Rehabilitation plan

Summary statement

L.C.Q.is a 45 year old teacher.He is very well,however,when he is teaching on 26^th January this year he suddenly fell on the ground due to right flaccid paralysis .Through the medical treatment ,the sydrone is released and he fell well.He is presenting for rehabilitation for the flaccid paralysis of upper and lower limb due to Vertebral artery obstruction through image analysis.Now the patient ‘s activities of the upper limb makes progress but limitation of activity of wrist extension and wrist radial and ulnar deviation is still exits ,while as well as spasmodism of finger’s flexor.The patient’s walking ability is limited due to poor control of the knee and plantar and inversion of the ankle.

Rehabilitation Problems

1. Function deficits:Inability to perfom some mobility activity ,some activities of daily living and to walk without 1000 meters.

2. Plantar and inversion of ankle :poor lower limb management skills.

3. Spasmodism of finger’s flexor: limitation of activity opper limb such as feeding,dressing,grooming,bathing,and toileting.

4. Balance disturbance

5. Patient and family adjustment to disability

6. Sexuality concerns

7. Discharge planning\living situation

Medical problems

1. Plantar and inversion of ankle and poor control of the kneerthosis

2. Control the progress of the disability and relieve the Spasmodism

Management Plan

1. Physical theraphy (pt) to address mobility deficits concentrating on walking activities,transfer skills,upper and lower extremity endurance for these activities,standing balance,and tolerance.The physical therapist will instruct patient on lower range of montion and management concentrating on management of the knee and relieve the spasmodism of finger’s flexor.All the team members will reinforce the skills once patient has receicesd basic instructions from the PT.

2. Occupational theraphy (OT) will concentrate on upper limb strengthing and endurance,activities of dailly living ,and ,when it is appropriate,have the patient begin easy housework. All the team members will reinforce the skills once patient has receicesd basic instructions from the OT.

3. Nursing to moniter and help the patient in the right way of ADL

4. The management team presents the patient specific ,rehabilition education program concentrating on preventing of future problems related to accessibility,mobility ,skin ,sexuality and psychosocial and medical problems

5. Community issue s such as accessibility ,driving ,social activities ,and difficult psychosocial situation are addressed by the team

6. Management team emphasis is placed on helpling the patient identify appropriate discharge placement,including accessible living arrangement,home modifications if needed,special equipment needs ,and support ststems for financial and psychosocial issues

7. Management team continues to monitor for lower limb strength and sensory improvements.

8. Relieving of ankle plantar and inversion is maintained by patient’s wearing of the ankle orthosis rightly and regularly as the therapist instructed

Therapeutic precautions:patient to wear ankle orthosis when out of bed

Therapeutic setting:patient rehabilitation setting necessary because patient is not safe or able to return to his previous living arrangement

Goals:

1. Independence with mobility skills

2. Independence with activities of daily living

3. Independence with household tasks

4. Independence with walking

5. Independence in knowledge about future medical problems related to paralysis

6. Supelrvison or independence for community reentry activities

7. Management of plantar and inversion of ankle

8. Identify a safe and accessible living situation

9. Obtain necessary equipment

10. Relieve the spasmodism of finger’s flexor

Estimated time of goal attainment:3~4 weeks

Obstacles to goal attainment

1. Decreased ankle range of montion due to ankle orhosis,which might prevent independence in some activities

2. Spasmodism of finger’s flexor might prevent good progress in the activities of daily living

Time of reaccessment of patient’s status:1 week

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