Permission for Use

Post-stroke Rehabilitation of an African Woman

Assessment

Objective Assessment

Sylvia's ADLs were assessed in her bedroom. Sylvia washes and dresses herself in the bedroom. Her grandmother fetches water from the tap outside the house, which she warms in the kitchen and brings to Sylvia in a basin. Sylvia cannot reach some body parts with her unaffected arm. When dressing, she has difficulty with garments that require putting one arm into a sleeve such as shirts and jackets and needs the assistance of one of her family members. In terms of her functional written communication, she cannot write fast or effectively with her right non-dominant hand. She is reluctant to use the outside toilet at night.

Her home management tasks such as clothing care and simple meal preparation are done for her by her family. She has not resumed any of her educational activities. She was left-hand dominant but since the stroke her left arm is non-functional. She is motivated to relearn to write with her right hand. Her assets are that she is motivated to be more active in home management tasks, she can read and study, and she is eager to resume her role as student.

Her leisure pursuits are limited. She is very passive and watches television all day. Thus far, she has not considered outings or socialization outside the house as she is reluctant to leave the house. Her assets are that she is keen to pursue more active leisure time activities, she is interested in singing and expresses the desire to attend a church service.

Physical Assessment

Her left upper limb had increased flexor tone, no active selective movement, and her shoulder elevation was limited at 120°. She had shortening of the long finger flexors and the biceps muscle. The above resulted in her left upper limb being non-functional.

She had some proximal movement of her left lower limb, and had selective knee flexion. However, ankle dorsiflexion was lacking. She had increased extensor tone in her left leg.

Analysis of her gait revealed that she had no active dorsiflexion on initial contact, with hyperextension of the knee and protraction of the pelvis during weight bearing. During a swing phase, circumduction of the leg occurred. She was able to walk independently inside the house but used an elbow crutch when walking outside.

It was evident that her two most serious functional problems were her reluctance to walk outside her house and her wish to be able to write again so that she could go back to school.

The occupational therapist felt that her current activities and occupations did not allow for the expression of her values and interests. She has not had the opportunity to work through the psycho-social aspects of the disability experience. She lacked self-confidence which affected her motivation to resume her previous life roles.

Analyze the patient's problems in terms of impairment, activity limitation, and participation restrictions, as described by the WHO ICF classifications.