Our Past Clinical Cases
Mild Impairment After Stroke
(Post Stroke Mild Level Disability)
Patient initially needs assistance from one person and walks with a walking frame
Patient can walk briskly at will after one month of treatment
01
Post Stroke Lower Limb Paresis, Mild
Background:
Age: Male, almost 70 y.o
Symptom: Cardio-embolic MCA infarct, with subsequent hemorrhagic transformation. Medical management (NOAC) for said condition.
Arrival Time: He was admitted to our center in the subacute phase (within six months post stroke).
Clinical Presentations:
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Mild impairment of control and sensation over the left lower limb
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MRC: Gr.3+
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As shown in video 1, with one assistance he can complete the walk along the corridor with his frame. Sway and incoordination of the legs were noted.
Treatments:
One month of intensive rehabilitation comprised of
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TMS
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Gait training
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stability training and plyometrics.
Results:
By the first month, he can walk unaided on his own both in and outdoor (as shown in video 2).
After discharge back home, he returned to his light-intensity farming work. (as shown in video 3).
Patient resumes light pastoral work after treatment and discharge
Moderate Impairment After Stroke
(Post Stroke Moderate Level Disability)
02
Post Stroke Lower Limb Paresis, Moderate
Patient can walk slowly by himself with the help of the handrail
In the second week, under the gentle support,patient can walk slowly indoors with most of his body
At the third month, the patient is able to walk indoors at a normal pace without any walking aids. Stick is used for walking outdoors
Background:
Age: Male, 50 y.o.+
Symptoms: Left temporo-parietal ICH. Emergency neuro-surgery required (craniotomy with clot evacuation, and insertion of EVD).
Arrival Time: He was admitted to our center in the subacute phase (within six months post stroke).
Clinical Presentations:
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MRC: Right Lower Limb Gr 2 (minor control preserved, unable to smoothly work against gravity).
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As shown in video 1, he was able to walk for few steps with one assistance along the rail.
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Obvious imprecise control of right lower limb noted, requiring correction of his right foot placement.
Treatments:
Three months of intensive rehabilitation comprised of:
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TMS
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electro-needling
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gait training and balance training
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Ankle splint has also been prescribed
Results:
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By the second week, he can walk indoor slowly with a hemi-frame and one light assistance (as shown in video 2).
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He has regained better control of his right lower limb, with more precise forward placement. Foot drag was still evident.
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By the third month, he can walk unaided indoor at a near-normal speed. He can walk with a stick outdoor for safety (as shown in video 3).
03
Post Stroke Bilateral Upper Limb Paresis, Moderate
Background:
Age: Male, 70 y.o.
Symptoms: Type A Aortic Dissection. Post surgical (hemi aortic arch replacement, endovascular stenting of aortic dissection, endovascular stenting of abdominal artery, open heart valvuloplasty) bilateral hemispheric embolic infarct.
Arrival Time: He was admitted to our center in the chronic phase (over six months post stroke).
Clinical Presentations:
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Bilateral upper limb paresis with right side worse than the left side.
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Presentations included lack of control, muscle power and the emergence of hypertonicity (as shown in video 1).
Treatments:
Two months of intensive rehabilitation comprised of
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tDCS
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upper limb motor training and weight bearing
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A personalized hand splint has also been prescribed
Results:
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By the second month, he can smoothly raise his arms with minimal restriction in the range and minimal presence of tremor (as shown in video 2).
Symptoms of moderate hemiplegia in both upper limbs
In the second month, the shoulder control has been greatly improved. In addition to the range of motion being close to normal, the constant tremor has also been reduced
Severe Impairment After Stroke
(Post Stroke Severe Level Disability)
Patient can standing with the help of one person, but the right leg can't support the body
In the first week, the patient was able to walk a few steps with the assistance of one person and the movement of the right foot.
Two months later, with the assistance of one person, the patient was able to hold on to the railing and walk slowly through the entire corridor while controlling his right foot
04
Post Stroke Lower Limb Paresis, Severe, Mild Cognitive Impairment
Background:
Age: Male, 70 y.o.+
Symptoms: Left MCA infarct, with bilateral frontal subdural effusion as a result of fall and head injury. Medical management (Duo Antiplatelets, DAPT) for the said condition.
Arrival Time: He was transferred to our center in the subacute phase (within six months post stroke).
Clinical Presentations:
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Complete flaccidity of the right lower limb
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MRC: Gr.0
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As shown in video 1, with one assistance he can stand with rail support.
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His right knee would give way and buckle constantly.
Treatments:
Four and a half months of intensive rehabilitation comprised of:
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TMS
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electro-needling
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gait training, balance training
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Ankle splint has also been prescribed
Results:
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By the first week, he can walk for few steps with rail support, an assistance passively raising his right lower limb forward and a gaitor supporting his knee from buckling (as shown in video 2).
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After two months, he can walk with self-raising his paretic leg slowly along the rail and with a single assistance (as shown in video 3).
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After four months, he can walk under the supervision of the physiotherapist along the rail indoor with increased speed and stability (as shown in video 3).
05
Post Stroke Hemispatial Neglect and Torticollis
90’ rotational torticollis during sitting and supine
The patient is able to keep the neck and eyes at midline level during daily activities, such as getting a normal haircut after undergoing treatment
Background:
Age: Male, 60 y.o.+
Symptoms: Cortical and subcortical ICH and received open skull surgery (removal of blood clot and lowering of intracranial pressure) in mainland China.
Arrival Time: He was admitted to our center in the chronic phase (over six months post stroke).
Clinical Presentations:
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90’ rotational torticollis during sitting and supine(as shown in image 1).
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An increased cervical muscle tone was noted.
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Near complete of absence of attention to the left sided hemi-space, including response to sound and visual stimulus.
Treatments:
Two months of intensive rehabilitation comprised of:
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TMS frequent exposure to left sided stimulus
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Neck collar has also been prescribed
Results:
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During daily activities, he can maintain his head in a neutral position and is responsive to left sided speeches and visual objects.
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This can be seen from image 2 of him having haircut in an upright position at our inhouse salon.
Other Special Obstacles
(Other Special Disability)
06
Gait Impairment Due to Atypical Parkinsonism
Background:
Age: Female, 70 y.o.+.
Symptoms: Admitted to public hospital following a dysphagia-led pneumonia.
Arrival Time:She had mobility issues and delirium and was admitted to our center.
Clinical Presentations:
Parkinsonism including:
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rigidity
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bradykinesia
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dyskinesia
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resting tremor
As shown in video 1, when she attempted to walk for few steps with one assistance, she demonstrated initiation and midway freezing of gait (FOG).
Treatments:
Two weeks of intensive rehabilitation comprised of:
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TMS
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Gait re-education
Results:
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By the second week, she can walk with her frame indoor with supervision only.
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FOGs have subsided mostly (as shown in video 2).
Parkinsonian gait, including initial and mid-frozen gait, when the patient attempted to walk with one person's support
Two weeks later, the patient was able to walk indoors with a walking frame alone under supervision, and the freezing gait was greatly reduced, and the gait and endurance also improved.A substantial increase
MRC Muscle Strength Grading
Evaluation Standards:
Grading/
Grade
5
5-
4+
4
4-
3+
3
3-
2+2
2-
1
0
Description
Can resist the same resistance as normal corresponding muscles and can perform a full range of motion (N)
Can resist the same resistance as level 5, but the range of motion is between 50%-100% (N-)
At the beginning and middle of the event, the resistance that can be resisted is the same as that of level 4, but at the end of the event, it can resist resistance of level 5 (G+)
Able to resist resistance and complete a full range of activities, but the resistance does not reach level 5 (G)
The resistance against is the same as level 4, but the range of motion is between 50% and 100% (G- )
The situation is similar to grade 3, but it can resist a certain resistance at the end of the exercise (F+)
Can defy gravity and can complete a full range of motion, but cannot resist any resistance (F)
Can resist gravity, but the range of motion is between 50%-100% (F-)
Against gravity, but range of motion is less than 50% (P+)
Unable to resist gravity, but capable of full range of motion after eliminating the effects of gravity (P)
Eliminate the influence of gravity to be able to move, but the range of movement is between 50%-100% (P-)
Palpation can detect muscle contraction, but does not cause any joint movement (T)
No muscle contraction (Z)