Methods of examination in physical therapy, and occupational therapy of people after stroke (clinical case)

Abstract

the prognosis of recovery of patients after acute cerebrovascular accident depends on the type, severity, and area of brain damage. This article highlights standardized tests and scales for physical therapy and occupational therapy for patients after stroke. An example is given of a clinical case of a patient with stroke consequences, with right-sided spastic hemiplegia. Medical rehabilitation was provided in April 2023 at the Municipal Non-Profit Enterprise "Consultative and Diagnostic Center", branch №6, Sviatoshynskyi district, Kyiv, Department of Physical and Rehabilitation Medicine. After the patient visited the outpatient department of physical and rehabilitation medicine, the examination was conducted by the attending physician. A multidisciplinary team of a physical therapist and an occupational therapist was involved. An important step is the use of standardized tests and scales in physical therapy and occupational therapy. Based on the results of the examinations, the patient's goals are determined, and an individual rehabilitation program is built using evidence-based physical therapy and occupational therapy methods to provide a high-quality and effective rehabilitation cycle. Description of the objective. The standardized tests and scales in physical therapy, and occupational therapy are analyzed on the example of a clinical case of a patient after a stroke with right-sided spastic hemiplegia. Materials and methods. The clinician's handbook for 2020 on stroke rehabilitation was analyzed, with the justification of standardized tests and scales for physical therapy, and occupational therapy. A systematic review of the PubMed database was conducted, which included 44 scientific randomized trials and meta-analyses with accurate diagnoses of tests and scales for physical therapy and occupational therapy. The National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) were used to assess stroke. Modified Ashworth Scale for the assessment of spastic muscles in patients with neurological disorders. To determine cognitive outcomes and complications after stroke: Montreal Outcome Cognitive Assessment (MOCA); Modified Barthel Index (BI); Line Drawing Test. For motor function: Fugl-Meyer Assessment (FMA); Chedoke Arm and Hand Activity Instrument (CAHAI). Berg Balance Assessment; Morse Fall Risk Test; Stand and Walk Test. Results. The results of the initial examination in physical therapy and occupational therapy determined the patient's functional and cognitive state, consequences, and limitations arising after a stroke. The intermediate examination summarizes the effectiveness of the selected rehabilitation measures. If the patient's results remain unchanged, the physical and occupational therapist changes the approach and methods to achieve the goals. The final examination analyzes the dynamics of restoration of impaired functions, and achievement of goals by the end of the rehabilitation cycle. Therefore, we used the patient's clinical case to compare the initial, intermediate, and final examinations. This allowed us to analyze the results and determine the effectiveness of the selected individual rehabilitation program. Conclusions. The main principle of providing quality rehabilitation measures is the examination in the clinical practice of a physical therapist, and occupational therapist, which is used to measure the goals and compare the results achieved.