Six months later

Mobility

Dave still stretches his muscles everyday as instructed by his therapists. He attended an exercise after stroke class at his local leisure centre for a few weeks and he now attends his local gym. He uses the treadmill, step machine and static bike equipment and does a weekly exercise session in the swimming pool.

Upper limb

Dave attended the specialist spasticity clinic a few weeks ago and was given a trial of Botulinum Toxin A injections with the aim to reduce the Hypertonus in his thumb. He was given specific activities to do at home and he will be reviewed in three months to measure any change in his function.

Activities of daily living

Dave can put on his AFO. He has changed his footwear so he can now put his shoes on and off easily. He is washing, dressing and showering independently. He has gradually been attempting more cooking and can make snacks for himself and the family. As he has been seizure free for almost six months he can be referred for his driving assessment in a few weeks time. There is a waiting list for appointments for driving assessment.

Work

Dave has been in contact with his employer and they are negotiating a phased return to work with some modifications to his previous workload and within his office.

Secondary prevention

Dave is still aiming to lose some of the weight he put on since his stroke but he is noticing a difference now he is going to the gym and swimming pool regularly. He has reduced the salt and fat in his diet. He has spoken to his GP about the medication he is taking and he understands that this will be ongoing to reduce the risk of further stroke.

Psychological

When Dave first went home he was quite bored and found it difficult to fill his week. After a conversation with his stroke liaison nurse he started to think about activities he could enjoy again or new challenges. He used the Self Help 4 stroke website to set some goals. One of these was to arrange a family break at the school autumn half term holiday. He also followed up the contact at the disabled anglers club and he will be going with a friend to look at the facilities.

Mobility

Dave also had a review and refitting of his AFO but he is reluctant to go outside unless accompanied. The community rehabilitation team worked with him on this issue for the first 5 weeks after he comes home. However he is still anxious about this. A friend goes with Dave to the local gym for two half hour sessions a week. He can manage stairs now additional bannisters have been fitted.

Upper limb

His arm orthosis has also been reviewed and a course of therapy and activities to do at home have helped to reduce the swelling so the orthosis now fits better. He had pain in his arm for some time before an appropriate medication was used with effect. Physiotherapy has helped to release some of the hypertonus in his elbow but the wrist and fingers have remained more difficult to treat. A referral was made to the specialist spasticity clinic for assessment. His treatment plan included Botulinum Toxin A injections along with further physiotherapy to stretch the affected elbow, wrist and fingers. He continues to be seen at the spasticity clinic every 4 months for review.

Activities of daily living

Dave is no longer incontinent now his mobility has improved and he can get to the toilet and adjust clothes independently. His initial care package was stopped after the community rehabilitation team worked on improving his dressing technique and suggesting alternative ways to manage some cooking and kitchen tasks. He can now make hot drinks using a lighter kettle. His wife continues to do all the cooking for the family.

Secondary prevention

Dave is still using nicotine replacement patches and has support from the NHS smoking cessation service. He stopped smoking after his second attempt. He has a Dosette box for his medication which Jenny fills for him weekly.

Psychological

Dave’s mood was low for a few months after discharge but he has been using talking therapy, relaxation tapes and mindfulness to help to ease his anxiety. His stroke liaison nurse discussed his secondary prevention measures and this also reassured him. He has been encouraged by family and friends to go out to social activities. He has been referred to vocational rehabilitation service and he is considering asking his employer about the possibility of part time hours and some changes to his workload before deciding on his future work options.