This week I attended the male inpatient gym, there was no much patients that day, they were all waiting for discharge, so it was really hard for me to stick to a case, I found a stroke case even though I tried to find another case because I made a lot presentations about stroke in the past and I wanted to make something new, but when I saw him it got more interesting to share in my reflection paper.
As I said before I didn’t want to write about him because of what I thought I already know what is his case, but when I continued it was really interesting comparing him with the previous stroke patients I saw, and it got me to remember that we studied even if you have to two stroke patients you’ll find that they are different than each other.
Stroke occurs when blood flow to an area of brain is cut off, brain cells are deprived of oxygen and begin to die, and abilities controlled by that area of the brain such as memory and muscle control are lost.
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The patient is a 44 years old male, lives in Riyadh and was seen in al imam hospital ER as a case of hyper tension then developed stroke. He was hospitalized for 1 month and was on a coma, he didn’t receive rehabilitation until he got accepted in kfmc.
To be able to do adl with modified independent and bathing and toilet transfer with setup/supervision, provision of equipment needed to facilitate adl, provide home exercises and education regarding safety at home and environment, improve cognitive skills for basic adls performance.
Patient has problems with balance, bed mobility, transfer, wheelchair mobility, endurance. His independency level are 4 for every component except toileting and bathing are 2, they used moca to assess his cognitive level. all of his cognitive abilities are impaired except consciousness, body awareness, right left discrimination, and motor planning/praxis were intact. He has receptive aphasia. His ROM, muscle strength and tone were normal.
His cognitive abilities have been upgraded from impaired to poor, except that they marked the orientation as impaired while it was intact! Even the muscle strength in the initial note was intact, but here it is marked 3/5. For the independency level there was a significant improvement to 5 of all except bathing and toileting is 3 and 4 respectively.
the therapist reassessed him with moca at first and then was doing cognitive training by presenting figures and asking him to identify what is in the picture, and then repeating the words for him and asked him to say it back, he wasn’t able to call the name of stuff but instead he was demonstrating it by acting it, when presented with juice he indicated it as food, bread was indicated as food. He kept calling for his brother and looking for him.
Based on the goals written I think it is cognitive behavioral frame of reference as it focuses on helping those who cannot remediate from their disabilities to perform their activities.
In my opinion it is component-based, because they used standardized assessment and they focused on the cognitive component. On the other hand it focus on improving the adl by trying different pictures of food that isn’t available and things used every day to enhance his memory and I think this goes under occupation-based]3[
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