Faculty Advisor(s)

G. Noel Squires

Document Type

Course Paper

Publication Date

12-1-2014

Abstract

Background and Purpose: Patients whom have experienced a cerbrovascascular accident (CVA) commonly have difficulties with functional mobility. Rehabilitation is a common route taken by individuals who have experienced a CVA in order to regain function and independence. Neurodevelopmental treatment (NDT), a rehabilitation technique, emphasizes the integration of postural control and task performance, control of selective movement for the production of coordinated sequences of movement, and the contribution of sensory inputs to motor control and motor learning. The purpose of this case report is to describe functional training in conjunction with NDT-based interventions for a patient with a CVA during a 3-week stay at an inpatient rehabilitation hospital. Case Description: The patient was an 80-year-old male who experienced a large right CVA in the setting of atrial fibrillation. The patient received three weeks of daily physical therapy at an inpatient rehabilitation hospital. The examination process revealed many functional limitations and impairments in strength, sensation, balance, posture, motor function and mobility. Procedural interventions had an emphasis on task-specific training and Neurodevelopmental Treatment based interventions, including therapeutic exercise, balance and gait training, and functional training. Progression was documented through outcome measures such as the Berg Balance, Functional Independence Measure and MoCA. Interdisciplinary discharge planning occurred at weekly team meetings. Outcomes: The patient displayed significant improvements in balance, gait and functional mobility, and level of assistance required. The patient nearly doubled his score on the FIM of 34/126 to 66/126 from admission to discharge, and increased his score on the MOCA from 6/30 to 22/30. The interdisciplinary rehabilitation team recommended temporary placement at a skilled nursing facility in order to continue intensive rehabilitation. Discussion: Physical therapists within the inpatient rehabilitation environment commonly utilize the importance of functional training into daily therapeutic interventions for patients with a CVA. Dramatic improvements in the patient’s functional movement with the use of an NDT approach may warrant using it as a model for patients with similar demographics. Future research exploring the effectiveness of constraint-induced movement therapy, body weight support treadmill training, and traditional therapy versus NDT-based therapy in the rehabilitation of patients with a CVA is warranted.

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