Friday, June 5, 2009

Observing some stroke patients and beginning input with stroke patients

I have had the opportunity to see a stroke patient today - she wasnt under the stroke team but her MRI came back with 2 R) Cerebellar infacts and CT results showed small ischaemic haemorrages.
Interestingly the patient had an inner ear infection about a month ago and her initial symptoms were suggestive of problems with inner ear - e.g. balance disturbance and dizziness...However she also had a headache and heart palipitations and ended up in hospital after collapsing (although not loosing conciousness).

I reviewed her notes and spent some time reviewing what had been happening for the patient. I had the opportunity to observe the registrar completing some sensory tests which was quite exciting.
She tested proprioception (asking the patient to close her eyes and describe the movement she was making with her metatarsel joint.
She tested vibration sense - with a metal fork that she banged and held on he joint asking the patient to identify when the vibration was present and when it stopped. I had the opportunity to experience what this sense felt like and the consultant was very helpful and also did a few other sensory tests on me
He did some sound and hearing tests with the vibration fork asking me to identify what sound of the fork was louder. He also put the end of the fork on my forehead and asking me to tell me what side was louder (was ment to be the same level of sound - which it was - so im normal)
The registrar also tested touch - with prick and dull pressure
The consultant tried to explain to me the senses they test for and it brought back some of the learning from teck about the spinal cord and the columns and which sense is associated with each - this interested me and i felt like looking this up on the net!
Next post will follow !!!!!!!!

As for my experience assessing this patient - her main issues were balance disturbance and fatigue
I completed an initial assessment wth the patient and identified any pre-dysfunction - good thing i did this becuase she had had a carpel tunnel repair to her effected side and this had already weakened her R hand strength.. She had no concerns about managing at home and the PT had assessed that she was safe for discharge with PT comm f/u.
I reviewed her function on the ward and set her home up for discharge, educated the patient on energy conservation etc.
After talking to my supervisor she took this a step further and we talked about fatigue diary as the patient still works and is keen to return to work as soon as possible. I plan to ring the patient next week and educate her on this

Fatigue diary - to rate the level of fatigue (am, late am, lunch, mid pm, late pm, bedtime) at various times and when doing activity. This aims to increase insight into fatigue levels during certain times of the day and during/after certain activities....then they can hopefully apply some energy conservation techniques to help control fatigue...

I also had the opportunity to observe the PT assessment - balance, gait, steps, nose finger (with increasing speed) and heel shin rub etc - it would be good if i could talk to the PT about what some of the more complex assessments were testing specifically - quite an interesting afternoon today!

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