Case Study Report
Population: Adult
Valerie Ann Carter, PT, DPT, NCS, Associate clinical professor of physical therapy, Northern Arizona University valerie.carter@nau.edu
Kay Wing, PT, DPT, NCS, GCS, Owner, SWAN Rehab, Phoenix, Arizona birdwing1@aol.com
Keywords: Participation, Stroke, Intensity, Periodic
Background and purpose: Stroke is the fifth leading cause of death, is a major cause of adult disability and costs the healthcare system billions annually. Individuals with stroke report a greater disability burden than other chronic illnesses with compromised mobility, dependence in activities of daily living, and diminished quality of life. After gains are made from traditional therapeutic interventions patients do not normally receive periodic therapy to prevent a decline in function. Our healthcare system will continue to bear the burden of care for chronic stroke survivors that have functional decline. The purpose of this case study is twofold: to demonstrate that ongoing intensive therapy can maintain and/or assist patients to regain function; and to introduce the concept that annual intensive therapy has the potential to reduce health care costs, burden of care, and overall quality of life for stroke survivors.
Case description: GM is a 63 year old male who was presented as a case study at III Step when he was 10 years post stroke. He had started intensive therapy 5 years prior. During the intervening years since his initial intensive therapy he has attended eight of thirteen annual 30-hour week-long intensive whole body therapy clinics at Northern Arizona University (NAU). This case study will include data gathered over 15 years on walking speed, upper extremity motor function, and balance. It will also include information regarding GMs loss and regaining of function during years missed as well as his abilities to gain or maintain his function during the ongoing years he received annual whole body intensive therapy.
Outcomes: GM was able to maintain his functional abilities with 30 hours of intensive whole body therapy per year. His gait speed and gait distance measured with the 10 meter and 6 minute walk tests approached age matched norms during years he attended the clinic. His upper extremity motor function measured with the Fugle Myer (FM) and Wolf Motor Function tests (WMFT) were maintained. His balance measured by the Berg Balance Test and Functional Gait Assessment was also maintained. GM was not able to maintain his outcome scores when he missed the clinic for one or more years. During this gap his gait speed and distance, FM, WMFT, and balance scores would drop as much as 50%. Upon his return GM was able to improve his test scores by 30-40%.
Discussion: GM maintained or improved most test scores during the years that he received annual intensive whole body therapy. He also had minimal medical interventions and costs (one total knee replacement and no injurious falls). The statics for persons post stroke on average have one injurious fall per year, have decreased quality of life and cost the health care system 2-3 times more than the average healthy individual. Annual intensive whole body therapy has value for our health care system.
Citation:
Carter, Valerie Ann, PT, DPT, NCS; Wing, Kay , PT, DPT, NCS, GCS. The effect of periodic intensive therapy for a stroke survivor: A Fifteen Year Case Study demonstrating the value of annual intensive therapy.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/002-carter-et-al/