Julio is a 40 years old, plumber, English man, who lives with his wife and 2 kids in a 4th floor 3-bedroom flat. Julio has been prescribed anti-hypertensive drugs however, he didn’t control his habit of smoking, drinking alcohol and the love of eating fatty foods. As a result, Julio developed R(MCA) stroke which prompted him to refer for rehabilitation. Initial evaluation conducted and shows all normal on the right side of the body except on the left side of his body which revealed: MMT is grossly graded 2/5 on UE and 4/5 on LE, moderate spasticity on UE, LOM on the UE both actively and passively, and hyperreflexia. Julio is able to sit unsupported, and able to stand and walk with close supervision. The patient has muscle weakness on the left side of the body and wishes to return to his work and live normally. Intervention were given which involves: strengthening exercises, ROM exercises on L(UE) and gait retraining using a cane.
2) Julio has found to have a thrombus formation on the right middle cerebral artery resulting to hypoxia on the right side of the brain. As a result of that, he had impairment with his body function which includes the following:
- has a moderate increase of muscle tone at the left upper extremity leading him to contracture around the joint. Because of this, he has LOM both actively and passively.
- has minimal weakness on the left lower extremity
- reduce endurance during long distance walking
- develop a mild impairment on his bladder functions leading him to be occasionally incontinent.
- develop homonymous hemianopsia (((((((state which side))))
3) Capacity:
Julio used to be very independent in all activities of daily living. After the stroke, Julio can only be independent in terms of the following:
- able to do personal care except having a bath,
- able to change his upper half if he wears loose shirt,
- able to change his lower half if he sits on a correct height,
- able to walk independently but with close supervision,
- able to change his incontinent pad, ability to lift light objects
Performance:
He is unable to perform domestic job such preparing foods, lifting heavy objects, doing house-works because of the LOM on the left UE and inability to grasp object by his left hand. Because of Julio’s inability to perform the above tasks, he is starting to lose his self-confidence and getting depressed. As a result, he gets angry easily even without reason at all.
4) Environmental factors
- Julio is living in a 4th floor flat with no lift at all. He has to walk up to fifteen flight of stairs. Although, he is using a quad cane on the right hand but he’s still anxious to use them.
- Julio develops homonymous hemianopsia and moderate contractures on left upper extremity which prevented him to drive. His family was relying with him in terms of transportation as he is the only driver in his family. His so worried on how his family will cope up considering there’s only limited bus service along their community.
- Since he won’t be able to drive, his last option is to use public transportation. In that case, he has to walk back and forth from his house to the bus station. He is concerned on how he will cope up since the landscape of the public road is uneven.
- For the issue of health and safety, Julio’s employer is not happy for him to return to his job as a plumber as they are concerned about his capability to fulfil his job properly.
- He used to be a basketball player. With his condition, his afraid that he won’t be able to play again.
- He’s thinking of the shame he will be facing if his incontinence pads will be soaking wet particularly if his outside the house.
- With the changing behaviour of Julio, he afraid that he will causing distress to his neighbouring flat.
- Before the stroke, he used to attend a vocational schooling for mechanics. He’s afraid he won’t be able to continue it.
Personal factors:
- Because his been unemployed for 2 months, his main problem is financial. His wife is only working part-time in a retail shop. With the wife’s small income, it is not enough to pay for their rent, bills and foods.
- Because the wife is the main earner at the moment, Julio feels that he lost the respect for himself. Similarly, he also feels that his wife is underestimating him because he cannot resume his role at present.
- Julio and his wife has always been having an active sexual relationship. Since after the stroke, they never had one. His wife seems no interest and for that, he feels that he is a lesser man.
- Julio and his wife used to talk to one another to resolve problem. Now, they rarely talk and never disclose discussion about the future waiting ahead for their family.
FKTPE