I thought that in this blog post it would be nice to look at a recent patient case study and see the real difference that neurological physiotherapy can make to patient who has suffered a stroke.

The patient - a male in his 50s and living on his own in Sutton Coldfield had a stroke approximately 2 years ago and had initially been recovering well but unfortunately he then suffered 2 further strokes after having a heart attack. He was hospitalised for a long period of time (approximately 6 months) and whilst in hospital received therapy from speech and language, occupational therapists and physiotherapists. Eventually he was well enough to be discharged home and there received a further 6 weeks of community NHS physiotherapy which unfortunately came to an end in Easter of 2013, despite the patient still having the potential to make further progress.

 We were contacted in the January of 2015 and asked to carry out an initial assessment to determine how the patient might best be helped to improve mobility, function and general quality of life. The initial physiotherapy assessment session was conducted at the patient's flat in Sutton Coldfield and after a discussion between the physiotherapist and patient the following key factors were noted: the patient was mostly using a wheel chair to self-propel around the flat, he lived on the second floor and needed to use a set of steep steps to get in and out of the block. Currently he felt unable to get out of the flat on his own and in fact had not been outside for many months. He was able to mobilise short distances indoors with a stick and had been issued an ankle foot orthosis (AFO) by the NHS but had not been using it as he did not like it. Overall the patient was motivated and keen to progress his mobility and arm movement but had no clear idea as to how to progress. 

An objective assessment (physical examination) by the physiotherapist showed his gait and walking to be severely affected with a clear foot drop on the right side and the patient using a classic hip hitching technique to avoid catching his foot. His balance was poor, he lacked control of his right foot and hip, was generally unstable on his feet and fatigued quickly in the session. At this point no attempt was made to assess the patient's ability on steps or stairs as he would clearly have been too fatigued and instead the assessment moved on to the upper limb and general sitting/core stability. Movement at the right arm and hand had been most severely affected by the strokes meaning he found reaching and grasping objects very difficult due to a lack of shoulder and hand control. General sitting balance and core stability had also been affected but much less severely than the arm. At this point it was agreed that initially physiotherapy sessions should focus on improving mobility and the ability to get in and out of the apartment in Sutton Coldfield as this was likely to have the greatest overall impact on quality of life. The patient was then given a series of exercises designed to improve balance both in sitting and standing, improve foot and hip control and also some exercises targeted at improving hand and shoulder function.

Over the next 7 months there were approximately 16 follow up sessions with the patient, these focused on tackling the stairs, steps in and out of the property, improving balance, progressing the patient's exercise program as he improved and slowly building up both his physical fitness and confidence. By the end of August 2015 the patient had made some remarkable improvements and both he and his family had all noticed a marked change in his walking and confidence. He was able to use the stairs independently and had been outside on his own to the garage, taken a taxi to the hospital and also been to the dentist. All of these tasks he had completed on his own due to significant improvements in balance and stability. He was using his AFO on the right foot which helped reduce any foot drop and significantly increased his walking speed and was working hard on the exercise program that he had been given by his physiotherapist. At his last session he was able to walk around the majority of the flat without any walking aid which was a remarkable achievement and showed the level of effort and hardwork that the patient had put in over the last 7 months. It is all the more remarkable when one considers that the majority of improvements made by stroke patients tends to occur within the first 6 months and shows what can be achieved by a motivated patient and a good physiotherapist working hard together. 

Hand and arm function has also improved over the last 7 months of neurological physiotherapy but remains much more severely affected and represents the next area to focus on with this patient and in the last session together both patient and physiotherapist agreed that this should be the priority from now on as mobility had improved so much. 

I hope that you have enjoyed reading about this success story for both our physiotherapist and patient and if you or someone you know has had a stroke (even if it was a long time ago) then please get in touch to see if we may be able to be of some help. We are a home visit physiotherapy service based in Lichfield and serving anywhere within a 25 minute drive which includes areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We can be contacted on 0788 428 1623 or via email: enquiries@threespiresphysiotherapy.co.uk