HEMORRHAGIC

CEREBROVASCULAR
ACCIDENT
BY:

REX GABRIEL CARADO

DOMINGO SUYO JR.

• Mr. Ponciano Rabe was born January 18, 1962, 57 years old,
married, a High school graduate, roman catholic and living in
Baranggay Katilingban Molo Iloilo City. Diagnosed with
Hemorrhagic Cerebrovascular Disease
• Patient complains of localized deep-nagging pain on left shoulder
with a scale of 8/10 and difficulty of reaching over head due to
pain.
• Patient started manifest symptoms of cerebrovascular accident
last November 17, 2017 during at work with a hot weather
condition and was rushed to the hospital and admitted for 15
days under the care of Dr. Licup. Once admitted again last May 26,
2018 for 4 days due to seizure.
FAMILY HISTORY AND FDA

• Patient have history of Hypertension and his father has a history

of cardiac disease.
• There is no known allergy as to food and drugs.
PATIENT LIFESTYLE

• Patient was a maintenance in engine and a driver at Camilleon

Association Inc. Patient has a history of smoking (2 packs/day),
drinking alcoholic beverages (3 bottles/day), coffee (2 cups/day)
and soda (Occasional drinker).
HOME SITUATION

• Patient is currently living in a 2-storey house with his family at

Barangay Katingban Molo, Iloilo City
• Patient’s goal: He stated that he wants to move well again his left
shoulder and arm
• Patient is conscious, cooperative, oriented x3 as to TPP.
• Patient is hyporeflexia of left side of the body and right lower
extremity
• Patient has difficulty in ambulation. Patient ambulates using a
assistive device, right cane. Patient uses circumduction gait to
ambulate with external rotation of the left hip. Independent as to
ADEPT except dressing and personal hygiene associated with
Hemorrhagic Cerebrovascular Disease
LONG TERM GOAL

• Patient will be able to experience relief of pain on left shoulder

• Achieve near normal to normal ROM on left UE joint
• Patient achieve normal muscle strength on left UE/LE muscles
• Eliminate tenderness on left arm
• Independence in all aspect of ADL’s as to dressing and personal hygiene
• Experience normal gait after 5 months of PTR
SHORT TERM GOAL

• Patient will experience decrease pain from 8/10 to 6/10 on left shoulder after 5 PT
sessions
• Patient will exhibit increase ROM on left UE/LE
• Patient will demonstrate increase in muscle strength in left shoulder
• Independence in ADL’s
• Patient will work towards LTG
PT MANAGEMENT

• HMP on left shoulder x 15 minutes

• ES on left UE flexor x 15 minutes
• PNF left LE with 10x reps
• PRE’s on right UE/LE/left LE with x 10 reps
• GPS on left UE x 10 reps with 7 SH
• HEP
• DBE
• BP precautions
RELATED JOURNAL TO HEMORRHAGIC
CEREBVASCULAR DISEASE
• Intracerebral hemorrhage (ICH) is the second most common
subtype of stroke and a critical disease usually leading to severe
disability or death. ICH is more common in Asians, advanced age,
male sex, and low- and middle-income countries.
• Intracerebral hemorrhage (ICH) is usually caused by rupture of small
penetrating arteries secondary to hypertensive changes or other vascular
abnormalities (Sang Joon An et al. January 19, 2017)
• Elevated blood pressure (BP) is common in the acute setting after an ICH,
and higher BP levels are associated with hematoma expansion and poor
prognosis. However, it is not clear that reducing blood pressure improves
outcomes. While lowering BP may reduce the risk of expansion, it may
theoretically also reduce cerebral perfusion. (J. Alfredo Caceres, MD and Joshua N.
Goldstein, MD, PhD, 2012)
• Contrary to common belief of clinicians that hemorrhagic stroke
survivors have better functional prognoses than ischemic, recent
studies show that ischemic survivors could experience similar or
even better functional improvements. However, the influence of
stroke subtype on gait and posture outcomes following an
intervention blending conventional physiotherapy with robotic-
assisted gait therapy is missing. (Frederic Dierick, 2017)
THANK YOU !!!