Stroke with dense hemiplegia

[Fyzzio]

Hi,
thanks gcoe, your comments are phantastic - as usual ...

In regards to ice stroking: that's a very old technique with origins in Bobath, if I'm not mistaken. If your patient has got absolutely no muscle contractions, you really are dependent on techniques, which cause extreme reactions. So, I would also recommend the use of ice.

Mirror technique: we build our own. Wasn't even too difficult. Just a tray, a bathroom mirror from an op-shop and a self-made wooden device to hold the mirror up.

The expressive aphasia shouldn't really cause too much trouble. You can overcome this with charts, pictures, spelling devices etc. If you've got access, get your Speech Therapist to guide you along. However, if it is a problem, then I presume, your client has got mixed dysphasia - combining expressive and receptive deficits.

The Alzheimers is a major draw back, however. A Physio treatment on it's own is not going to make a great change. As we rely on patients to continue their 'therapy' on their own, you will need to have some help there, especially, if your patient is unable to remember the actual session or any education you have provided.

Maybe this (the receptive dysphasia + non practice time) is why there has been such a poor progress in the first place. You need muscle contractions to keep to your muscle alive. First you loose muscle fibres, but after a prolongued time of inactivity you can actually loose whole motor units. And that doesn't leave much hope. Haven't got the reference handy, which gives more detail, but the longer there is absolutely no activity, the worse the prognosis.


Regards,
Fyzzio

[Termy]

Good suggestions.

As for the aphasia, I believe it's not the impressive type, because he seems to understand everything I say to him. Unfortunately there's no speech therapist available. He's at a geriatric nursing home (not sure if that's the right term?), and I'm the sole physiotherapist there as well as a bunch of other places, which severely limits my rehabilitation time with individual patients.

I've tried to emphasize to him the importance of mental practice and trying to activate the arm himself in addition to the rehabilitation, but I can't be sure how much of that he actually does. He was in a pretty bad shape even before the stroke, and right now he can't really move at all himself. He needs total assistance for getting out of bed into a wheelchair, etc. Also, he gets exhausted really fast, even when the assistant nurses do passive movements to prevent contractures...

One peculiar thing is that I once saw him move his hand from his side to his belly when he was lying down in bed. That was perhaps 3 weeks ago. The assistant nurses have said that he has done that a few times, although not in the past weeks. There was never any discernable muscle activity before and after those moments though.