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72 yo with significant CVA

72 yo with significant CVA. Cathy Ciolek, PT, DPT, GCS. Initial Evaluation. Subjective information 72 yo female Cva July 09 with probable 2 nd cva in same time frame family brought her to PT via paratransit in wheelchair What else do you want to know?. Question #1.

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72 yo with significant CVA

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  1. 72 yo with significant CVA Cathy Ciolek, PT, DPT, GCS

  2. Initial Evaluation • Subjective information • 72 yo female • Cva July 09 with probable 2nd cva in same time frame • family brought her to PT via paratransit in wheelchair • What else do you want to know?

  3. Question #1 • Based on her past medical history and medications- her stroke(s) was most likely a result of: • Brain bleed/ hemorrhage • Blood clot • Brain bleed and clot • None of the above

  4. Initial Examination • Where do you start your examination?

  5. Question # 2 • Pusher syndrome is characterized by the patient • Actively pushing towards the contralateral side from the brain lesion • Actively pushing towards the ipsalateral side of the brain lesion • Believing their body is “upright” when tilted to the side • A and C • B and C

  6. Question # 3 • Neglect of one side after stroke is often associated with all of the following except: • Visual field cut • Decreased sensory feedback • Pain in impaired arm/leg • Decreased motor activity and proprioceptive feedback

  7. Assessment/Evaluation • What are her major impairments? • What is her prognosis? • What goals would you set for this patient? • What psychosocial issues would play a factor for this patient?

  8. Plan of Care • What frequency and duration would you choose? • What interventions would you use to accomplish your goals? • What other factors do you need to keep in mind?

  9. Question # 4 Before we started any substantial standing (beyond transfers) we contacted the physician for clearance- what do you think was the key reason for this contact? A. Vital signs aren’t stable enough to stand B. This intervention was not listed on the prescription C. Concern for bone health/osteoporosis D. Concern for cardiac history- stress of standing

  10. Question # 5 • During today’s treatment session therapy included the following interventions: • 10 min transfer to/from mat • 35 min balance activities while sitting on the mat • 10 min facilitating use of right and left UE motor control • The Most appropriate billling if this patient was Medicare (and no other Medicare pts were being treated simultaneously) would be? • 1 unit 97110(Ther Ex), 1 unit 97530 Inc Fnct Perf, 1 Unit 97112 Neuromuscular Re-education • 1 unit 97530 Increase Fnct Perf, 3 units 97112 Neuro musc Re-ed • 4 units 97110 Ther Ex • 3 units 97110 Ther Ex

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