Howdie. Another week has gone by.
I’m going to keep my blog short this week so it will be more appealing to read.
This week I got to see this patient together with my supervisor. This pt, Mrs H, has got a subarachnoid haematoma in the frontal area. The first day we saw her, she was really drowsy and doped from the medications. She had difficulty performing on commands and her initiation to tasks are poor (e.g. rolling on her side). From observation, she seemed to have inattention to the left. We helped to sit her up and it was obvious that she had some perceptual issues. In sitting, she was leaning backwards as well as to the left. She was a “pusher” (i.e. pushing to the left), so the only way to correct her sitting alignment was to facilitate her to reach to the right as well as forward.
On the 2nd day that I saw her, she was more alert and she could follow commands better. She was also more attentive. Her sitting alignment was slightly better but was still leaning to the left and backwards. After a few repetitions of forwards and right lateral reaching, we managed to get an upright sitting posture. Then, my supervisor decided to try to stand her up. To our surprise, while standing, she did not lean to the left like we would have expected her to. She leaned significantly to the right instead. She couldn’t maintain upright due to her poor hip extensors strength as well as Quads strength and they had to be supported. My supervisor also thinks that she maybe weaker on her Right LL, as she was buckling more on the Right, thus probably the reason that she’s leaning to the ®.
On the 3rd day, I actually wanted to have a closer look at Mrs H, in terms of tone, strength and sitting & standing alignment. However, Mrs H was to be transferred to a rehabilitation hospital. Such a pity I couldn’t explore more to this interesting presentation. Has anyone ever come across such case scenarios? To give me some light on this?
Anywaez, hope everyone had a nice long weekend! One more week to go!
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I had my neuro placement prior to this one but haven't had anyone the same as the pt you described. I would say that 3/4 of the stroke pts I have seen displayed pushing behaviour. A little more challenging isn't it! While lots of strokes present with the classic S+S, it is quite amazing the variety within each presentation - severity, location, recovery, pt characteristics all important factors I am sure! Sorry I can't offer any further insight!
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