Post-stroke rehabilitation demands a multifaceted approach to restore independence and quality of life (Hartford et al., 2019). For Mr. John Anderson, a 75-year-old retired teacher, a recent stroke has brought about left-sided weakness, coordination difficulties, and balance challenges. The primary goal is to improve his mobility, enabling him to engage independently in activities of daily living and regain participation in cherished leisure pursuits. This report will discuss a rehabilitation intervention plan encompassing a range of strategies and techniques, each designed to target distinct aspects of his physical well-being. Over a time period, the intervention will be meticulously implemented and tailored to his progress, ensuring a steady trajectory toward improved mobility and enhanced quality of life. This report will delve into the rationale behind each facet of the intervention, examining the potential benefits and anticipated barriers while proposing strategies to overcome identified challenges. The ultimate aim is to optimise the effectiveness of the rehabilitation plan for Mr. Anderson's recovery and well-being.
Through a structured physical therapy program targeting muscle strength, joint flexibility, and overall mobility, Mr. Anderson will increase his walking distance without assistance within 12 weeks.
As a registered nurse (RN), the rehabilitation intervention plan for Mr. Anderson's goal to improve mobility is Physical Therapy (PT) (Arienti et al., 2019). Mr. Anderson will undergo a personalised physical therapy program to address his left-sided weakness, coordination, and balance issues. The physical therapy program will encompass a range of exercises and activities designed to improve muscle strength, enhance joint flexibility, and restore mobility (Arienti et al., 2019).
Aim of physical therapy |
|||
|
Improvement of Muscle Strength |
Enhancement of Joint Flexibility |
Overall Restoration of Mobility |
Duration |
4 weeks |
3 weeks |
5 weeks |
Frequency |
- Weeks 1-2: Three sessions per week - Weeks 3-4: Four sessions per week |
- Weeks 5-6: Three sessions per week - Week 7: Four sessions |
- Weeks 8-10: Three sessions per week - Weeks 11-12: Four sessions per week |
Complexity |
Initially, focus on lower weights and controlled movements. As Mr. Anderson progresses, increase resistance and incorporate more challenging exercises. |
Begin with gentle stretches, gradually increasing the range of motion. Introduce more advanced stretches in Week 7.
|
Start with basic gait training and balance exercises. Progress to more |
Exercises |
Leg Press, Bicep Curls, Core-Strengthening Plank Exercises |
Shoulder Stretches, Hip Flexor Stretches, Ankle Rolls |
Gait Training using assistive devices. Stair Climbing of ascending and descending stairs. Balance Exercises |
The three evaluation criteria for gauging Mr. Anderson's advancement in enhancing mobility encompass assessing the risk of falling, appraising his stability in sitting and standing positions, and his proficiency in executing everyday activities.
TUG test- The timed Up and Go Test (TUG) is used to evaluate a person's mobility and assess their risk of falling (McCreath Frangakis et al., 2023; Sakthivadivel et al., 2022). It measures the time to stand up from a chair, walk three metres, turn around, walk back to the chair, and sit down. Mr. Anderson will be timed as he performs this task. A shorter time indicates improved mobility and reduced fall risk.The frequency of the TUG test will involve administering the test at the beginning, middle, and end of the 12-week intervention period.
Berg Balance Scale (BBS)- BBS is designed to assess balance and stability in sitting and standing positions, including tasks such as reaching, leaning, and turning (Huang et al., 2019; Miyata et al., 2022). Mr. Anderson will be scored on a scale of 0 to 56 based on his ability to complete the tasks. An increased score indicates improved balance and stability. It will be administered at the beginning, middle, and end of the 12-week intervention period.
Barthel Index- The Barthel Index evaluates a person's ability to perform activities of daily living (ADLs), including mobility-related tasks such as walking, transferring, and stair climbing (Yi et al., 2020). Mr. Anderson's performance in various ADLs will be assessed, and a score will be assigned. An increased score indicates improved independence in daily activities. It will be administered at the beginning, middle, and end of the 12-week intervention period.
Physical therapy, encompassing the improvement of muscle strength, enhancement of joint flexibility, and restoration of overall mobility, plays a pivotal role in post-stroke rehabilitation in patients such as Mr.Anderson. Research consistently demonstrates the significance of muscle strength improvement in stroke rehabilitation. Strengthening exercises are essential for Mr. Anderson to overcome left-sided weakness, a common post-stroke impairment. Increased muscle strength will facilitate independent mobility and contribute to a reduced risk of falls and improved overall function. Daumas et al. (2023) found that targeted strength training significantly enhanced lower limb muscle strength in stroke survivors, leading to improved walking ability and overall mobility. Similarly, Fragala et al. (2019) highlighted the positive impact of resistance training on upper limb strength, ultimately translating to increased independence in activities of daily living. Studies also emphasise the crucial role of joint flexibility in post-stroke recovery (Fang et al., 2022). Addressing joint flexibility is vital in Mr. Anderson's rehabilitation journey as improved range of motion in his shoulders, hips, and ankles will directly contribute to enhanced mobility, reduced stiffness, and increased comfort in daily activities. A study by Alamer et al. (2021) demonstrated that regular flexibility exercises improved the joint range of motion in stroke survivors, enhancing their ability to perform various tasks. Furthermore, Feng et al. (2020) emphasised the beneficial effects of stretching exercises on balance and gait patterns. One of the main goals of stroke rehabilitation is mobility restoration. It is critical to concentrate on total mobility because Mr. Anderson wants to be able to resume his independence and participate in leisure activities. Stair climbing and gait training are designed to meet his needs and have measurable advantages for his functional independence. A study by Cirstea (2020) highlighted how gait training can help stroke survivors walk farther and faster. It also emphasised the benefits of stair-climbing exercises for improving balance and strength in the lower limbs.
Enhancing Mr. Anderson's range of motion via physical therapy presents numerous advantages. Firstly, it promises to regain his functional independence in daily activities, allowing him to move freely and confidently around his surroundings. With this newfound independence, he will feel more empowered and confident, improving his quality of life overall (Yu et al., 2023). Furthermore, by providing a vital barrier against falls and associated injuries, the intervention gives Mr. Anderson a greater sense of security and stability. The most important benefit of improved mobility is that it can lead to a more active and satisfying lifestyle. Physical therapy will improve Mr. Anderson's social interactions and foster a deep sense of fulfilment and contentment in his everyday experiences by allowing him to actively participate in leisure activities like park walks and time spent with his grandchildren.
In Mr. Anderson's case, there are specific obstacles to physical therapy. Exercises may initially be difficult for Mr. Anderson due to his physical limitations, which include left-sided weakness and coordination problems. Mr. Anderson is getting older, so sticking to the recommended exercise schedule might be difficult for him. It might be difficult for Mr. Anderson to get to the hospital for his physical therapy appointments. This could be the result of a number of things, such as potential transportation issues, travel-related discomfort, or mobility restrictions (de Rooij et al., 2019). These difficulties might have an effect on how frequently and regularly he attends therapy sessions.
Several tactical solutions can be developed to overcome the potential roadblocks that Mr. Anderson might experience while undergoing rehabilitation. First off, his original limitations can be carefully taken into account when designing a customised programme. Owing to this individualised approach, the exercises' intensity and complexity increase gradually to suit Mr. Anderson's particular needs and abilities. Additionally, the involvement of family members and caregivers in the rehabilitation process serves as a crucial source of motivational support (de Rooij et al., 2019). Their encouragement and reinforcement play an integral role in sustaining Mr. Anderson's commitment to the program. Furthermore, to address potential resource constraints, a set of home-based exercises can be provided by a visiting physiotherapist. These exercises will come complete with clear instructions and minimal equipment requirements, offering Mr. Anderson a convenient means to continue his rehabilitation efforts within the comfort of his own living space.
The comprehensive rehabilitation intervention plan for Mr. John Anderson, the focussed on restoring his independence and improving his quality of life following a recent stroke. The physical therapy approach, combining targeted exercises and techniques under the guidance of a registered nurse, aims to address specific challenges including left-sided weakness, coordination difficulties, and balance issues. The 12-week timeline, meticulously structured for progressive improvement, reflects a thoughtful strategy to optimise Mr. Anderson's mobility over time. The chosen evaluation criteria, including the Timed Up and Go Test, Berg Balance Scale, and Barthel Index, offer a well-rounded assessment of his progress. Moreover, the literature review underscores the evidence-based rationale behind each facet of the intervention. While potential barriers such as physical limitations and resource availability have been acknowledged, tailored strategies have been proposed to mitigate these challenges. This comprehensive plan is poised to facilitate Mr. Anderson's journey towards regaining his independence and reengaging in the activities he cherishes, ultimately enhancing his overall well-being and quality of life.
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Daumas, L., Zory, R., Garcia, A., Jaafar, A., Ientile, L., Michel, E., Sacco, G., & Chorin, F. (2023). Effects of individualized lower limb isokinetic strengthening in clinical rehabilitation of older post-stroke patients: A retrospective study. Journal of Rehabilitation Medicine , 55 , 7803. https://doi.org/10.2340/jrm.v55.7803
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McCreath Frangakis, A. L., Lemaire, E. D., & Baddour, N. (2023). Subtask segmentation methods of the timed up and Go test and L test using inertial measurement units—A scoping review. Information , 14 (2), 127. https://doi.org/10.3390/info14020127
Miyata, K., Tamura, S., Kobayashi, S., Takeda, R., & Iwamoto, H. (2022). Berg Balance Scale is a valid measure for plan interventions and for assessing changes in postural balance in patients with stroke. Journal of Rehabilitation Medicine , 54 , jrm00359. https://doi.org/10.2340/jrm.v54.4443
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