T6- The Impact of stroke: Disorders in motor control, perception, cognition, communication, emotion and motivation A Short Case Study. E Exercise & Fitness After Stroke: Specialist Instructor Training Course

E is a 44 year old lady, Stroke 1991 resulting in a Right Sided Hemiplegia. Referred to the Community Stroke team urgently for psychological intervention. Initial assessment revealed by the patient; Left Handed, worked as a barmaid, has 14 year old daughter. History leading to CVA (self-blamed), belief that it was self administered, increasing risk factors of: Contraceptive pill, Heavy Smoking (She did not count Passive smoking due to occupation), Not recognising signs of TIA from previous collapse resulting in 4 hour disability.

Current social history is Lives with daughter/ground floor flat,5 steps Not going out unless for essentials Uses buses/taxis for distances greater than 200 yds No social links except 1-2 friends that have stayed and visit. Poor psychological state – feeling suicidal with plans for suicidal outcome. Previous therapy was inpatient PT for approx. 2 months, and 2 years ago by PT at Community Out-patients.

Present levels of function: Walking limited by pain in R>L legs which fatigue quickly then lose control. AFO worn from 6/12 post CVA, reviewed yearly Falls each month – mainly outside Never had appropriate rehab for upper limb, don’t really use it other than to hold bag or use a steadier for other hand. Don’t see point in rehab now for it. Dressing, grooming, toileting, showering, shopping, cooking, cleaning etc done by self but very slow due to fatigue and low mood. E was accepted for input by the team for urgent Psychological Ax and imminent PT. (as it was strongly suggestive was that mood was directly related to feelings of poor functional ability and altered self-image)

Q. What would you see as most impactful issues?

Q. If this lady presented for exercise how would you assess her and tailor your approach with relation to full inclusion in your class? (non-physical)

Goal setting 1 Initial goals were easily achievable in order to reinforce success of input and to allow her sense of achievement to tackle her mood levels. Start and maintain a regular exercise programme in house Start walking to shops Reports back on use of right hand during ADL’s and attempts to type

Goal setting 2 Later goals were about bigger issues e.g. Improve self-belief/ self – worth Seek future employment / improve health Go swimming regularly (enjoyed prior to CVA) Improve walking style > reduce worry / anxiety levels of feelings towards how others might see her. Look at possibilities of training towards some form of employment (voluntary to start with)

Where did M get to? Completed computer course – uses both hands for some tasks Looking at possibilities of 9 hours voluntary work Gait: much smoother / more efficient Psychological state: stable Weekly swimming Linked up with 2 regular friends for weekly trips out.