Darin Trees, PT, DPT, CWS

Moveo™ XP Beta Test Series

Case Study – Stroke Rehabilitation

History
52 year-old male admitted to the ICU with right-sided weakness and diagnosed with a left hemorrhagic stroke. Patient was extubated and
deemed medically stable on day two. Physical and Occupational Therapy were consulted on day three. Patient was independent with all
ADLs prior to admission, working as a truck driver.

PT Evaluation
General: Patient was mentally alert and could follow simple commands, but presented with expressive aphasia.
Strength: Left UE and LE: 4/5. Right UE 0/5 (flaccid). Right LE: 2/5 knee flexors and extensors; 0/5 ankle musculature. Patient was
unable to isolate joint movements but able to flex and extend the right lower extremity in a synergistic pattern.
Bed Mobility, transfers: Moderate assistance to roll. Maximal assistance for supine-to-sit and sit-to-stand. When standing, patient
displayed a flexed right lower extremity (LE) and did not weight-bear through the right LE.
Gait: Unable to stand without maximal assistance.
Sitting balance: Able to sit on edge of bed unsupported in midline for 10 seconds, then required moderate assistance due to leaning to
the right. Patient required maximal assistance for dynamic sitting activities.
Standing balance: Maximal assistance required to stand upright.

Treatment
Patient education and exercise therapy included an in-bed exercise program, sitting balance activities, and functional mobility training
(transfers and standing activities) performed every morning. In addition, the patient participated in a partial weight-bearing exercise
program using a dynamic tilt exercise platform for weight-bearing strengthening, and LE forced-use every afternoon for 20-30 minutes.
The left unaffected LE was positioned on a support pad which allowed exclusive weight-bearing on the right LE.

The first treatment on the exercise platform was three sets of eight mini-squats on the right leg at 10% body weight. The pattern of the
unilateral squat was non-fluent. The patient displayed difficulty with initial movement and required assistance to initiate right knee flexion
and complete terminal extension. The patient needed verbal and tactile cues to keep the right knee in proper alignment. Without cueing,
the right knee tended to abduct and externally rotate during eccentric flexion.

The exercise platform was used for five consecutive days in conjunction with functional mobility training. At each session, the patient
performed three sets of 15 mini-squats at progressively increasing inclines or body weight. Functional mobility training consisted of bed
mobility, transfers, sitting balance, standing, and gait in the parallel bars.

On the sixth day after initial evaluation, three sets of 10 mini-squats on the exercise platform were performed at 40% body weight with
improved eccentric control, proper knee alignment, and independent knee extension. No tactile cues were required during the sessions.
Upon reassessment of mobility, the patient could transition from supine to sit and transfer from bed to wheelchair with minimal assistance.
He was able to ambulate 40 feet with a hemi-walker with standby assistance for safety. The patient transferred to the inpatient
rehabilitation facility on day seven where he daily continued with the LE forced-use program at progressive inclines on the exercise platform.

Discharge
The patient was discharged to home four weeks after admission to ICU. The patient was independent with bed mobility and transfers, and
could ambulate 350 feet using a hemi-walker at modified independence.

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