Faculty Advisor(s)

G. Noel Squires

Document Type

Course Paper

Publication Date



© 2015 Bettie Kruger


Background and Purpose: Hemorrhagic stroke accounts for 10% to 15% of all strokes and is associated with a high mortality rate. A decompressive craniectomy is a neurosurgical procedure to reduce intracranial pressure in order to minimize risk of mortality and disability. It has been suggested that early and frequent mobilization following stroke onset is optimal for motor recovery. The purpose of this case report is to provide a framework of sub-acute rehabilitation that facilitated motor recovery and functional mobility in a patient with delayed participation in physical therapy (PT) following a stroke. Case Description: A 54 year-old female underwent an intracranial hemorrhage (ICH), subsequent decompressive craniectomy, and a cranioplasty. Sub acute PT occurred 6 days a week for 45-60 minute sessions over the course of 11 weeks. Initial findings included impaired spatial orientation, cognition, and impaired mobility. Treatment included therapeutic exercise, therapeutic activities, neuromuscular reeducation, and gait training to address all functional impairments. Outcome Measures: A Physical Performance and Mobility Examination (PPME) score at baseline was 1/12; Modified Barthel Index (MBI) was 60/100, however, ambulation was scored a 12/15 (minimum assistance) in the parallel bars for 7’; 30-second chair rise and gait speed were unable to be performed. At discharge: PPME score improved to 9/12; MBI was 96/100; 30‐second chair rise was 7; and gait speed was 0.23m/s using a wide based quad cane (WBQC). Discussion: Functional gains were noted over the course of care. The patient’s improved outcomes, and increasing level of independence could be a result of consistency and gradually progressing interventions. Further research should investigate optimal time of rest and return to activity following ICH in order to regain optimal functional mobility.


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