Case Study: Hemiplegia Rehabilitation: A 48-Year-Old Female

-

Managed in Clinical Physiotherapy Setup- 2010–2012

One of the most memorable cases I handled during 2010–2012 was that of a 48-year-old woman who had developed right-sided hemiplegia following a cerebrovascular accident (stroke). She was brought to the physiotherapy department by her family members shortly after her hospital discharge. In the beginning, she was quite uncooperative—showing no interest in engaging with therapy, often refusing to participate, and showing frustration and emotional resistance to movement.

However, with time, consistent care, and reassurance, her attitude gradually began to shift. As she started noticing small improvements—especially regaining slight movement in her hand and becoming more upright during transfers—her confidence grew. Eventually, she became an active participant in her own rehabilitation, attending sessions willingly and even encouraging other patients.

Presentation and Complaints:

• Complete weakness on the right side (upper and lower limb)

• Difficulty with bed mobility, transfers, and walking

• Increased muscle tone and early spasticity in the affected limbs

• Poor sitting and standing balance

• Emotional withdrawal and low motivation in the early phase

• Risk of joint stiffness, shoulder subluxation, and contractures if left unmanaged

Assessment:

• Modified Ashworth Scale (MAS) for spasticity evaluation

• Brunnstrom Stages of Recovery to monitor motor return

• Berg Balance Scale (BBS) to assess sitting and standing balance

• Functional Independence Measure (FIM) to assess overall daily functioning

• Manual Muscle Testing (MMT) to assess residual strength

• Basic ROM and joint integrity check for both upper and lower limbs

• Observation of gait pattern, initially with support

Physiotherapy Management:

My approach was patient-centered, focusing on gentle handling initially, while ensuring functional recovery remained the priority. I gradually introduced techniques as she became more cooperative:

1. Early Bedside Activities and Positioning:

  • Proper limb positioning to prevent deformities and manage early tone
  • Bed mobility training, including rolling, bridging, and assisted sitting

2. Passive and Active-Assisted Range of Motion Exercises:

  • Gentle stretching of tight muscles, especially shoulder flexors, elbow flexors, hip flexors, and ankle plantarflexors
  • Active-assisted exercises for shoulder, wrist, and knee movement

3. Neurofacilitation Techniques (Based on Brunnstrom and Rood principles):

  • Encouraged movement using tactile, visual, and auditory stimuli
  • Focused on facilitating voluntary movement patterns, especially in the hand and foot
  • Mirror therapy and weight-bearing activities as tolerated

4. Sitting and Standing Balance Training:

  • Practiced static and dynamic balance while sitting on a therapy ball or edge of bed
  • Progressed to standing with support, with tasks like reaching or stepping in place

5. Gait Training and Functional Mobility:

  • Initiated gait training using parallel bars, followed by walking with a walker
  • Step-up and sit-to-stand exercises were gradually introduced
  • Visual cueing and verbal feedback helped correct gait deviations

6. Upper Limb Functional Activities:

  • Introduced simple tasks like holding, reaching, and grasping with affected hand
  • Shoulder stability exercises and functional hand opening/closing tasks

7. Family and Emotional Support:

  • Counseled the family and involved them in helping the patient with home exercises
  • Encouraged the patient emotionally, highlighting every small progress made

Outcome:

By the end of several weeks of consistent rehabilitation, the patient showed remarkable progress:

• She was able to walk independently with minimal deviations

• Upper limb control improved, allowing her to use her hand for basic tasks

• Balance scores improved on the Berg Balance Scale

• Spasticity was better managed, and joint movement was preserved

• Most importantly, her emotional outlook transformed — from being withdrawn to smiling and engaging with therapy confidently

The day she walked on her own in the department, with her family watching proudly, was one of the most satisfying moments of that period in my clinical experience.

This case reminded me of the importance of patience, encouragement, and the human connection in rehabilitation. Watching her transformation, not just physically, but emotionally, remains one of the highlights of my early career.


Popular posts from this blog

Case Study: Stroke Rehabilitation

-
Multispecialty hospital, outpatient clinic, and freelance settings During my practice, I had the opportunity to work with several stroke patients across varied settings — including a multispecialty hospital and clinical OPD setup as well as a freelance physiotherapist providing home-based care. These experiences allowed me to develop a comprehensive and adaptable approach to post-stroke rehabilitation, tailored to each individual’s condition and environment. Presentation and Common Complaints: Most patients I managed during this period had suffered an ischemic or hemorrhagic cerebrovascular event affecting either the dominant or non-dominant hemisphere. They commonly presented with: • Hemiparesis or hemiplegia • Spasticity, especially in the upper limb flexors and lower limb extensors • Poor balance and postural control • Gait disturbances or inability to ambulate • Shoulder subluxation or pain on the hemiplegic side • Difficulty with activities of daily living (ADLs) • C...
Read more

Introduction to Women's Health Physiotherapy

-
Introduction Women’s Health Physiotherapy focuses on the prevention, assessment, and treatment of conditions that specifically affect women. These conditions can span the entire female lifespan, from adolescence to post-menopause. It covers a wide range of issues related to musculoskeletal, pelvic health, reproductive health, post-pregnancy care, and more. Women's health physiotherapists play an important role in improving the quality of life for women by addressing these physical, emotional, and psychological aspects.   1. Overview of Women's Health Physiotherapy What is Women’s Health Physiotherapy? • It is a specialized area of physiotherapy that focuses on treating physical and musculoskeletal issues, particularly those that are specific to women. • It also involves education and prevention techniques to address issues that women face due to physiological changes (such as pregnancy, menstruation, or menopause). Core Areas of Focus in Women's Health Physiotherapy: • ...
Read more

Physiotherapy Management of Low Back Pain

-
  Lower Back Pain and Pelvic Health: Understanding, Healing, and Empowering Women Lower back pain—something so many women experience but often feel like they have to “just live with.” Whether it’s a dull ache that won’t go away, sharp, stabbing sensations that come and go, or a tight, nagging discomfort that makes everyday tasks feel impossible, lower back pain is something you don’t have to accept as a part of life. It’s common, but it’s also something you can address and improve with the right tools and support. What’s even more important? Lower back pain and pelvic health are often deeply connected, and understanding this connection can unlock the path to relief. In this article, we’ll dive into what lower back pain is, how to identify it, why it’s often tied to pelvic health, and how you can start healing from home. We’ll also talk about when to reach out for professional help and how you can support other women in spreading awareness about the importance of pelvic and spinal...
Read more