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Dave attends a class at the local gym. | Dave is inactive. |
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MobilityDave is walking indoors independently when wearing his Ankle Foot Orthosis (AFO). The stroke team are assisting him to practice walking outdoors without a stick and he is gaining confidence using the steps with his new rails. The physiotherapist is going to refer Dave for Functional Electrical Stimulation (FES) to activate the muscles which lift the foot while walking. This should give him more independence. He practices the stretching exercises which he was given before he left hospital. The team discuss with Dave and he agrees to having a referral to an exercise after stroke class at the local gym. Upper limbHe practices the stretching exercises which he was given before he left hospital and he wears his splint in the evening. He practices the stretching exercises which he was given before he left hospital. His thumb remains difficult to stretch because of increased muscle tone. The therapists wonder if Botulinum Toxin injections would be useful and they decide to refer to the spasticity clinic for an opinion. ADLHe still needs help to put on his AFO but he keeps practising. He is slow but can dress himself independently once his AFO is on. The OT has assessed Dave in the kitchen and he is making a cold lunch or reheating a plate of food in the microwave for himself. He can put meals, which Jenny has previously frozen, into the oven for his family and his wife serves them when she gets home. He is trying to eat healthily because he noticed he has put on weight since he has been less mobile. Dave eventually wants to get back to work and back to driving. Dave must wait until his motor function and control have improved and he has been seizure free for at least six months He will need to be medically assessed for fitness to drive before he can have his driving assessment. By law he must inform the DVLA (Driver and Vehicle Licencing Agency) about his medical condition. The long term plan is to have a graded return to work following a referral to the return to work service or vocational rehabilitation service or employment coordinator and his occupational health advisor at work. Secondary preventionHe can manage his medication independently. He has stopped smoking. PsychologicalOne hobby he and his son enjoyed before the stroke was fishing and he would like to get back to doing this eventually. The team give him a link to a local disabled anglers club for more information. Dave eventually wants to get back to work and back to driving and has been referred for a driving assessment. The stroke team discuss his goals and encourage his self management by showing him the goal setting section on the Self Help 4 Stroke website resource to keep active. |
MobilityDave is inactive. He is having difficulty managing stairs so is reluctant to go out as he needs assistance and is frightened of falling. Practicing transfers, walking indoors and stairs and trying to maintain his range of movement in his limbs. His Ankle Foot Orthosis (AFO) is not fitting well, this is affecting his walking. He also uses a quad cane for balance. The physiotherapist refers him to an Orthotist for a review of his AFO. The team also discuss an exercise after stroke class at the local gym but this cannot happen until his mobility improves so this becomes one of his longer term goals. Upper limbPhysiotherapist refers him to an Orthotist for a review of his AFO and arm splint. The physiotherapist refers for specialist assessment at the spasticity clinic. She is concerned that Dave may be at risk of developing a contracture at his elbow, wrist and fingers. ADLHe has functional incontinence due to limited walking and not being able to get to the toilet and manage his clothes in time. A referral is made to the continence service for review. Dave has a care package to help with washing and dressing which is difficult because his arm tone is increased. Jenny has to leave a cold lunch for Dave and a flask of tea but she notices he has not been using the flask as he has difficulty opening it after the morning carers have gone. Dave has a raised toilet seat and bathing equipment. Extra rails have been installed on the steps at home. Dave wants to get back to work but he can’t see how that will happen. A referral is made for Occupational Therapy assessment. Secondary preventionHe wants to give up smoking but he is struggling with this. The rehab team suggest smoking cessation using free nicotine patches from his GP and the stop smoking help line. Medication is monitored by his GP. He needs help to open the medication packaging. PsychologicalDave is inactive and watching TV for long periods of the time. His mood is low. The team inform his GP about his low mood. He wants to ‘get his life back”. |
Page last reviewed: 06 May 2020