Rifah 75 Saudi women with history of ischemic
stroke affecting right middle cerebral artery with left side hemiparesis 2
months ago. The patient displayed mild
aphasia resulting from the stroke, so her daughters provide the subjective
information regarding her medical history and current level of function. The patient
has history of hypertension and takes
anticoagulant drug. The patient’s daughters served as her caregiver and
reported that the patient able to maintain sitting but require maximum
assistance in transfer from bed to chair and sit to stand and roll to right
side, but moderate assistance when roll to left side. She required maximum
assistance in bathing, grooming, toileting and dressing but can eat
independently with right hand. She use standard wheelchair for household ambulation
and when she goes out in the community. She Lives with her family in villa in
AlSuwaidi in ground floor, she has 4 daughters. Patient chief complaint is the pain
in left shoulder, knee and the dependency in activity of daily living. Patient
goal from the treatment is to walk independently to be able to go to the
Left side hemiparesis with deficit in
force production, sensory integration affect her dynamic balance and ability to
perform activity of daily living independently.
Observation was conducted to determine
skin integrity which was intact, pitting Edema in the legs shaft and dorsum of
the foot grade 1.
Sensation test include deep and
superficial sensation for upper and lower limbs and the results were: lower
limbs both sides deep are intact. lower limbs both sides superficial is impaired.
Upper limb deep sensation for right side intact but the superficial sensation was
impaired. Upper limb left side deep
and superficial was impaired.
Coordination tested by finger to nose
test. The results: upper limb was functional, lower limb not tested due to knee
static and dynamic Balance in sitting
is intact. but static and dynamic balance in standing is impaired.
Left upper extremity and right lower extremity tone
were assessed using the Modified Ashworth Scale. The patient lower extremity
left side tone score was 1. While upper limb was normal.
Manual muscle testing was performed to
determine upper and lower extremity muscle strength. The results In (table 1)
Other examination findings include right
side hamstring tightness approximately 20 degrees when tested in a 90/90