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Post-stroke Rehabilitation of an African Woman

History

Medical History

Sylvia had no serious previous illnesses and no risk factors for stroke were evident.

The incident had occurred eighteen months previously. At the time of the incident, she was not fully conscious, felt dizzy and experienced weakness on her left side. Her family took her to the local GP who referred her to a secondary hospital where she was admitted and stabilized before being referred to a tertiary hospital for further investigation and admission to a stroke unit.

Medical investigations included the following special tests:
a full blood count, echocardiogram, carotid doppler and a CT scan.

All the tests were normal except the scan which revealed a small infarct in the right basal ganglia. There was compression of the body of the right lateral ventricle. No midline shift or hydrocephalus was recorded.

Results of a neurological examination revealed that her left pupil was not responding. She had decreased reflexes, sensation and motor function in her left limbs; decreased muscle tone of her left limbs and Babinski responses of left plantar extension and right plantar flexion. After three weeks of acute medical care, she was referred back to a rehabilitation unit at the secondary hospital as an in-patient for three more weeks where she received physical and occupational therapy.

Assessment at this period revealed that she needed assistance with the functional activities of sitting to standing and walking, and the following activities of daily living: toileting, personal hygiene and dressing. On discharge she could perform these activities independently.

A year later, she was referred to the community physical and occupational therapist by a community nursing sister.

Personal History

The physical and occupational therapists conducted a combined subjective interview and an objective evaluation. Sylvia reported that she had graduated from high school at the age of 19 years. She was enrolled in a Travel and Tourism course at a Cape Town college when she had the CVA. She wishes to continue her studies but she cannot write after the stroke.

Environmental Factors

Sylvia lives in a two bedroom house with a lounge containing a small kitchen area. Although small, it is comfortably furnished and contains a television set. In the kitchen area, there is limited cupboard space below the work surfaces and a small table in the middle of the kitchen. Sylvia shares a double bed with her grandmother and cousin. She keeps her clothes in an overfull wardrobe which she shares. Her own clothes are mixed with other people's possessions.

Community resources in the immediate vicinity are a taxi rank, a church, a library and a small grocery shop within 15 minutes walking distance from her home. The sidewalk is unpaved and sandy. Despite being functionally mobile, she has not tried to use public transport on her own as she does not want to walk outside the house for fear of ridicule.