St Mary's Hospital Stroke Rehabilitation Unit
Phoenix Park, Dublin, Ireland
Rita's Story
Rita is a 54 years old lady who lives alone. She smokes 20 cigarettes per day and drinks alcohol regularly with an intake of 20 units per week.
Rita was an independent lady prior to the stroke. She has three daughters. Rita lives in a ground floor accommodation with steps for access.
Pre Stroke Introduction
Rita was admitted to Hospital in December 2016 with severe communication impairment, Right sided weakness and neglect. A CT brain scan revealed a Left Middle Cerebral Artery Infarct with haemorrhagic transformation. Her rehabilitation journey commenced in the acute hospital with recovery of some functional communication, single words with short sentences and power in the upper limb and lower limb. She spent 14 days in Acute Hospital.
Stroke Acute Care
While in Acute Hospital Rita was assessed as a candidate for rehabilitation in Isolda stroke rehabilitation unit. The assessment identified the following:-
• Rita required assistance of one person for personal activities of daily living
• She had good sitting and standing balance
• Rita was unsafe on transfers (Ross Return hoist for transfers)
• She had mild-moderate dysphagia (difficulty in swallowing),
• Moderate receptive and expressive aphasia (inability to formulate and comprehend language).
• Rita had some difficulties with continence due to her communication difficulties - she was aware when she needs to use toile but unable to communicate it.
Rita was identified as having good potential for stroke rehabilitation and arrangements were made for transfer to Isolda stroke rehabilitation unit.
Assessment for Stroke Rehabilitation
Rita was transferred to Isolda stroke rehabilitation unit in January 2017. An initial assessment on admission identified the following deficits as a result of his stroke: -
• Rita presented moderate communication disorder; she can comprehend but issues noted to responding. She was following commands using visual ques.
• Required standard wheelchair and Ross Return hoist for transfers.
• Required assistance of one person for washing and dressing with verbal prompting
Rita was also provided support in quitting smoking and reducing her alcohol intake as these would be seen as high risk of secondary stroke if not addressed.
Arrival on Isolda Stroke Rehabilitation Unit
After 4 weeks Rita made good progress.
• She was able to transfer by step with assistance of one person
• She required assistance of one person with washing and dressing technique using her Right upper limb
• She was able to mobilise with the handheld assistance of two people to the toilet and dining room
• Improvements in communication
Rita was happy with her improvement. She was trying to verbalise that she could walk and was using her affected hand much better. Rita’s daughters visited each day and they were delighted with how well their mother was walking again.
Rita made great improvement with stroke rehabilitation at the end of eight weeks and felt well prepared to go home. A home visit was scheduled with members of the stroke rehabilitation team. It was established that Rita was not quite ready for moving back to her own home as she required some supervision.
4 Week Progress Update
Rose continued to improve and agreed to go to her daughter‘s house as she required supervision on some tasks. At the time of discharge:-
• Rita required set up and distant supervision in the morning for washing and dressing
• Is independent using the toilet day and night
• Is independent walking with the walking stick
• Rita’s communication skills and language improved
• She successfully completed the self-administration of medication programme
• Rita has quit smoking
Rita was happy and excited to go home. Additional supports at home included a home care package - 2 calls per day, Community Rehabilitation Team for her Speech and Public Health Nurse. Rita also was linked into the Volunteer Stroke Scheme.
12 Week Progress Update
Rita attended the Stroke follow up clinic - Outpatients Department four weeks post discharge with her daughter.
She was in good mood, her mobilisation was much improved and she was able to reply in short sentences to all the questions.
She reported good appetite and she is eating regularly healthy meals and her weight was stable.
She engaged in daily exercises and liked walking with her daughters.
She is no longer smoking or drinking alcohol and continues to receive support on this from her family.
Rita manages her medication and she is attending her GP regularly.
She also receives support from the Public health Nurse.
Rita is looking forward to moving back to her own home in the near future.
4 Weeks Follow Up in Stroke Follow Up Clinic
Volunteer Stroke Scheme (VSS)
Tel 01 6346925
National Heart & Stroke Helpline
Freephone 1800 252550