31-year-old male presenting with weakness and increased tone throughout the right side with a non-functional right upper limb. At the time of the incident, he had passed out of Naval College and was doing advancements in communications for the Royal Navy in Portsmouth. His hobbies include listening to music, watching rugby and relaxing in front of the television. He supports Harlequins Rugby team and enjoys drinking a pint of Guinness.
● Left upper limb mild increase in tone + ataxia
● Right sided spasticity and hemiplegia (flexor pattern)
● Contractures in right hand
● Reduced range of motion throughout lower limbs
● Poor trunk control
● Cognitive impairments including poor short term memory
● Severe expressive and receptive aphasia – language severely affected
● Ceiling hoist for toilet and bed transfers in the morning- tonal issue
● Electric Wheelchair for indoor and outdoor mobility
● Molift transfer with assistance of one for chair transfers
● Only outdoor mobility in garden using parallel bars (built by carer) and assistance of one
● Short phrases used to respond in social situations
● Understands short instructions
Speech and Language Therapy
● Language was fully assessed using a formal assessment to establish level of both expressive and receptive language abilities
● Introduced to an app called Tactus which will enable him to continue working on improving his language after returning home
● Also introduced a text-speech app to enable him to communicate with less-familiar people, allowing increased independence
Physiotherapy
● Upper limb and lower limb stretching programme to improve range of motion
● Treatment sessions using neurotechnology to improve postural control and gait
● Carer education on bed positioning, tone management and home exercise programme
● Functional assessments of sit-to-stand, lie to sit and rolling practice to promote independence with transfers at home
● Regular standing practice
● Explored safe transfer method from the wheelchair
● Indoor mobility practice with pulpit frame and assistance of two
Occupational Therapy
● Shopping trip to Aldi to buy ingredients to make his own dinner
● Meal preparation assessment to cook an Italian pasta dish
● Able to use utensils independently with the left arm
● Assistance of one by 1:1 carer to support with problem solving and following the recipe.
● More actively involved in washing and dressing during the morning routine
● Working towards increasing independence with washing self in the shower and improve upper limb control when brushing teeth
● Recommendations made for Bendable cutlery and Kitchen board to increase independence with cooking
● Safely pivot transfers from wheelchair to bed/commode with minimal assistance of one
● Able to sit on the edge of a plinth (previously unable to achieve 90 degree hip flexion for sitting)
● Able to transfer from lie to sit ( /sit to lie) independently
● Improved right upper limb range of motion. Able to grasp handle on the pulpit frame whilst mobilising
● Improved trunk control and sitting balance during functional tasks with carer
● Independently mobilising in own garden using parallel bars (prev. assistance of one)
