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STROKE
CASE STUDY
46-year-old male admitted to Lawrence Rehabilitation Hospital from Robert Wood Johnson University Hospital New Brunswick, where he initially presented with garbled speech and right-sided weakness. Patient found to have acute left thalamic infarct with extension into the ventricles, hypertensive crisis with hypertensive encephalopathy resulting in right hemiparesis and expressive aphasia. Patient s/p IV Labetalol and Nicardipine with eventual transition to oral blood pressure regimen. Hospital course c/b bilateral pulmonary infiltrates s/p antibiotic course. Past medical history significant for diabetes, depression, and dyslipidemia. Patient transferred to Lawrence Rehabilitation Hospital for comprehensive acute inpatient rehabilitation and medical optimization.
Rehabilitation Focus
Cerebrovascular accident – intensive PT/OT, continue Lipitor daily
Hypertension – close monitoring of vital signs, continue Amlodipine, Enalapril, Hydralazine
Diabetes – continue Metformin daily and Accu-Checks 3 times daily
Depression – continue Zoloft daily
Anemia – continue low-dose iron
Duodenal ulcer – continue Prevacid q12hrs
Therapy Interventions
Goals: Patient’s goal was “I want to go home”.
Initial Evaluation: Upon admission, he required Max A for sit to stand and bed-to-chair transfer and to complete his activities of daily living. He also presented with severe expressive and receptive aphasia.
Interventions: Individualized therapy plan was developed consisting of PT/OT/SLP. He actively participated with therapy 5 days per week.
Discharge Evaluation: The patient made significant gains with therapy to regain his independence with mobility and self-care. At the time of discharge, he was independent for bed mobility and required supervision for sit-to-stand transfer. With contact guard assistance, he was able to transfer from bed-to-chair and ambulate 300ft with RW. He was also able to safely ascended/descend 12 steps with contact guard assistance. He was contact guard assistance for bathing and set-up assistance for dressing.
After a successful stay in acute rehabilitation, the patient was discharged home with support from family. He will continue to receive outpatient therapy at Lawrence Outpatient. He will continue to be followed by his PCP, Dr. Darshana Tawde in the community.
