In October 2013, Emily had a right sided stroke which led to a hemi craniotomy (removal of part of skull to relieve pressure from the injured brain). It was later found to be caused by a PFO (Patent Foramen Ovate) heart abnormality.
The stroke led Emily to have severe left sided weakness with no activity in the arm, absent sensation and proprioception (awareness of her body position in space) throughout the left side and weakness in the left leg.
Emily was discharged home with the community stroke team on 9/11/13 using a rotastand for transfers and sleeping downstairs. She had intensive rehabilitation for a period of 6 months with the NHS team. At this point, she was able to walk 500 yards with a stick and manage the stairs reciprocally . She wore a foot up splint and sensory dynamic orthosis (SDO) support for her trunk and shoulders. She had the bone flap replaced in November but unfortunately it got infected and was removed in April 2014 and during this period she had two falls. She then had a fall in August 2014 which led to a fracture of her left hip and hemiarthroplasty and a severe loss of confidence and fear of falling as a result of this.
Emily first came to PhysioFunction, Bedford in October 2014 and has been seeing Wendy on a weekly basis ever since.
When Wendy first assessed Emily, she presented with a global left sided weakness, foot drop, absent sensation through the left side, no activity in the left arm with a subluxation. She was able to walk up to 25 metres very slowly using a tripod stick. She was able to manage the stairs, 1 at a time and very slowly. Emily really struggled with turning and had dizziness and vestibular symptoms. Emily had severe loss of confidence due to fear of falling. Emily’s short term goals were to improve her confidence, balance and return to her baseline mobility of walking 500 yards with a stick, managing reciprocal stairs and to go to the local gym.
Her long term goals were to dance with her husband again, walk without an aid, drive, return to work and climb the mountain Pen-y-gent.
Emily was provided with an FES unit in early 2015, which Wendy worked closely with the team in Birmingham to ensure that it was used effectively.
Over the past 2 and a half years, Emily’s progress has been fantastic and her positivity and continued improvements have made Wendy’s job hugely satisfying. Wendy reported the immense job satisfaction in still seeing improvements four years after a stroke.
Emily reported that one of the most satisfying part of coming to see Wendy is the variation in treatment and encouragement to always improve and ‘taking me out of my comfort zone’. Treatment has consisted of use of the intelli stim, Saeboflex and saebo stretch and bilateral arm exercises for the upper limb , sensory re -education, use of the gym equipment (bike, cross trainer and treadmill, weights, theraband), balance and falls prevention and re- education: gym ball, practicing getting on and off the floor, darts, use of the Wii , vestibular exercises, Floor and mat work in high kneeling and kneeling and many more exercises. The most fun- filled but frightening physio sessions were practicing ballroom dancing with her husband again!
She has been able to participate in a varied gym programme and now attends her local gym 1-3 times a week.
Emily has also worked intensively on gait re- education, increasing weight bearing on her left side and building her stamina. She now walks with a stick and in recent weeks for the first time, she has managed to walk short distances around the house and in therapy without any walking aid. This is a giant leap in progress as it’s something we were unsure that she’d ever manage but with grit and determination she has done it. Her ‘fear factor’ has gone from 9/10 to 3/10 when walking without an aid. She started driving for the first time on her own to therapy in April last year.
Emily’s progress has been mapped from 2014 - 2017 and we found that:-
In a 10 minute timed walk in 2014 - Emily took 33 steps in 57 seconds
In a 10 minute timed walk in 2017 - Emily took 27 steps in 32 seconds ( 6 steps and 25 seconds quicker over 10 metres!)
Sit to Stand in 1 Minute in 2014 - Emily completed 3
Sit to Stand in 1 Minute in 2016 - Emily completed 11
Sit to Stand in 1 Minute in 2017 - Emily completed 16
Emily now is keen to return to work and her long term goal is still to climb that mountain so the next stage of therapy is to practice climbing the small hill outside of headway and from there we are sure she will go onwards and upwards!
