CASE STUDY #2 65 y.o. African American male that sustained a L CVA that resulted in right hemiparesis of both upper and lower extremity.

           CASE STUDY #2                                                   65 y.o. African American male that sustained a L CVA that resulted in right hemiparesis of both upper and lower extremity.

           CASE STUDY #2                                                   65 y.o. African American male that sustained a L CVA that resulted in right hemiparesis of both upper and lower extremity.

Diagnosis/ICD 10 Codes

Pain in right shoulder

Pain in right hand

stiffness of right shoulder, not elsewhere classified

stiffness of right elbow, not elsewhere classified

stiffness of right wrist, not elsewhere classified

stiffness of right hand, not elsewhere classified

other lack of coordination

muscle wasting and atrophy, not elsewhere classified, right shoulder

muscle wasting and atrophy, not elsewhere classified, right forearm

hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side

Models/FOR

Interventions/Treatments

Goals <--Functional Deficits

Screening/Evaluation Tools

NDT: This FOR focuses on treating individuals with difficulties in function, movement, and postural control due to a neurological injury (Instructors Group of NDTA, 2016). NDT uses guided motor control and handling to help facilitate or elicit a response from the central nervous system (Instructors Group of NDTA, 2016).

Biomechanical FOR: This FOR focuses on the patient regaining voluntary motor skills that are necessary to engage in occupations and ADLs (McMillan, 2011). The patient sustained a L CVA that resulted in right hemiparesis and this FOR looks to improve his ROM, muscle strength and endurance (McMillan, 2011).

Rehabilitative FOR: This FOR focus on the rehabilitation as a method to address the patient's limitations and different ways to help them re-engage in daily activities (Gillen, 2014). The therapist and patient must look at what ability they have and what can be done to engage in desired activities: adaptation, compensation or modificiations (Gillen, 2014).

Occupational Adaptation: This model focuses on the process of adaptation when patients are faced with occupational challenges (Schkade & Shutlz, 1992). The therapist takes into consideration the person: client factors, cognitive and physical status, and psychosocial factors; as well as the environment and their interactions (Schkade & Shutlz, 1992). The therapist looks at the different demands that are required to complete the task and what modifications are necessary for the patient to accomplish this (Schkade & Shultz, 1992)

Physical: Modified Ashworth Scale, ROM, MMT (if appropriate)

Sensory: Sharp/dull, Semmes Weinstein, 2 point discrimination

Fine Motor Control/Hand Dexterity: 9 Hole Peg, Minnesota Manual Dexterity, Box & Blocks, Jebsen Hand Function

Cognition: AOx3, MoCA, Toglia (TCA)

Functional Assessment: Motor Assessment Scale (MAS), Fugl Meyer, Barthel Index, FIM/QoL, KELS, TOGGS (grocery)

Neuromuscular Re-Education: motor learning, motor control sequencing, body awareness & positioning

Therapeutic Exercise: strength, endurance, ROM

Therapeutic Activity: ADL based activities, 'ing' activities

Manual Therapy: PROM, AAROM, K-tape

Modalities: ESTIM, orthotics,

Quite a bit of difficulty managing personal care needs with right hand.

Quite a bit of difficulty engaging in household chores and maintenance activities with right arm.

Unable to use right hand to complete fine motor tasks such as grabbing medication or buttoning up shirts.

Patient with little difficulty completing fine motor tasks such as grabbing medication or buttoning shirts.

Patient with little difficulty managing personal care needs with right arm.

Patient with little difficulty to moderate difficulty with engaging in household chores and maintenance activities with right arm.

References

Gillen, G. (2014). Occupational therapy interventions for individuals. In B. A. B. Schell, G. Gillen, M. E. Scaffa, & E. S. Cohn (Eds.), Willard and Spackman's occupational therapy (12th ed., pp. 322-341). Philadelphia: Lippincott Williams & Wilkins.

McMillien, I. R. (2011). The biomechanical frame of reference in occupational therapy. In E. A. S. Duncan (Ed.). Foundations for practice in occupational therapy (5th ed., pp. 179-194). Edinburgh: Churchill Livingstone.

Schkade, J. K., & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, Part 1. American Journal of Occupational Therapy, 46, 829-837.

Instructors Group of NDTA. (2016, May 27). The NDT/Bobath (Neuro-Developmental Treatment/Bobath) Definition. Retrieved from https://www.ndta.org/

Balance:TUG, BERG, Functional Reach, Dynamic reach- seated & standing

Potential treatment/approach ideas: PNF, CIMT, Mirror Therapy

Client strengths

Receiving OT & PT services

Good support system with wife and family members

Function in right upper and lower extremity are preserved

Stroke within last 6 months

Motivated to regain function, has good carryover to HEPs