Physiotherapy Case Study: Left sided Hemiplegia Treatment with Online Physiotherapy
by Physiotherapist Dr. Gaurika Kapote (PT)
Tele physiotherapy treatment for Hemiplegia: ABSTRACT
Stroke (MCA – Middle Cerebral Artery infarct) resulted into left sided Hemiplegia or simply understood as left sided paralysis for Mr Siddique. After hospital discharge, he was advised home physiotherapy management of hemiplegia. Owing to prevailing lockdown for Covid-19 situation, he could not get a physiotherapist near by. He opted for Online physiotherapy with ReLiva’s tele physiotherapy service and soon made good progress in all his hemiplegia symptoms. Tele physiotherapy (also known as Online Physiotherapy and Virtual physiotherapy) appears to be a great way to continue treatment of Hemiplegia when in-person physiotherapy treatment may not be possible.
Tele physiotherapy treatment for Hemiplegia: PREFACE
Hemiplegia (Partial paralysis) may be manifested as left sided paralysis or right sided paralysis. Whichever type of Hemiplegia it may be, it needs timely treatment and sustained physiotherapy. For a complete recovery, physiotherapy based hemiplegia rehabilitation exercises play a crucial role and need to be started as soon as advised by the doctor.
A 42 years old male residing in Pune, Mr Siddique (name changed) was looking for physiotherapy treatment for weakness in face and left side of his body, diagnosed as stroke resulting in left sided Hemiplegia. Local physiotherapists could not manage to see him due to the lockdown. Meanwhile, the patient came to know about ReLiva offering tele rehabilitation to the patients who are stuck at home and need physiotherapy interventions.
Online Physiotherapy Appointment & Scheduling:
The patient’s wife immediately connected on the Helpline number and took the earliest appointment possible.
In this time of crisis, we advised Mr Siddique to be safe at home and undergo Physiotherapy sessions online. The patient was explained in detail, how tele physiotherapy would help him. The consultation was done for around 30 to 45 minutes. Mode of ephysio was the whatsapp video calling feature through smartphone. Here are the details of how online physiotherapy progressed, session by session for this patient.
Online Physiotherapy Consultation:
Patient History:
First consultation was taken by Reliva physiotherapist, Dr Gaurika Kapote (PT) on 9th of April.
A general history was taken and we found out that Mr Siddique suddenly felt numbness in his left arm while coming back home from his workplace (16th March). His mouth too deviated to right side of the face. After reaching home he called up his sister who is a doctor by profession and narrated the whole episode. She advised him to immediately get admitted in a nearby hospital and get an MRI done. Patient followed her advice and was admitted to a local hospital in Pune. It was identified that the cause of numbness and facial droop was spike in his Blood Pressure, which had shot up to 220/ 120 mmhg. During assessment, we came to know that the patient had co-morbidity of Hypertension for last 2 years and that he had skipped his anti-hypertensive medicines for about 10 days resulting in such high blood pressure.
His MRI reports revealed that he had Right side MCA (Middle Cerebral Artery) infarct.
[Read it as Stroke on the right side of the brain. After a stroke in the right hemisphere, the patient is paralyzed on the left side of the body and vice versa.]
Patient was discharged after 10 days and was advised Home Physiotherapy. By then, the country was in a lockdown and he was unable to take physiotherapy at home.\
Online Physiotherapy Assessment: Session 1 (Day 1)
At the time of assessment, it was found that the patient didn’t have any abnormal sensation such as tingling/ numbness/ pain. He had been on medication including Anti Co-agulant, Anti Hypertensive and antacids.
His major complaints were noted down and assessed in detail to understand the extent of trouble.
- Weakness in left side of the face. On observation, we could note there was deviation of the mouth (facial droop) and the rest of the facial muscles were weak as well.
- Difficulty in moving left arm and left leg. Movement analysis was done. Movements on the Left side were slightly jerky and few movements were completely absent.
- Tightness in muscles (which could be a sign of spasticity). Patient’s wife assisted us, in passively exercising the limbs of the patient throughout the session.
- Further assessment was done to examine power wherein, left side was found weaker in comparison to the right side (Left side scored as 2/5 and right side as 5/5).
- We noted the functional difficulties currently faced by the patient. He was able to manage static sitting. But he was unable to hold any object from left side and was unable to bend his knee.
By this time, the treating physiotherapist had outlined three important goals for the treatment:
- To increase the strength of muscles of face, left arm and leg.
- To make him stand.
- To make him independent in his day to day activities.
Given the medical history and assessment, the patient was diagnosed as Right side MCA (middle cerebral artery) infarct, also named as Stroke resulting in left sided Hemiplegia. (Hemi- half, plegia- paralysis).
Tele physiotherapy treatment for hemiplegia
The treatment started with gentle breathing exercise (to be done as per prescribed dosage) every 3-4 hours. Upright sitting on the bed to be performed every 4 hours.
As in any case of a stroke paralysis rehabilitation, the patient’s attendant (his wife, in this case) was actively involved in his physiotherapy treatment. Passive range of motion exercises were given by his wife for left upper and lower body. The active range of motion exercises were explained to the patient, so he could continue those by himself on the non-affected side. The exercises included a variety of movements for his left side:
- Arm movements using smiley ball
- Overhead shoulder exercise assisted by non-affected side
This session also included counselling, care to be taken and general do’s and don’ts for the patient. All their doubts and questions were answered as well. Extra effort was made to communicate that ‘exercise is medicine’ and that it should be taken in the prescribed dosage and frequency religiously. Next appointment was scheduled for a day later at a mutually convenient time.
Online Physiotherapy Treatment: Session 2 (Day 3)
In the next video session, we could observe that patient was able to move his left arm better than in the previous session. However, he was still not able to grip any object with his hand. Over all patient’s mobility had improved. It is worth noting that the patient had been doing all the exercises religiously as advised by us.
The exercises taught in the previous session were reviewed and corrected wherever required. The exercise prescription was accordingly progressed and additional exercises were explained (including facial exercises, body stability practices, followed by breathing exercises.) The patient’s next session was scheduled after a day at similar time.
Online Physiotherapy Treatment: Session 2 (Day 4)
In the next session his progress was reviewed. Thereafter the following objective baseline measurements were established:
- Range of motion
- Swelling (girth of finger)
The patient was initiated into exercises for strengthening of proximal joints. We took extra efforts to communicate that “Exercise is Medicine” and that it should be taken in the prescribed dosage and frequency religiously.
Online Physiotherapy Treatment: Session 3 (Day 5)
Session 3 was also done using Whatsapp video call. We could note significant changes in the overall mobility and health of the patient. He was able to move his toes now, though not ankle.
Despite communication gap due to language barrier, visual interaction greatly helped and the patient has been highly compliant. Hence, we managed to complete the sessions smoothly.
All the previous exercises were reviewed. Mr Siddique said he could feel some pain in his left shoulder due to the exercises for which he was advised hot fomentation followed by appropriate exercise.
It is worthwhile to note that the patient’s wife had managed to arrange a walker and had made him stand by the bedside for 10 seconds, twice.
The exercise prescription was accordingly progressed and patient was advised to continue the ‘exercise medicine’ at home.
Online Physiotherapy Treatment: Session 4 (Day 9)
As per the usual protocol, the patient’s recovery and exercises were reviewed. Patient was able to do his activities of daily living on his own. His speech was also quite clear. Additional exercises were explained to progress him further. These included weight-bearing in sitting, leg and arm movements in appropriate dosage. The patient would continue doing these at home until the next appointment.
Online Physiotherapy Treatment: Session 5 (Day 12)
Upon review it was noted that the patient’s facial movements were back in place except for the minute deviation at his mouth. We prescribed appropriate exercises for these, using what was available at home (straw and balloon, paper sheets etc) along with speaking practices and other body movements to be done at a prescribed dosage for every waking hour.
When body movements were further reviewed, the patient complained of tightness in the forearm. He was able to bend his fingers slightly (read flexion) but unable to open his fist (read extension of fingers). Appropriate stretching exercises were added for the flexor and extensor compartment of forearm of the affected hand.
By the end of this session, the patient was able to move independently in his bed. He could turn on his side, he could sit upright, he was able to stand and he could even walk few steps, with support.
Online Physiotherapy Treatment: CONTINUANCE
Now, the tele physio sessions are scheduled on a weekly basis for further follow ups.
Tele physiotherapy treatment for hemiplegia: CONCLUSION
Treating physiotherapist Dr Gaurika Kapote (PT) remarks, “All in all, tele rehabilitation is amazing. It is the safest method of delivering Physiotherapy treatment when the patient is unable to meet the Physiotherapist in-person due to various reasons such as Covid-19.”
Patient Review about Tele physiotherapy Treatment
The patient has been very co-operative and compliant in following the prescribed hemiplegia rehabilitation exercises and seen visible benefits from online physiotherapy treatment. The caregiver (patient’s wife), expressed that they will continue with the sessions and are also looking forward to continue home physiotherapy from Reliva physiotherapist once the Covid-19 lockdown ends, which in itself has been a positive feedback from the patient.
If you, or someone you know would benefit from physiotherapy treatment and you do not have access to it right now, please register for an online physiotherapy session here or simply call us at +91 99209 91584 and we will connect you with a physiotherapist best suited for your requirement.
Related Case Studies for Online Physiotherapy:
Shoulder Pain Treatment: Online Physiotherapy
Online Physiotherapy for Fracture Treatment: A Case Study
Day by Day account of Lower back Treatment with Online physiotherapy
Other Reading:
Paralysis Treatment after Stroke
Stroke Treatment and Life after Rehabilitation
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