Transient-Ischemic-A

Case Study Transient Ischemic Attack (TIA)

Karen Shuler, PT, DPT Who: 93-year-old male 2 weeks s/p TIA with moderate balance Lifestyle Physical deficits, difficulty ambulating on even and uneven terrain, gait Therapy, Lake Wylie, SC deviations, difficulty negotiating stairs, and inability to drive.

What: AlterG Walking Program for this patient from Initial Visit in rehab helped improve TUG, Berg Balance Score, and Dynamic Gait index. Pt was Independent with household and community mobility at discharge.

Why: Body weight support allowed patient to train for longer periods without c/o calf pain (patient had h/o vascular claudication). Patient was also able to work on dynamic balance within the AlterG feeling safe and having confidence, with direct carryover to overground walking.

Introduction The patient is a 93 y.o. male who experienced a TIA 2 weeks ago. He presents with moderate balance de cits, dif culty with ambulation on even and uneven terrain, gait deviations, dif culty negotiating stairs, and he is unable to drive. He is an extremely active 93 year old and prior to his TIA he was driving, taking care of his 2 story condo, stretching daily, and walking outside for 30 minutes which included 2 hills. He has a history of claudication which limited his walking to 30 minutes daily. He was independent with walking in the home, the community, negotiating stairs, and he had no balance de cits prior to his TIA.

Goals 4 Weeks • Pt. to increase dynamic gait index to 10/24

8 Weeks • Negotiate over various terrain for 1500 ft. with minimal calf cramping and no LOB in 8 weeks • Negotiate 10 steps with independence without falling in 8 weeks • Report 1/10 pain after 20 minutes in calves and thighs in 8 weeks • Increase BERG balance score to 41/56 in 8 weeks • Reduce his TUG to the left to 13 seconds in 8 weeks • Increase dynamic gait index to 18/24 to reduce risk of falling in the home

History Progression Table Pt. exhibits: • Increased base of support with decreased Initial Incline/ Speed Days Frequency stride length.w WB% Speed (mph) • Dizziness when standing. Week 2 75% 1.1-1.3 10 min 1 x daily • Decreased muscular endurance with walking; Week 3 75% 1.0-1.7/ 11.3/13 2 x daily quick to fatigue. 1.0-1.4 min • Calf cramping with walking throughout the day. Week 4 75% 1.0-1.5/ 14/15 2 x daily 1.0-1.5 min Objective Data At Initial Evaluation Week 5 75% 1.0-1.5/ 17/16 2 x daily • Berg balance score-38/56 1.1-1.7 min • Dynamic Gait Index- 6/24 Week 6 75% 1.0-1.7/ 17/20 2 x daily 1.0-1.4 min • TUG (Timed up and go)- 14.51 sec (turning left), Week 7 75% 1.0-1.5/ 20/20 2 x daily 11.91 (turning right) 1.0-1.5 min ™ The AlterG Anti-Gravity Treadmill was implemented Week 8 75% 1.0-1.6/ 20/20 2 x daily the rst week of physical therapy (2 weeks s/p TIA). See 1.0-2.0 min progression table for details. Week 9 75% 1.0-1.8 20/20 2 x daily min Physical therapy treatment for this patient also included gait training, dynamic balance activities (with Powerplate), and other therapeutic exercises like biking and closed-kinetic chain strengthening.

Considerations Pt. has the following co-morbidities: Transient Ischemic Attack (TIA), Peripheral Artery Disease (PAD), High Blood Pressure, Macular Degeneration in R eye, Vascular Claudication. Results • Dynamic Gait Index score improved from 6/24 to 23/24. After training on the AlterG: Patient progressed at a good pace throughout his physical • Patient stated that leg pain was relieved for the therapy. At discharge, he presented with independence remainder of the day. with household and community mobility. Vascular • Patient able to demonstrate a reciprocal gait pattern claudication was a limiting factor throughout the rehab without loss of balance on level and uneven terrain. process however improvements were noted following • Patient able to turn his head, step over objects, and physical therapy. The AlterG allowed the patient to train change his speed without loss of balance. for longer periods without calf pain. Training on a regular • Patient able to ambulate safely without an assistive treadmill and overground were limited due to reports of device with increased muscular and cardiovascular calf pain within 5 minutes of gait training. The patient endurance and decreased symptoms. was also able to work on his dynamic balance within • Timed Up and Go scores improved the AlterG feeling safe and having con dence with direct - At initial evaluation: 14.5 seconds turning to the left, carryover to overground walking. 11.91 seconds turning to the right) -Berg balance score improved from 38/56 to 50/56. The rehabilitation program incorporating the AlterG At discharge: 8.88 seconds turning to the left, 8.81 enabled this 93 year old patient to return to an seconds turning to the right). independent active lifestyle in his home and community.