of the body along with difficulty in the movements. The patient also have a history of fall and had a fracture of hip on 8th September 2018 which lead to restricted movements of the lower limbs. The patient was admitted to Sacred Heart Palliative Care on 9/10/2020 by her brother in law. Past medical history : Hypertension since 15 years Type 2 diabetes since 15 years
- 4. Medication history :tab glyciphage 500mg , tab eslo tel Surgical History : present (fracture of proximal femur bone.) Family history : 1 daughter Bread winner – daughter Marital status - widow Environmental history : not significant Socioeconomic status : lower middle class Personal history Diet : non veg Appetite : normal Sleep : disturbed Bowel/bladder : regular Habit : not significant
- 5. Objective assessment Vitals Pulse rate– 80 bpm Respiratory rate – 19 bpm Blood pressure – 150/90 mm Hg On observation Attitude of the patient – Supine lying Attitude of limb – hip and knees are slightly flexed and ankle is slight dorsiflexed. Facial expression- discomfort
- 6. Swelling – absent Deformity– flexion deformity Built – mesomorphic Gait- unable to walk. Mode of ventilation- independent On palpation Tenderness – grade 1 (over the left hip) Oedema – absent Warmth – normal
- 7. Pain assessment : Onset: gradual Duration : since september 2018 Pattern : intermittent pain Character : dull aching Site : lateral aspect of the hip Side : left Aggrevating factor : lying on affected side , sitting more than 2-5 minutes. Relieving factors : supine lying , medicine VISUAL ANALOGUE SCALE (VAS) : On activity : 6 on rest : 4
- 8.
- 9. Sensory Examination • SUPERFICIAL- • pain - intact • temperature - intact • touch - intact • DEEP SENSATION - • propioception- intact • kinesthesia- intact • 2 point discrimination - intact
- 10. CRANIAL NERVE EXAMINATION •CN 1 (olfactory) – Intact bilaterally • CN 2(optic) – intact bilaterally • CN 3,4,6 ( oculomotor, trochlear, abducent) – intact bilaterally • CN 5 (trigeminal) – intact • CN 7(facial) – intact • CN 8(vestibulocochlear) – intact at right side • CN 9 (glossopharyngeal) – not significant • CN 10 ( vagus) - intact • CN 11 (accessory) – intact bilaterally • CN 12(hypoglossal) – slightly deviated
- 11. On Examination :ROM(upper limb) JOINTS RIGHT JLEFT SHOULDER FLEXION ACTIVE (0-120), PASSIVE (0-128) ACTIVE (0-87), PASSIVE (0- 95) SHOULDER EXTENSION ACTIVE (0-42), PASSIVE (0-45) ACTIVE (0-20), PASSIVE (0- 26) SHOULDER ABDUCTION ACTIVE (0-110), PASSIVE (0-120) ACTIVE (0-85), PASSIVE (0-90) SHOULDER ADDUCTION ACTIVE (110-0), PASSIVE (120-0) ACTIVE (85-0),PASSIVE (90-0) SHOULDER INTERNAL ROTATION ACTIVE (0-40), PASSIVE (0-45) ACTIVE (0-20), PASSIVE (0-23) SHOULDER EXTERNAL ROTATION ACTIVE (0-45), PASSIVE (0-52) ACTIVE (0-20), PASSIVE (0-28) ELBOW FLEXION ACTIVE (0-140), PASSIVE (0-145) ACTIVE (0-110), PASSIVE (0-115) ELBOW EXTENSION ACTIVE (140-0), PASSIVE (145-0) ACTIVE (110-0), PASSIVE (115-0) FOREARM SUPINATION FOREARM PRONATION Not significant Not significant Not significant Not significant WRIST FLEXION WRIST EXTENSION NOT SIGNIFICANT NOT SIGNIFICANT
- 12. JOINTS RIGHT LEFT HIPFLEXION HIP EXTENSION HIP ABDUCTION NOT SIGNIFICANT NOT SIGNIFICANT KNEE EXTENSION KNEE FLEXION NOT SIGNIFICANT 0- 45 NOT SIGNIFICANT 0-44 PLANTAR FLEXION DORSIFLEXION NOT SIGNIFICANT NOT SIGNIFICANT Tone – hypertonia (spasticity) Grading of spasticity – 1 (by modified ashworth scale)
- 13. Manual muscle testing(MMT) UPPER LIMB (Within available range) MUSCLES RIGHT LEFT SHOULDER FLEXORS GRADE 4+ GRADE 3+ SHOULDER EXTENSORS GRADE 2 GRADE 2- SHOULDER ABDUCTORS GRADE 5 GRADE 4- SHOULDER ADDUCTORS GRADE 4- GRADE 4-
- 14. MUSCLES RIGHT LEFT SHOULDERINTERNAL ROTATORS GRADE 4+ GRADE 3+ SHOULDER EXTERNAL ROTATORS GRADE 4+ GRADE 3+ ELBOW FLEXORS GRADE 4+ GRADE 4- ELBOW EXTENSORS GRADE 5 GRADE 4 WRIST FLEXORS WRIST EXTENSORS GRADE 4- GRADE 4 GRADE 4- GRADE 4-
- 15. MUSCLE RIGHT LEFT HIPFLEXION GRADE 3- GRADE 3- HIP EXTENSION Not significant Not significant HIP ABDUCTORS GRADE 2- GRADE 2- HIP INTERNAL ROTATION HIP EXTERNAL ROTATION Not significant Not significant KNEE FLEXORS KNEE EXTENSORS GRADE 2- GRADE 2- ANKLE PLANTAR FLEXORS Grade 2 Grade 2 ANKLE DORSIFLEXORS Grade 3- Grade 3- Reflex- SUPERFICIAL PLANTER- Babinski sign positive DEEP TENDON REFLEX- Knee jerk – absent bilaterally, grade 0 Ankle jerk – present bilaterally , grade 2
- 16. Coordination test Non equilibriumtest • Finger to nose – 4(R), 2(L) • Finger to finger – 4(R), 2(L) • Finger opposition – 4(R), 3(L) • Drawing a circle (hand) –4(R),3(L) • Drawing a circle (foot) – 2(R,L) • Heel to knee – 1 (L,R) • 0- activity impossible • 1- severe impairment • 2- moderate impairment • 3- mild impairment • 4- normal impairment
- 17. Functional assessment (FIM) •A) SELF CARE: • FOOD- 5 • CARE OF APPEARANCE- 4 • HYGIENE- 2 • DRESSING UPPER BODY- 3 • DRESSING LOWER BODY- 1 • B) SPINCHTER CONTROL: • CONTROL OF BLADDER- 4 • CONTROL OF BOWEL MOVEMENT- 4 • C) MOBILITY: • BED,CHAIR,WHEEL CHAIR- 2 • TO GO TO TOILETS- 1 • BATH TUB,SHOWER- 1
- 18. • D) LOCOMOTION: •GO,WHEEL CHAIR- 1 • STAIRCASES- 1 • E) COMMUNICATION: • AUDITIVE COMPREHENSION- 6 • VERBAL EXPRESSION- 6 • F) SOCIAL ADJUSTMENT/ COOPERATION: • CAPACITY TO INTERACT AND TO SOCIALLY COMMUNICATE- 6 • RESOLUTION OF THE PROBLEM- 4 • MEMORY- 5 • TOTAL SCORE- 56/126
- 19. DIAGNOSIS- ACA STROKE( hemiparesis) • Problem list- • Functional disability • Muscular weakness • Spasticity • Reduce ROM • Unable to sit on her own
- 20. MANAGEMENT • SHORT TERMGOALS: • To make the patient aware about the status of her condition. • Prevention from secondary complications • Prevent from deconditioning • LONG TERM GOALS: • Maintain all the short term goals. • Improve strength • Manage spasticity • Improve upper extremity function
- 21. Intervention • PROM exercisesfor all joint. • Icing over spastic muscle for 10-15 mins. • To improve motor control- • exercise in lying- • ankle & toe movement • hamstring stretching • TA stretching • Elbow flexion extension exercise • Bridging exercise • Pelvic rotation exercise • Supine to sit
- 22. • Exercise insitting - • weight shifting exercise while sitting • To improve muscle strength- • AROM exercise than gradually progress to progressive resisted exercises.
- 23.