Stroke Rehab Case Study. Robert Teasell MD FRCPC Professor and Chair-Chief Physical Medicine and Rehabilitation Schulich School of Medicine University of Western Ontario Lawson Health Research Institute St. Joseph’s Health Care London, Ontario. Case Study. 73 yo married male
Robert Teasell MD FRCPC
Professor and Chair-Chief
Physical Medicine and Rehabilitation
Schulich School of Medicine
University of Western Ontario
Lawson Health Research Institute
St. Joseph’s Health Care
Is this good care? Could we do this better?
Specialized Interdisciplinary Stroke Rehabilitation is the “gold standard” of care
Is this a good model of care?Could we do this better with the resources we have? Is this the best it can be?
In German and Swiss centers, the rehabilitation programs were strictly timed (therapists had less freedom), while in UK and Belgian centers they were organized on an ad hoc basis (therapists had more freedom to decide)!
“More formal management in the German center may have resulted in the most efficient use of human resources, which may have resulted in more therapy time for the patients”
De Wit et al. Stroke 2007:38:2101-2107
How much U/E therapy should the patient be getting?
Barreca et al. 2001 Heart and Stroke Foundation Ontario Guidelines for Hemiplegic Upper Extremity
Patient had significant Lt neglect to confrontational testing
Describe treatments available for the treatment of left neglect
For the same patient (moderate to good motor recovery, left sensory loss and nonfunctional upper extremity), his wife has read that if the patient rehearse movements of the involved extremity in their head that it may help
Would mentally rehearsing movements be helpful?
There is strong evidence that mental practice may improve upper extremity motor and ADL performance following stroke
What is the cause of the pain and how is it best treated?
Is this good care? How could we do it better?
73 y.o. male suffers a large Rt MCA infarct, undergoes rehab and is preparing for d/c
Spouse reports feeling ill-prepared to manage him at home; the social worker provides her with written material on home discharge and support systems
Is this appropriate?
“Doctor says you can come home
when I am up to it.”
Strong evidence of a positive effect, associated with the provision of information and education through a variety of intervention types
One on one education sessions have a greater effect on outcome than the provision of information materials alone
Strong evidence that skills training is associated with a reduction in depression
Moderate evidence that training in basic nursing skills improves outcomes of depression, anxiety and quality of life for both the caregiver and the stroke patient