© 2016 Darien Lewis
Background and Purpose: Strokes affecting the middle cerebral artery (MCA) cause impairments of recovery affected by the patient’s premorbid status. Although there is a significant amount of research detailing physical therapy (PT) interventions for patients with hemiplegia, there is a lack of evidence supporting interventions for patients with hemiplegia following stroke that have multiple comorbidities. The purpose of this case report is to describe a progressive PT plan of care (POC) for a patient following MCA stroke with multiple comorbidities in the skilled nursing setting. Case Description: The patient was a 71-year-old male admitted to the skilled nursing facility (SNF) 50 days following a subacute right MCA infarct, non-ST elevation myocardial infarction, type II, and multiple significant comorbidities. The patient received PT five days a week for 35 days, with PT interventions focused on bed mobility, transfers, lower extremity strength, activity tolerance and balance. Outcomes: Throughout his POC, the patient improved his sitting and supported standing balance, rolling in bed from moderate-maximum assist to supervision-minimum assist, and his transfers, progressing from a hoyer lift to a sit-to-stand lift. Caregiver training was provided for the patient’s family, prior to the patient’s discharge from the SNF, to aid in his transition home with home health services. Discussion: Recovery from MCA stroke, complicated by several comorbidities, proves to be a difficult journey for patients. Despite several insurance denials and cessation of funding from the family, the patient demonstrated improved independence and function following the PT POC. Future studies should be conducted to further examine ideal PT interventions to improve functional outcomes for patients following stroke with multiple comorbidities.
Lewis, Darien, "Functional Training In A Patient With Middle Cerebral Artery Stroke With Multiple Comorbidities: A Case Report" (2016). Case Report Papers. 61.