You have already measured Peter’s sitting and standing balance after 2 weeks post stroke when he starts his rehabilitation in rehabilitation center (assessment task 4). You have given the points by using the PCBS test and written a short summary about his balance ability. Peter’s PCBS test 2 weeks after stroke. Based on these measurements plan two tasks for Peter which will improve his standing balance. Justify the reasons for your choices.
To take in considerations, Peter’s hobbies are reading, computers and household chores (lawn and forest work).
The patient experiences difficulties in controlling static balance. The patient is able to maintain static standing position in excess of 30 seconds, however experiences significant difficulty with feet together (requires wall support in less than 5 seconds). The patient is unable to maintain balance on one foot.
The first exercise is to improve static balance. The patient starts the exercise in wise stance and progress to a narrow stance/tandem stance. In others words, the progression is to reduce the base of support. The oriented-task is to look a look over the left shoulder, as far as comfortable. Then it is repeated on the other side. Repetitions and sets shall be determined through observation of the patient performing the task. Thus, the visual and vestibular system are challenging the balance and the somato-sensory system has to compensate it.
The patient is unable to control dynamic balance. The patient is unable to bend down to pick up an object from the floor, nor to turn 360° degrees in place. However, he can touch a mark spot with the elbow on the right side, whereas, on the left side, the patient is unable to control his balance.
The second exercise is to improve dynamic balance. The patient task is to catch one book that he likes on the left side being stand up. And then, it is repeated on the right side. The progression is to increase the distance of the book and the patient and decrease the base of support. Reps and sets shall be determined through observation of the patient performing the task.
PHYSIOTHERAPY REFERRAL
Patient: Peter Smith Social security number: 110350-1O3N
Diagnosis: Infarctus cerebellum 25.11.2014
Background information
The patient is a computer teacher and two days ago he felt dizzy and sick at home and fell down on the floor. His sister called for an ambulance and the patient was taken to the central hospital. Thrombolytic care was given within three hours of the first symptoms. The patient is now in the stroke unit. He has no hemi paretic nor sensory symptoms, but he has a strong pusher syndrome on the right side and he cannot control his sitting and standing position.
The patient continues his rehabilitation in the rehabilitation center of Kruunupuisto for three weeks and the main goal is to be discharged home after that. He lives in the countryside on a farm with his sister. His own goal is to be discharged home as soon as possible and return to his work as a computer teacher. His hobbies have been reading and computers and household chores such as mowing the lawn and forest work. His sister lives near and helps him in housekeeping. He is motivated in his rehabilitation process and the main form of rehabilitation is physiotherapy two times per day and he is guided to keep an independent training diary and he also participates in group practice.
I ask politely to continue physiotherapy according to the condition of the patient.
Neurologist George Brown
Jehanne Crouzier 