Hi Angela
Just some personal thoughts and opinions - I am a Physio working with under
65 year olds in a community rehab unit in the U.K.
It is difficult to strike the balance between realism /hope /optimism
/motivation /pessimism. At the end of the day there is so little published
information on long term recovery post stroke.I feel it is important to be
realistic and not give false hope but on the other hand not to depress and
demotivate with sweeping generalisations.
I see many patients long term post CVA, many of whom are still improving,
even 5 years or more post event. What is very satisfying to see is someone
regaining movement with therapy when their condition has been at a plateau
for some time.
I always point out that there is a whole host of difference between movement
and useful function, though try & find some way that even the tiniest
movement can be incorporated into function to allow practice.I explain that
the longer post event it is the less likely that any major life changing
recovery will take place, but feel free to prove me wrong.
I encourage patients to look back at how far they have come along the road
from their stroke, not how far off perfect they are.
I always work towards patient determined goals, be it independent toileting,
fishing or having ana arm that looks cosmetically acceptable.I try &
encourage patients to take back control of their own lives and get out of
the rehab treadmill, so it is them that says I'm happy with where I am, I've
had enough physio for now ( but I try and leave the door open if needed ).
I think what I'm trying to say is in the absence of much documented evidence
of physio effectiveness long term post stroke, it is hard to be strike the
balance and neither write off or over encourage people.
Having said all that, as far as upper limbs go, I generally find that floppy
arms have a poor lookout, but those with any spasticity or associated
reactions usually make at least a partial recovery with therapy. Recently I
have found some interesting results with patients post bot tox. For
instance, one lady 8 years post sub arachnoid haemorrhage had bot tox to her
finger flexors as hand hygiene was a major problem and her elbow was stuck
at 90 degrees. She now has after several sessions of therapy the beginnings
of assisted grasp/release in her hand and is able to control a football
under an outstretched arm on a table in front of her. At present her goals
of treatment are a more normal looking arm with relaxed elbow during gait
and an ability to hold things steady with her hemi arm e.g. a newspaper or
when ironing.
There is alot of untapped potential out there with so calle chronic CVA
patients - few though get any rehab more than 6 or at best 12 months post
event.
> From: "Angela Hutton" <[log in to unmask]>
> Reply-To: [log in to unmask]
> Date: Wed, 25 Oct 2000 15:24:47 +0100
> To: <[log in to unmask]>
> Subject: Chronic CVA patients
>
> Dear all
>
> We frequently have the problem of CVA patients being referred again and
> again several years after their stroke for Outpatient Physiotherapy not
> because of any deterioration but simply because they have not yet made a
> full recovery - e.g. their arm hasn't started working yet!
>
> I wonder if anyone has been involved in setting up any strategies for
> dealing with these sorts of patients, their relatives and referrers. e.g.
> education programmes, treatment programmes, support groups etc, etc, etc.
>
> I'd be interested in any information regarding this difficult area.
>
> Thanks
>
> Angela Hutton
>
>
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