neuro week 1

Hey guys, I’m on my neuro prac at the moment, and I know it’s only been one week but I can’t help but get the feeling that I’m not actually making that much of a difference…

I have a patient who has had a thalamic stroke and presents with cerebellar symptoms of disdiadochokinesia and dysmetria. However, because it is a thalamic stroke the impairment is motor control rather than cerebellar.

The patient tends to lean to the left during gait due to a flexion resting position of the left knee in standing. I have tested tone and there is no notable increase in tone compared to the right, hamstrings feel a bit short and tight but equal left and right, the patient also has full hip extension range and good active hip extension, so it’s not a hip problem…

The patient also told me after 2 days of treating him that he also used to walk with a slight limp. Upon asking the patient if he knew if the limp was on the left, he couldn’t recall. So I know that when the patient brings weight to the left he has trouble balancing and falls to the left, but I think a lot has to do with the persistent knee flexion. The question is what else could I possibly assess to determine if the knee is a result of the stroke or if it was like that prior to the stroke i.e contributing to his limp in the first place and therefore I am not going to have much of an effect on treating the left lower limb in regards to its length issue…??? Also the dysmetria causes the patient to have quite a narrow base and he has trouble slowing the movement down, so when he stops to turn around his feet often get caught up underneath him and he loses his balance.

I have leant a bit about thalamic stroke since treating this patient, which has been the most interesting part about it, and I like the fact that it is a little bit challenging, but this is a question for Trudi, do you know if there are any good articles on thalamic stroke or not that could help me with this patient???