Neurological Case Study

Neurological Case Study
Client Details
The patient under study is Doreen and she had a stroke that impeded on her hand functions. She is around 80 years and plans to be able to do basic household activities of reach, grasp, and release mechanism. She suffered the stroke 11months ago and now requires hand rehabilitation. She has problems moving her right wrist and fingers are non-responsive.
Neurological Event and Frames of Reference
Neurological event in this case was cerebrovascular accident, otherwise known as stroke. The patient suffered from ischemic stroke because of poor flow of blood that culminated into poor functioning of the brain. Since the brain coordinates different parts of the body, some of them may malfunction when it fails. In this case, the right hand of the patient was affected and incapacitated to such an extent that it exhibited the inability to move. Based on the Occupational Therapy Intervention Process Model, it is possible to achieve the desired therapeutic outcomes when applied in each step. The model highlights the need for occupational therapists to focus on rational reasoning to ensure they provide personalized services to the patients. According to the model, occupational therapy must be done in three phases. The first step entails evaluation, which means the therapist must check the patient’s current medical situation and the personal attributes such as age. In this case, Michelle the therapist had to evaluate Doreen and gauge her current medical condition after suffering the stroke. Her age would also determine how aggressive the therapy would be. Doreen is an elderly woman of more than 80 years and her age limits aggression in therapy. The next step entails goal setting, which involves the development of realistic objectives that can be achieved by the end of the therapy sessions. The objective in this case is to ensure that Doreen can have her hand rehabilitated such that she can continue with her domestic chores. The third step comprises on intervention method in which the problem is mitigated in different steps. The measure for intervention is the functional electrical stimulation, which is often effective for stroke treatments. In this case, Michelle has introduced the use of Bioness H200 and Dual Channel Hand Rehabilitation System. The last phase is the reevaluation stage that shows the milestones achieved since the therapy was initiated.
Brain Systems, Structures & Areas Affected
The brain constitutes of three components known as the cerebrum, cerebellum, and the brain stem. Once a stroke occurs, these components form a major focus area for doctors while seeking to minimize or eliminate effects paralysis on the body. Important regions in the brain include the Wernicke’s area, the Broca’s area, Parietal lobe, facial and motor areas, facial and arm areas. The effect on the Wernicke’s area leads to disruption on language characterized by poor speech and inability to comprehend speech. Other problems include difficulties differentiating between left and right, difficulties when reading, calculating, naming objects, and when writing. The Broca’s area helps with articulation of speech and becomes impaired when people experience a stroke leading to difficulties when speaking and writing. The brain system is responsible for controlling the neural structures that propel different courses of action. The neural prosthetics can only function well when the entire system is flawless. In this case, the motor system of the brain has been affected because action in the right hand has been impeded. The motor system is essential because it helps to coordinate any goal oriented movement that must follow a certain sequence. When targeting something or trying to follow a given path, the motor system facilitates this kind of achievement. Such goals include locomotion have been curtailed in this patient because the hand is not responsive.
On the other hand, the cerebellum has been affected as part of the entire brain structure. The cerebellum is essential because it helps in motor control. It is located in the back part of the cranial fossa while the medulla, pons, and forth ventricle are anterior. In this case, it has been affected because the timing and precision of the patient’s hand are not coordinated. The cerebellar damage exhibited in this context has impeded fine movement such as grasping items such as seen when the patient is trying to hold fruits on the table.
In this case, the frontal and parietal lobes have been affected because they are responsible for movement, which has been affected because the hand is non-responsive. These two lobes are part of the cerebral cortex, which coordinated through the precentral gyrus that possesses the primary motor cortex that allows the voluntary motions to be done. The Parietal lobe affected focuses on the brain’s left side that controls the right leg and arm which when impaired results in poor coordination. Impairment to the facial and limb areas in the left part of the brain especially the motor cortex occasion paralysis of the right leg, arm, and face. Sensory cortex areas are also affected focusing on the face and arms. Impairment to this area results in poor sensation in the right side of the face and arm while eyes lose their ability to detect optic radiation.
Treatment
Treatment of strokes depends on whether an individual is experiencing an ischemic or hemorrhagic stroke. When dealing with an ischemic stroke, physicians focus on restoring the flow of blood to the brain. For emergence treatments, doctors focus on using clot-busting drugs where medications should start at least within three. Common drugs include aspirin and TPA (tissue plasminogen activator). Aspirin works by diffusing blood clots, which limits chances of suffering further strokes upon admission to a healthcare institution. Use of TPA works quickly based on its application as an intravenous recombinant injection. As a clot-busting agent, TPA should be administered within four hours by injection into a vein in the arm. The possibility that the brain could be experiencing a clot requires use of other emergency procedures such as a catheter inserted into the brain for direct delivery of the drug. Mechanical removal of the clot is also considered especially where doctors can surgically break the brain clot. Treatment of a hemorrhagic stroke requires using warfarin and clopidogrel that prevent bleeding and clotting while blood pressure drugs are administered to reduce severity of the hemorrhage. In addition, surgery is necessary when dealing with large areas of the brain to help ease the pressure.