A CASE REPORT BY: MAUREEN SABRI, SPT Does CNS-depressive medication impact the physical therapy prognosis of a 65 year-old patient with chronic stroke receiving intensive, repetitive-task training intervention?

Background Info 65 yo male retired vetran s/p seizure lasting >45 min due to discontinuation of clonazepam. Referred to inpatient rehab with a diagnosis of “generalized weakness” 9 days after admission to ICU. Hospital course included heavy sedation with Ativan (lorazepam) due to continuing seizures and agitation.  I also saw pt during his acute stay and he was frequently too sedated to follow commands

Past Medical History L parietal lobe and basal ganglia stroke (STN)  R UE and LE hemiparesis  R UE spasticity, increased RLE tone  R hemiballismus  Seizure disorder  Aphasia  Cognitive deficits HTN DMII Carotid artery stenosis Afib Smoker: 1 pack/day x 30 years +

Prior Level of Function Gleaned from family due to sedation, aphasia, and decreased cognition Mod I with hemi WC for household distances Mod I with WC<>bed/toilet transfers Mod I with basic ADLs  Spaghettios, upper body dressing Walked short distances with HHA of daughter Could asc/desc 6 STE with uni hand rail & HHA Daughter assisted with complex ADLs (shopping/laundry)

Areas of Concern Lacking social support:  Family visited once during month-long hospital course  Daughter worked as a tow truck driver and was not home during the day  Continued smoking…family had to be buying cigarettes  Pt stated that he did not wear pants at home due to difficulty with lower body dressing Fall Risk: When asked about previous falls at home, family stated that the patient would fall out of his WC occasionally, but could scoot to the phone to tell his daughter, who would come home to help him up

Examination PROM: B knee flexion contractures, R elbow, shoulder, and ankle contractures.  R shoulder flexion & abd: ~90◦  R knee ext: -19, L knee ext: -15  R elbow ext: -75  R ankle dorsiflexion: -5 Similar AROM Strength: 2/5 for most RUE and LE testing Sensation: Allodynia to light touch C6-8, L2-S2 * Coordination: RUE impaired Proprioception: n/t due to aphasia DTR: slightly increased on R (2+ vs 1+ on L)

Outcome Measures Primary OM: FIM Modified Ashworth:  3/4 for R bicep and R hamstring Mini Mental State Exam  14/30* indicating “severe” cognitive impairment

Goals