Stroke

Mr PM suffered a CVA causing slight left sided weakness.  He was admitted to SHH for investigations and discharged home 6 days later.  Mr PM was referred to the Stockport community rehab service with ongoing rehab needs.  He was triaged and placed on the acute CNRS pathway.

Assessment

Mr PM was assessed via telephone consultation due to restrictions bought about by COVID 19.  The subjective history was taken via telephone call and the objective assessment was carried out via face time with PM’s consent.  Initially no major issues were revealed.  Mr PM had only been home for 24 hours at assessment and was therefore had not returned to his normal ADLs.

Mr PM was followed up via phone plus video consultation one week later.  Mr PM had many questions re stroke but had not been contacted by the stroke association.  Referral was made to the stroke association.

The first two consultations revealed the following:

Functional level

Mr PM had good gross range of movement and functional muscle strength in all 4 limbs.  He had good sitting balance and was able to sit to stand without using his hands.  He could walk independently at a slow pace.  He was able to go up and down the stairs using a bannister.  He had supervision with getting in and out of the bath to shower but washed and dressed independently.  He could walk outdoors with supervision of one but did not feel confident enough to do this independently.  He was off work on sick leave and had stopped driving.

Problems

• Reduced speed of movement.
• Patient unsure regarding appropriate level of activity and exercise following CVA.
• Post stroke fatigue.
• Reduced high level balance.
• Reduced confidence.
• Reduced coordination.

Outcome measures

Subjective measures

	Assessment	Discharge
Patient reported recovery	85%	100%
Modified Rankin	1	1
Neadl	49/66	63/66
Barthel	20	20

 

Objective measures

	Assessment	Discharge
Timed up and go	15 secs	6.5 secs
Berg balance	50/56	56

 

Goals

1)     To return to work	Achieved.
2)     To be able to manage to walk for 20 mins outdoors.	Achieved.
3)     To take part in regular exercise program long term.	Achieved.

Total number of treatment sessions

• one telephone assessment
• 2 treatment sessions via video call
• 1 home visit keeping a 2-meter distance.
• 6 balance class sessions via zoom.
• 1 final review session.

Functional outcome

Mr PM is walking safely and independently and is able to carry out all functional activities.  He self-reports improvement in fatigue, balance, strength, and stamina and feels that his functional level has returned to that pre CVA.  He has returned to full time working but is currently working from home due to COVID.  He has had permission to return to driving from his consultant and is awaiting authorisation from the DVLA to do this.  He has purchased a wobble board and therabands to help him to continue to exercise at home.

Mr PM has chosen to continue with the exercise class privately as he feels the sessions are of benefit. Mr PM walks 1.5 miles outdoors each day independently and walks 4 miles at the weekend.