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A 41-year-old right-handed male with a history of left basal ganglia ischemic cerebrovascular accident (CVA) 12 weeks ago presented to an outpatient physical therapy clinic. Initially after his stroke, he was hospitalized for 1 week and discharged to his home. He received home health physical therapy for 12 visits and then went to an outpatient physical therapy clinic for 12 more visits. The patient has been improving since his stroke, stating that he feels stronger every week. However, he continues to fatigue easily, suffers from decreased balance, and right-sided upper extremity (UE) and lower extremity (LE) weakness. The proposed mechanism of his stroke was related to his use of warfarin (Coumadin) to treat atrial fibrillation and initiation of a diet high in vitamin K. He was unaware that a diet rich in vitamin K would decrease the effectiveness of warfarin, thus increasing his risk for an ischemic stroke. His health history also indicated he had high cholesterol and sleep apnea. It has been 3 weeks since his last outpatient physical therapy visit. He is returning to outpatient physical therapy because he is unable to walk long distances without fatigue, has difficulty with running or shuffling to play softball, and is unable to throw or hit a softball accurately and consistently. His stated participation restrictions include an inability to walk his dog, coach his daughter's softball team (including demonstrating how to slide into and steal bases), or play sports with his two children.

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What outcome measures are best suited to this patient and his presentation?

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What are the most appropriate physical therapy interventions?

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What are the examination priorities?

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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 risk factors contributed to this patient's health condition?

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  • BASAL GANGLIA: A group of interconnected deep subcortical nuclei comprised of two principal input nuclei (striatum and subthalamic nucleus) and two principal output nuclei (substantia nigra pars reticulata and internal globus pallidus) that help start and control movement
  • ISCHEMIC STROKE: Disruption of cerebral circulation caused by a blocked artery due to either an embolus or thrombus
  • VITAMIN K: A fat-soluble vitamin required for blood coagulation

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  1. Describe how a drug–food interaction such as warfarin and a diet rich in vitamin K increases the risk for a cerebrovascular accident.

  2. Design a physical examination schema for a higher functioning person poststroke.

  3. Compare and contrast selected outcome measures for use with high-functioning individuals poststroke.

  4. Incorporate principles of sports rehabilitation into the care of a person poststroke.

  5. Describe neuroplasticity principles that should be considered when designing a plan of care for a person poststroke.

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PT considerations during management of the high-functioning individual with a stroke in the basal ganglia:

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  • General physical therapy plan ...

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