CASE STUDY: STROKE
History of Present Illness
• 63 y/o, male
• (+) HPN
• Weakness of right upper and lower
extremities for 2 days
• Slurred speech
Physical Exam
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Awake and can follow commands
Approximately answers questions
Dysartric
(+) drooling
Shallow right nasolabial fold
Weak gag reflex
Tongue deviated to the right on protrusion
MMT: 3/5 Right upper extremity (proximal and dista)l;
3/5 lower extremity (proximal, 1/5 right distal)
• MSR UE/LE: +++ at right side
On Hospital Admission
• Rehabilitation program started on bedside
• Discharged able to ambulate in between
parallel bars
After Discharge
• Unable to continue outpatient therapy
seession
• After 5 months, (+) right shoulder and right
hand pain, with spastic gait, and dragging of
foot
Working Impression
• Cerebrovascular Accident, Ischemic with
Right-sided hemiparesis and dysarthria
probably due to occlusion of Left Middle
Cerebral Artery or Left Anterior Cerebral
artery
Manual Muscle Testing
Grade 5: Patient can hold the position against maximum
resistance and through complete range of motion.
Grade 4: Patient can hold the position against strong to
moderate resistance, has full range of motion.
Grade 3: Patient can tolerate no resistance but can perform
the movement through the full range of motion.
Grade 2: Patient has all or partial range of motion in the
gravity eliminated position.
Grade 1: The muscle/muscles can be palpated while the
patient is performing the action in the gravity eliminated
position.
Grade 0: No contractile activity can be felt in the gravity
eliminated position