The patient is a 63-year-old African American man wgho sustained an ischemic cerebrovascular accident (CVA) 6 months previously, resulting in right-side hemiparesis.
The patient is married and lives in a single-level home with his wife and daughter. He reports a history of smoking (quit more than 40 years ago) and drinks alcohol socially on occasion. He enjoyed carpentry, fishing, and hunting prior to his stroke.
Patient is a retired steel mill worker.
The patient reports no previous surgeries or significant medical problems except for hypertension and type II diabetes; both are currently under control with lifestyle changes and medications.
History of Present Illness:
Patient sustained an ischemic CVA, resulting in right-side hemiparesis. Magnetic resonance imaging revealed a left pontine infarction. Cerebral angiography revealed severe stenosis of the right vertebral artery and proximal basilar artery. Prior to the stroke, the patient was right-handed.
Patient complains he is unable to use his right arm and hand effectively. His goals are to use his right arm and hand well enough to perform household chores and return to his hobbies.
Current medications include aspirin, Glucotrol, glucophage, Coumadin, and warfarin.
The examination results of tone in elbow flexors, forearm pronators, and wrist flexors from the Modified Ashworth Scale2 for grading spasticity are presented in Table CS5.1.
Range of Motion:
UE range of motion (ROM) results are presented in Tables CS5.2 (passive ROM) and CS5.3 (active ROM).
Balance was examined using the following:
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