Effectiveness of physical therapy of a person with a hemorrhagic stroke during the recovery period: a clinical case

Abstract

Purpose: to scientifically substantiate and develop a program of physical therapy for a patient after a hemorrhagic stroke (during the recovery period) and check its effectiveness. Material & Methods: the study was conducted on the basis of the "Skalyansky Clinic" Medical Center. The organization of the study involved conducting a comparative analysis of the dynamics of indicators obtained with the help of clinical tools for assessing the patient’s functional state in the process of applying the author’s physical therapy program. A 71-year-old patient with a diagnosis of "Acute cerebrovascular hemorrhagic disorder: subarachnoid-parenchymal hemorrhage with the formation of a stroke-hematoma of the left temporal-subcortical area of the brain with breakthrough into the ventricular system with right-sided hemiplegia, sensorimotor aphasia" by a multidisciplinary team (doctor, physical therapist, speech therapist and psychologist) an individual program of physical therapy was developed. In order to evaluate the effectiveness of the experimental methodology, a formative experiment was conducted. Clinical tools for assessing the functional state of the patient during the research were domains in the form of the ICF-core-set tool (a set of ICF basic categories) (ICF Research Branch, 2022) for complex stroke: Lovett’s test, Barthel scale, Gait Velocity (GV) tests and Berg Balance scale (BBS), Montreal Scale of Cognitive Assessment (MoCA), Get Up and Go Tests, Trunk Control Test, Functional Independence Measure (FIM). The developed individual program of physical therapy for hemorrhagic stroke in the recovery period is a comprehensive course of physical therapy, occupational therapy, which is carried out in stages and includes the following components: therapeutic gymnastics classes; electrical stimulation of the shoulder, psychological (psychological counseling, psychological support, developmental classes for the recovery of cognitive impairments) and speech therapy (speech therapy gymnastics, articulation exercises, Su-Jok (massage ball and ring) component. After applying the specified author’s individual physical therapy program, qualitatively positive changes in the functional and psychophysical state of the patient, in particular: b7301.4 to b7301.2; d550.2 to d550.1; d510.3 to d510.2; d520.3 to d520.2; d540.3 to d540. 2; d598.3 to d598.2; d4100.3 to d4100.2; d450.3 to d450.2; d469.4 to d469.3; d330.3 to d330.1; d355.3 to d355.3; d998.3 to d998.2. Results: after applying the author’s program of physical therapy, we found qualitatively positive changes in the functional and psychophysical state of the patient, as evidenced by the positive dynamics of the studied indicators. The psychological and speech therapy work carried out contributed to the improvement in the process of restoring the patient’s cognitive functions (from moderate to mild impairment), stabilization of his emotional state, acquisition of stress resistance skills, harmonization of the patient’s system of relationships with himself, Conclusions: the effectiveness of using the author’s individual program of physical therapy is confirmed by the dynamics of qualitatively positive changes in the functional and psychophysical state of the patient.