Case Study 1

PP is a 54-year-old gentleman who was admitted to Stepping Hill Hospital  with word finding difficulties and weakness on the right side.  PP followed the hyperacute pathway and a clinical diagnosis of stroke was made (CT scan were inconclusive).  He was referred as an Acute ‘As Per Protocol’ patient to the CNRS team. An initial telephone contact was completed within one working day.

His past medical history includes a diagnosis of Guillain Barre syndrome in 2004, migraines and asthma.  He was previously fit and well prior to the stroke and owns his own business as a car mechanic.

At the initial contact it was apparent that the wife was extremely concerned about PP, he was struggling to get out of bed due to an intense migraine, not wanting to eat or drink.  I advised wife to contact GP/ ward if PP deteriorated and to try to get him to remain as hydrated as much as possible and to try short periods out of bed.  Within the first week post discharge I had contacted the patient and wife 3 times with reassurance, advice on exercises for his right arm, fatigue management, sensory input into right hand and foot and relaxation techniques.

As the patient slowly improved, I was able to email balance exercises and encourage more day to day tasks, as well as continue his therapy input via the non-acute pathway.  I discussed PP starting our NHS balance class which was being run online due to the pandemic and the patient agreed.  He completed the full 6 classes funded by the NHS.  The patient reported continuing problems with his right arm “not feeling right” and not having full movement so I was able to get him a face to face appointment when the outpatient clinic was open safely with Covid guidelines in place.  There were obvious sensory issues and a restriction in the right shoulder.  I was able to treat the right shoulder and the patient regained full movement within 2 face to face sessions.

PP also complained of ongoing memory and visual issues.  I was able to liaise with the multi-disciplinary team for an Occupational Therapy review and for which he continues to be treated at home.

The patient received 14 acute CNRS sessions including 6 balance class sessions via zoom, and 3 non acute sessions.  I was able to help the patient and his wife throughout lockdown via telephone and face to face reviews as well as seamlessly transfer his case to occupational therapy when needed.