L CVA

Hi, my placement now is in neuro.

My patient was suffered from L CVA. This patient did surprisingly well on initial assessment without any major complaint, compare to the result showed on MRI.

As we know the results from MRI and presenting S & S of a patient sometimes do not match, but I was still surprised how capable this patient was physically.

The major problems on this patient were dysphasia (expressive > receptive) and dyspraxia. As we all have learned the strategies to address for dyspraxia/apraxia at uni, I was using some of them such as ‘simple commands/instructions’, ‘visual, tactile & kinesthetic input’ and ‘demonstration’ as much as possible.

In terms of addressing for dysphasia, my patient and I made a rule as ‘thumb up’ for ‘YES’ and ‘thumb down’ for ‘NO’. This patient seemed to understand the simple instructions or commands, but some of the responses from this patient were not clear in my head. It could be from my instruction which made this patient confused, could be from cognitive involvement, or could be decreased concentration by long Ax. I have realized there were many possibilities could contribute to this patient which made me difficult to write a note on this patient.

On the 3rd day, this patient presented having difficulty to grab a cup on R UL. During this patient was performing this task, it seemed easier to hold a cup from top using index finger inside and rest of fingers and thumb were outside. As this patient was asked to hold from side way which we normally do, this patient was capable but having difficulty more than from top. At this stage, this patient started having tears in front of me. Imagine how stressful or frustrate knowing the activities or tasks not be done smoothly or taking longer than used to be. In addition, this patient was unable to express self verbally.

I have explained to this patient that it was not the exactly same situation but I could relate to my experience how frustrate not being able to express self. That explanation made this patient more in tears. I have realized I should not say anything to emphasize this patient’s emotion, but it was too late. I started to encourage this patient on keep trying and practicing to get better. At the end of the session, this patient held my hands say nothing but keep nodding the head. Did it mean this patient understood the reasons for having PT Rx or where this patient was heading to? Hopefully this patient was happy with my explanation on the session.

I have learnt that those patients especially who suffered from stroke need lots of encouragement and important to let them see their improvement in each PT treatment even though it was small.