Does the Presence of Ideomotor Apraxia Affect the Prognosis of Functional Recovery in a Women Who has a Stroke?

Abstract

A 74-year-old woman was transferred from a local acute care hospital to the stroke rehabilitation unit in my rehabilitation center. She had been admitted to the hospital 9 days earlier after experiencing unsteady gait and left hemiparesis for 24 hours. A computed tomography (CT) scan of the head in the acute care facility indicated that the patient had a right-sided parietal infarct and that she had a pre-existing left frontal infarct that had gone undetected until the current episode. She had a history of non–insulin-dependent diabetes mellitus, emphysema and recurring bronchitis, hyperlipidemia, and hypertension. The patient was treated with aspirin and 2 liters of oxygen per minute delivered through a nasal cannula. Medications prescribed during hospitalization and continued during rehabilitation included Lasix* (furosemide, a diuretic) and Sectral† (acebutolol hydrochloride, a beta blocker) to treat hypertension, Zocor‡ (simvastatin) to treat hyperlipidemia, and Aerolate§ (theophylline, a bronchodilator) to treat emphysema. The patient lived alone in a single-level, 6-room house that required climbing 5 steps to enter. Two years earlier, she had retired from her job as a factory worker on disability compensation because of pulmonary disease. She was independent in all mobility and self-care activities prior to admission; however, she had stopped driving years earlier after an accident. Her sister regularly drove her to the grocery store. Her diet largely consisted of prepared, processed food that was reheated in a microwave. She spent most of her time crocheting and watching television. She continued to smoke 1.5 packs of cigarettes a day. Her goal was to return home independently. Because she did not have insurance, the social worker on the stroke rehabilitation unit began the paperwork for Medicaid coverage. My examination of the patient revealed several perceptual deficits. She was unable to discriminate left from right during mobility tasks …