ASSESSMENT OF THE NEUROLOGICAL PATIENT Case Study

Presenting complaint: - 55 yo male admitted via A&E following collapse - CT scan showed sub-arachnoid haemorrhage (SAH) of the (L) anterior cerebral artery (ACA) - Current problems relate to standing balance, unable to stand unaided. - Mobilising few steps in therapy sessions only - Keen to return home, but unable to do so while balance remains problematic as wife works away from home Events: Complained of sudden intense headache while doing DIY at home Collapsed and ambulance called, transferred to A&E On arrival, CT scan conducted which showed extensive SAH Angiogram completed which showed ruptured berry aneurysm on ACA Transferred to regional neurosurgical unit, where urgent coiling procedure was completed Following surgery, transferred to ICU (3 days), followed by Neurosurgical HDU (6 days) Transferred to neurological rehabilitation unit 3/52 post surgery Continues to be closely monitored due to high risk of re-bleed in subacute phase

Objective Ax: Sitting - Kyphotic posture in sitting with decreased Lx lordosis - With verbal prompting, able to anteriorly tilt pelvis and increased Lx lordosis - Static sitting balance good, able to withstand challenges to balance and effectively recruit equilibrium reactions - Dynamic sitting balance, has difficulty in recruiting activity at right hip when reaching outside BOS on the right. Able to correct with verbal prompting, though fatigues quickly. - No evidence of increased tone in sitting Sit-to-Stand - Independent - weight-bearing left > right with overuse of left UL evident - Retraction of right hip and hyperextension of right knee during extension into full stand minimal weight-bearing through right lower limb - Decreased activity tibialis anterior with ankle remaining in PF throughout transfer Standing - Weight-bearing left > right with retraction at right hip, hyperextension of right knee and right ankle in PF - With facilitation to extend right hip, able to transfer weight to the right, though complains of FOF Questions:

PMH:

Chronic low back pain (attributed to driving as part of job) s/p medication (Ibuprofen)

Social Hx: - Lives with wife in a terraced house with bedroom and bathroom upstairs - Alcohol consumption 40+ units per week - Sales representative for engineering company - 2 children (live away from home)

1) What symptoms could be associated with damage to the ACA? 2) What is a sub-arachnoid haemorrhage? 3) This patient had a surgical intervention to treat the underlying cause of his condition, what factors indicate that surgical intervention is appropriate? 4) List out some of the treatment intervention to improve patient's gait performance. 5) Is orthosis like AFO appropriate for this patient? 6) This patient presents with some weakness of the right UL, can exercise be used to increase muscle strength in this patient?