| Case 2: 76-year-old male. | Overall picture at 5 weeks after onset of left-sided cerebral infarction (LSA) Problems and responses in the second week after admission to a convalescent rehabilitation ward. | |
| ① Clinical features | History only of hypertension noted 17 years ago, difficulty removing spectacles 6 weeks ago, left hemiplegia 5 weeks ago, admitted on the same day as an emergency, no difference in limb movements between right and left, heart failure lightened after admission, motor paralysis worsened immediately after admission, right LSA infarction diagnosed 3 days after admission, admitted to ileal rehabilitation ward 2 weeks ago, neurological left hemiplegia, higher functional impairment? | |
| ② Psychological aspects | Assembled cars until age 60; hobbies include carp and planting; independent in ADL and driving a car; ate without teeth for 10 years; accurate memory since onset of illness; driving difficult. | |
| ③ Environmental aspects | He lives with his wife and he says that she cannot take care of him and that if he does not get better, he intends to go into an institution, but he would prefer to stay at home. | |
| ④ Functional impairment issues | BRS (Brunnstrom Stage) upper limb-fingers-lower limb III, able to grip, elbow extension, standing, grip strength right 30/0 kg, pain sensation upper limb 3/10, lower limb 5/10, HDS-R (Hasegawa’s Dementia Scale-Revised) 23/30 points, BIT (Behavioral inattention test) 140/146 points, assisted except for eating activities, transfer with fingertip assistance, standing. | |
| ⑤ Issue identification | Awareness of the issues | What is the standard intervention for left hemiplegia? |
| Response on the day Intervention points | Standard intervention methods for rehab professionals; for cases with moderate motor and sensory paralysis and no cognitive or higher brain dysfunction problems. The post-onset period is divided into 3 - 6 weeks and 6 - 8 weeks, with the early period being transfer independence and wheelchair self-walking, and the latter period being gait acquisition. In the early period, the patient was able to leave the bed all day, grasp the handrail with both hands, and stand up, knee flexion and extension, and foot stomping, which also encouraged a sense of weight on the lower limbs. In the latter period, the patient was able to walk with a forearm-supported walker, weaned from a wheelchair and had a short leg brace made, enabling her to walk with a cane independently from looking after her. | |
| Three-day reflection Best practice | Tips for standard left hemiplegia interventions. Muscle tone in the lower limb is flexion-dominant when standing up, you can feel the grip - you can also feel the soles of the feet. 3 - 5 weeks after onset of illness - Pre-walking preparation with a combination of three evidence level A (formerly 2009 edition) More standing and seated exercise - lower limb muscle strengthening and aerobic exercise - repetitive exercise of both upper limbs. 6 - 8 weeks after onset, two good prognostic predictors combined to gain independent walking. Lower limb BRS III can walk with orthotics and cane - walking independence is possible with comprehension and learning ability. | |
| ⑥ Goal setting | Full-day weaning after 1 week, independent transfer and wheelchair self-walking after 2 weeks, supervised toilet transfer after 3 weeks, supervised walking after 4 weeks. | |
| ⑦ Communication | Functional prognosis of patients recovering from stroke with reference to high evidence of healing (Lessons learned). | |