Due to carotid artery blockage my wife had problem of left leg movement. She could not stand. After treatment for stroke she now stands on the leg.She is 70 years old. She had left carotid artery completely blocked for long time. This was never noticed. Now in additio we observed that her short term memory is getting deterioted.In the past twenty years slowly it is observed that her blood supply to brain was getting reduced. This process was stabilised .But now we find that memory loss is occuring.At present she is practically all the time in the bed lying. She does not have stamina. Gets exhausted early.Doesnot like to exercise.Willthis deterioration continue or it can be stopped at this age and at this health condition.
Risk factors for falling among stroke patients
Avoiding falls and keeping records of falls is most important task for care giver.
0 Diagnosis – Acute infraction in right frontal sub cortical location. No evidence of hemorrhage. Occulision of left ICA along its entire extent beyond origine.
2 old age-69 year-Geriatric- osteoporosis
3 weight-67 kg: over weight-to reduce weight
4 BMI- patient is eating less, weight is gradually reducing is good sign.
5 other problems- vertigo, no teeth, angina, knee joint ,
6 stroke- Left leg, shaking hand –right, upper limb stiffness and shaking create balance problem
7 stiffness of body, ankle joint muscle and hip joint muscle problem more on left side, weakness, reduced lower limb strength.
8 Fear of falling, balance problem, complex tasks can not be performed. Fears more while passing through narrow space, After initial first fall lost confidence severely. Second fall on bottom caused some pain in thigh bone due to which exercises were suspended. Three fall on the bed . Possibility of hip fracture. Sixth fall created problem of spine-pain and stiffness increased. Seventh fall-noproblem(on 12th June).
9 Gait- left hand up through elbow while walking, feels left leg heavy and can not lift, left foot pulled along the floor sweeping. Due to left leg problem straight gait is disturbed.
10 Eyes- looking down semi-closed eyes
11 urination- frequent every hour, burning sensation, incontinence.
12 fecal incontinence, constipation, stooling not smooth, excretion in a day three four times.
13 itching around boobs, stomach,on the back, frequent and on legs from near knee down.
14 Lost the taste of mouth, feeling too hot chillies
15 some cognitive functions impaired,Immediate memory impaired.
16 seeing and hearing very good
17 at a time one thing, can not manage more.
18 All the time enjoyes lying down in the bed, does not like even to sit, dizziness
19 stamina very poor, gets exhausted early
20 psychologically disturbed, lost confidance
21 Activities of daily living can not be carried out, like dressing, eating,
22 In- activity creates further problems. No self will to be active.
23 exposure to Sun light is required for bones vitamin D, But she does not like sun-light.
24 effect of sedative ,hypnotic medicines-such medicines are not there.
25 Status on various domains-
a-basic self-care (bathing or showering, dressing, eating, or toileting),
b-upper extremity domain (raising arm above the head, using fingers to grasp or handle objects, or lifting and carrying 10 lb or 4.54 kg),
c-mobility domain (walking one fourth of a mile, climbing 10 steps without resting, getting in and out of a bed or chair, or doing heavy housework),
d-and higher functioning domain (telephoning, doing light housework, preparing meals, and shopping for personal items such as medicines).
26 Actual status as on 7th May 2010
a-Patient walks with wheel chair, or with hands supported by care giver, patient washes after toileting but pouring of water is done by care giver. Even can walk some distance without support very slowly. Since 1st of June some immediate or recent memory loss is noticed even by patient.
Main task is to remove the fear of falling from patient’s mind. Patient should be made to walk himself without presence of care giver. Patient should pour water during toileting.Immediate task is to stop memory loss if possible.
Attention— 1 Stop itching 2 Stop memory loss
Left leg is affected due to stroke. during walking support is needed. After 6 months nonsense speaking started. During rehabiliation there were two falls but no severe injuries. Most of the time patient is normal.How long will it take to rehabiliate.