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A 69-year-old male presented to the emergency department (ED) after awakening this morning with aphasia and right hemiparesis. His wife phoned emergency medical services immediately and the patient arrived at the ED with the acute stroke team in attendance 30 minutes after the patient awoke with these signs. The patient's wife stated that the patient went to bed at approximately 10:30 p.m. the evening before without these complaints. The patient's prior medical history includes type 2 diabetes managed with metformin (Glucophage XR0) and hypertension controlled with atenolol (Tenormin). A computed tomography (CT) scan upon arrival to the ED showed evidence of a left middle cerebral artery (MCA) ischemic stroke with no evidence of hemorrhage. The acute stroke team determined that the patient was not a candidate for thrombolytic therapy, and they subsequently admitted him to the hospital. Physician admission referrals include “evaluate and treat by physical and occupational therapy” and “speech therapy for videofluoroscopy and aphasia treatment.” It is currently 1:30 p.m. on the day of admission and the patient has just arrived on the Neurosciences floor of the hospital. The unit's case manager has approached the physical therapist to ask when the evaluation will be performed so she can begin working on his discharge to an acute rehabilitation unit, if indicated.

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Based on his health condition, what do you anticipate will be the contributors to activity limitations and impairments?

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What are the examination priorities?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy interventions?

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What are possible complications interfering with physical therapy?

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  • APHASIA: Inability to read, write, and/or speak due to damage to language centers of the brain
  • COMPUTED TOMOGRAPHY (CT): Diagnostic imaging procedure that uses radiography and computers to produce cross-sectional images of the body
  • DYSPHAGIA: Difficulty swallowing
  • HEMIPARESIS: Inability to move one side of the body
  • HYPERTENSION: Increased blood pressure, defined as ≥ 140/90 mm Hg most of the time1
  • ISCHEMIC STROKE: Disruption of cerebral circulation caused by a blocked artery due to either an embolus or thrombus
  • SUBLUXED SHOULDER: Glenohumeral joint instability often seen after stroke due to muscle imbalances caused by hemiplegia and/or abnormal muscle tone
  • TISSUE PLASMINOGEN ACTIVATOR (tPA): Thrombolytic drug used to break up and dissolve clots that cause heart attacks or strokes
  • TYPE 2 DIABETES: Disease in which blood glucose levels are persistently elevated due to the body's inability to make or use insulin appropriately
  • VIDEOFLUOROSCOPY: Examination of swallowing using a series of radiographs of patient swallowing radiopaque dye in various food consistencies (thin liquid, thick liquid, solid, etc.)

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  1. Describe indications for use of tPA.

  2. Identify the medical purpose for maintaining hypertension post-stroke.

  3. Describe signs and symptoms consistent with hemorrhagic conversion and increased intracranial pressure.

  4. Prescribe appropriate early mobility in an ...

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