SHRIDEVI COLLEGE OF PHYSIOTHERAPY

Case presentation on sub

acute infarct in left
centrum and parietal
region.
Name of Presenter: Saranya (4th year)
Shruti Shrestha(3rd year)
Case Presented on: 9/28/2022

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 Topic Page
no
1. Subjective Assessment 3
2. Objective Assessment 8
3. Investigation 16
4. Provisional Diagnosis 23
Contents 5. Problem list 24
6. Anticipated goals 25
7. Goals 26
8. Treatment 27
9. Physiotherapy Management 28
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Demographic Detail
• Name: SIDDAMMA
• Age:60
• Gender: Female
• Occupation: Farmer
• Address: Hosahalli, Tumkur
• Contact: +919740105772
• Date of admission:03-08-2022
• IP no:2208030126

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Chief Complaints
• Inability to talk since 02/08/2022 night 9pm.
• Inability to walk since 02/08/2022 night 9pm.
• Vomiting (2 episode).

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History of present illness
Patient was apparently normal on 02/08/22 till 7pm then later she wasn’t able to
talk & walk, insidious onset, gradually progressive developed these complain after
waking up at 9pm. She then developed vomiting(2 episode). For these symptoms
patient was taken to Government Hospital, Tumkur. From there the patient was
referred to Shridevi Institute of Medical Science &Research Hospital(SIMS&RH).

N/H/O Headache/Breathlessness.

N/H/O Chest pain/Abdominal pain.

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Past medical history
K/ H/O Old CVA- Acute infract in left cerebellar hemisphere, 3 month
ago and was treated in SIMS&RH, Tumkur .

Present Medical history

K/H/O Hypertension Since 2 years on medication but not as
regular intake (T. TELMA 40).
K/H/O CVA – T . Clopilet A 150
T . Atorva
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Family history
-No significant history.

Personal history
-No Smoking/Alcohol intake.

Social history
-Upper Middle Class.

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General Examination
❖Temperature- 97.6f
❖Pulse- 85bpm
❖Blood Pressure-140/80 mm Hg
❖Respiratory Rate- 20cpm
❖Spo2 -98% on 2litres of Oxygen through nasal cannula

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• Observation
1. Patient is unconscious
2. Body built- Mesomorphic
3. Position of the patient- Supine lying
4. IV Cannula (Left hand)
5. Urinary Catheter
6. Ryle’s tube
7. Nasal Cannula: Patient was on 2L of oxygen
8. Attitude of limb
9. Upper limb : Right shoulder adduction, elbow flexed, wrist flexed, finger flexed.
10. Lower limb : Right leg is neutral.

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• On Examination
❑Consciousness (by GCS scale)
GCS - E1V1M2
GCS – 4(severe)
❑Orientation
Disoriented/drowsy
❑Speech
Global aphasia
Higher mental functions – couldn’t assess

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Motor Examination
• Tone of muscle
Upper limb flaccid.
Lower limb normal.

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➢ Pathological reflex

Babinski’s sign- positive (+ve)

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Functional activity
Barthel Index Score – 0

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Radiological investigation
• CT
▪ Subtle hypodensity ,seen in left centrum semi- ovale - subacute
infarct
▪ Areas of gliosis in left cerebellum –old infarct
▪ Chronic small vessel ischemic changes in bilateral periventricular
white matter.

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 .

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• MRI

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 Ischemic Stroke (Right
hemiplegia) with
Provisional aspiration pneumonia
diagnosis Middle Cerebral
Artery(MCA) was
affected.
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 Reduced tone in right upper limb

Patient is on 2 liters of oxygen

Patient is unconscious
Problem
list Inability to carry out ADLs

Inability to speak

Inability to sit, stand and walk independently

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 • To normalize the tone within 2 months.
• To wean off the patient from oxygen
within 5 days.
• To arouse the patient within 21 days.
• To make the patient independent in
Anticipated sitting, standing and ambulation within
3 months of duration.
goals: • Rehabilitation of the patient in carrying
the ADL’s independently within 3
months.
• Prevention of bed sores.
• To improve strength of right upper limb
and lower limb.

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 Educate the patient’s attenders.
To prevent chest complication.
To reduce spasticity.
Goals
To prevent bed sores.
To improve the muscle strength.
To improve the joint mobility.
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 Treatment

Joint compression(10 reps, 3sets).

Facilitatory movements of both left and

right (UL&LL) (10reps, 3 sets).

Positioning.

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Treatment for STROKE.

• Multimodal sensory stimulation for arousing the patient

• Olfactory stimulation
• Vestibulo-cochlear
• Optic
• Tactile
• Kinesthetic
• Facilitatory techniques( Icing, brushing, passive movement )

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 Chest care

Patient caregiver education on bed sore management

Bed mobility exercises

Balance training exercises

Ambulation training in treadmill and progressing it to parallel bar walking with mirror biofeedback

Strength training exercises

ADL training

Home environment modification

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 Thank you

For your time

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