Topic Two

Situation: Patient with Lateral Medullary Stroke on the Stroke Rehab ward who requires physiotherapy to improve his ambulation so he is safe for discharge. He has L) sided weakness and leans to the L) in standing due to impaired vertical alignment.

Task: My task today was to continue rehab with this patient to improve his quality of gait and transfers.

Action: I spent the morning working on foot placement and weight shift to the R) during gait and dynamic balance. The session was shortened due to a mild onset of nausea and exacerbation of longstanding right hip pain during exercises. The patient had complained of nausea over the past few days so I decided it was safer to shorten the session for today and talk to his doctor about what the possible source of the nausea was.

Result: By the end of the session the patient’s gait had improved with an increased stance phase on the R) LL and larger steps with the L) LL. He reported that his confidence with walking had improved as well. After consulting with the Doctor I found that the nausea was a likely symptom from the stroke or a symptom from their medication and was still safe to exercise.

Evaluation: I feel that the intervention I conducted targeted the patient’s impairments and activity limitations. However the intermittent nature of the session meant that it lacked efficiency and discharge would be prolonged if sessions were continually shortened due to complaints of nausea.

Strategies: The next session with this patient I will educate them on the likely reasons for the bouts of nausea. I will inform him that as long as the nausea is bearable it is important to continue with therapy to help him recover his function efficiently and that by working through it can help to manage and control it. Thereby ensuring that he is discharged as early as can be.