When I met Derek and his wife, we discussed the physical difficulties he had. I used this information to help assess Derek’s current impairments, and from there we made a plan of action and set goals.
Derek often struggled to remember where his right arm was and he could only move it by using his other arm to help. It would not stay where he put it and it would often be in the way. He regularly needed help from his family as activities needing two hands, like tying his shoelaces, or cutting up his dinner was impossible. This frustration was further compounded by shoulder pain. Even using his ‘good arm’ was hard, as he often lost his balance, even if he was sitting down. His right leg was also difficult to move and swollen and uncomfortable. He felt he was too dependent on his stick when he was standing or taking steps, and he could not climb steps or stairs.
From my assessment I could see why Derek was having the difficulties he described. He was less aware or ‘attentive’ of his right side, which meant he would be subconsciously using his left side more to keep his balance, and do everything he would previously have been able to do with both sides.Derek’s right side was much weaker and had ‘lower muscle tone’ than the left, and he had reduced control in the movements of his pelvis, trunk and ribs. Consequently Derek’s trunk had become stiffer and was unable to work properly to hold him up against gravity and help his balance. This reinforced his body’s new reliance on his left side to stabilise him.
In addition to the original neurological deficit, the position, length and role of his muscles had altered, impacting the way his joints were positioned at rest, and during movements. This was most evident around Derek’s right shoulder and hand, andalso within his foot and ankle. This explained the difficulties Derek was having in being able to let his right foot settle on the floor with weight equally on both legs. When he stood up he had to shift his trunk over his left leg, which pulled his right side backwards and left, allowing him to ‘lever’ his right leg through to step, which simultaneously disrupted his balance. This explained exactly why Derek was worried about falling over.
Now we had a clearer idea of the specific issues that Derek was struggling with from the neurological impairments he had due to his stroke, I discussed the key things we would target in physiotherapy sessions, and what I expected to see change with treatment. Derek was very clear about the key things he wanted to see change as quickly as possible; the things that he found most frustrating. We discussed Derek’s goals, and ‘what he wanted to do’.