Case Study: Stroke Rehabilitation

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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)

• Communication deficits (aphasia) or cognitive impairments in some cases

• Psychological challenges like depression, frustration, or loss of motivation

Assessment:

I conducted detailed physiotherapy assessments including:

• Muscle tone (using the Modified Ashworth Scale)

• Voluntary motor control (Brunnstrom stages of recovery)

• Balance and coordination (Berg Balance Scale, Functional Reach Test)

• Mobility (Timed Up and Go Test, 10-Meter Walk Test)

• Independence in ADLs (Barthel Index)

• Joint integrity and risk of complications (e.g., contractures, pressure sores)

Treatment Approach:

My approach to stroke rehabilitation during this time focused on restoring function, maximizing independence, and preventing complications. Key interventions I used included:

1. Neurodevelopmental Techniques (NDT/Bobath):

  • Facilitated normal movement patterns through guided handling and positioning
  • Trained trunk control and weight shifting to improve balance and postural control

2. Task-Oriented Functional Training:

  • Practiced sit-to-stand, transfers, stair climbing, and bed mobility
  • Introduced goal-directed activities for upper limb function

3. Gait and Mobility Training:

  • Used parallel bars, walkers, and eventually cane/crutch support
  • Employed mirror therapy and visual feedback to improve limb awareness

4. Strengthening and Stretching Exercises:

  • Targeted weak muscle groups, especially dorsiflexors, hip abductors, and trunk stabilizers
  • Stretching to manage spasticity and prevent contractures

5. Sensory Re-education and Proprioceptive Training:

  • Used vibration, tapping, and proprioceptive inputs to enhance sensory feedback

6. Caregiver Training and Home Program:

  • Educated families on safe transfers, positioning, and home modifications
  • Provided tailored home exercise programs with progressive goals

7. Psychological and Motivational Support:

  • Ensured consistent encouragement, set achievable short-term goals
  • Encouraged family participation to maintain a positive environment

Outcome:

Over time, most patients showed measurable improvements in mobility, independence, and overall quality of life. Recovery varied, but through consistent therapy and support, many progressed from being dependent in basic ADLs to walking with or without assistance and performing routine tasks more confidently. These experiences deepened my clinical understanding of stroke recovery and reinforced the importance of a patient-centered, interdisciplinary approach.


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