Modern Psychological Studies Volume 3 Number 2 Article 4 1995 Recovery from stroke involving the left middle cerebral artery Lori Walter Colorado College Follow this and additional works at: https://scholar.utc.edu/mps Part of the Psychology Commons Recommended Citation Walter, Lori (1995) "Recovery from stroke involving the left middle cerebral artery," Modern Psychological Studies: Vol. 3 : No. 2 , Article 4. Available at: https://scholar.utc.edu/mps/vol3/iss2/4 This articles is brought to you for free and open access by the Journals, Magazines, and Newsletters at UTC Scholar. It has been accepted for inclusion in Modern Psychological Studies by an authorized editor of UTC Scholar. For more information, please contact [email protected]. RECOVERY FROM STROKE Recovery From Stroke Involving neglect of the right visual field, and global aphasia (difficulty in all communication the Left Middle Cerebral Artery processes). When the lesion occurs in the Lori Walter anterior branches of the MCA, there is increased risk of executive control deficits Colorado College (Beeson, Bayles, Rubens, & Kaszniak, 1993; Huff, Mack, Mahlmann, & Abstract Greenberg, 1988) and long-term memory The rehabilitative treatment of a 73-year- impairment (Beeson et al., 1993). old male who suffered from a left middle The prognosis for recovery from cerebral artery (MCA) thrombotic infarct left hemisphere MCA is fairly positive. In was observed to analyze the effects of age Kaste and Waltimo (1976), 72% of the and psychological and social factors on MCA patients who survived the acute stroke recovery. The patient was assessed phase of stroke became fully independent, as having minimal verbalization, right 27% required assistance, and only 1% side neglect, right hemiparesis, right were completely disabled. Several factors hemisensory deficits, decreased balance such as age, medical environment, and and mild dysphasia. After 29 days of social interactions may affect stroke physical therapy, occupational therapy, recovery. and speech therapy, he showed Recovery from stroke may be improvement in activities of daily living, dependent upon the patient's age. Some walking, and communication. He was researchers (Ahlsio, Britton, Murray, & discharged 33 days poststroke (DPS). Age Theorell, 1984; Kaste & Waltimo, 1976; of the patient and severity of the stroke Kotila, Waltimo, Neimi, Laaksonen, & seemed to be poor predictors of stroke Lempinen, 1984; Wade, Wood, & Hewer, outcome. Early rehabilitation, patient 1985) have shown that older patients have motivation, family support, and treatment less positive effects from rehabilitation in a rehabilitation unit appear to have than younger patients with similar severity positively influenced his recovery and may of stroke. Other research found age to be be good predictors of rehabilitative unrelated to stroke recovery (Bonita & success. Beaglehole, 1988; Feigenson, McCarthy, Greenberg, & Feigenson, 1977a; In order to illustrate the effects of Heinemann, Roth, Cichowski, & Betts, age and psychological and social 1987). The present study questions interactions on stroke recovery, the whether age can predict rehabilitative present study documents a stroke patient's success. rehabilitative progress from hospital Social and psychological factors admittance to discharge. The patient, CH, may be more indicative of stroke a 73-year-old Caucasian male was outcome than chronological age. The diagnosed as having an evolving left patient's self-motivation and interaction hemisphere cardiovascular accident with the rehabilitation staff, interaction (CVA), located in the middle cerebral with the family, or all three combined may artery (MCA). The left MCA supplies the be more representative of stroke recovery lateral aspect of the left cerebral (Feigenson, 1979; Feigenson et al., 1977a; hemisphere. When an infarct affects the Kaufman & Becker, 1986; Reding & MCA, cerebral processes such as McDowell, 1989; Strand et al., 1985). communication, perception, sensation, and Older patients with less positive voluntary movements can be impaired. recovery in studies by Ahlsio et al. (1984), Clinical manifestations of left-hemisphere Kaste & Waltimo (1976), Kotila et al. MCA ischemia are characteristically (1984), and Wade et al. (1985) may have dense contralateral hemiplegia (more had less social support and less motivation severe in the upper extremity than the than the younger patients, which is not lower), loss of sensation on the right side, uncommon for elderly persons (Kaufman & Becker, 1986). Therefore, an older MODERN PSYCHOLOGICAL STUDIES 21 Lori Walter stroke patient with strong motivation, magnetic resonance imaging test (MRI) family support, medical support, or all indicated the CVA was located in the three combined may have a higher degree putamen and parts of the caudate as well of recovery regardless of his or her age. as in the intervening gray matter (see In order to examine the effects of Figure 1). Patchy areas in the peritrigonal age and psychosocial factors on stroke recovery, CH, a 73-year-old man, was chosen for this study. He was treated in an early intervention team rehabilitation approach which has been shown to increase staff interest, communication, and expertise in a patient's recovery as well as increase patient interaction with other rehabilitation patients (Feigenson, Gitlow, & Greenberg, 1979). CH also had 4.11 NZ • good family support and motivation which •••• I • 1•16 • • has also been shown to positively affect a. see stroke recovery (Feigenson, 1979; • ••••1 • Feigenson et al., 1977a; Kaufman & Becker, 1986; Reding & McDowell, 1989; Figure 1. Magnetic Resonance Image (MRI) Strand et al., 1985). The present case depicting the coronal view of the left hemisphere. study suggests, despite his advancing age, The infarct arrows are located in the putamen, CH will have a positive outcome due to parts of the caudate, intervening gray matter, and his strong social and psychological extensions into the left cerbral peduncle and left factors. occipital horn. CH's prognosis considering the patient's age and stroke severity was rated region and extensions into the left cerebral as "fair" by the rehabilitation team at four peduncle and left occipital horn were also days poststroke (DPS). CH was affected. The result was a mass effect on subsequently transferred to a rehabilitation the left ventricular body, with sparing of the peripheral gray. Mild volume loss of wing and was treated in a the brain was present, but was not multidisciplinary stroke rehabilitation significant for the age. The final program. The present case study assessment from these tests was a documents CH's recovery from left MCA infarct by first assessing anatomical and subacute, nonhemorragic, mildly swollen functional deficits at stroke onset. infarct of the left hemisphere due to a Detailed daily notation in physical, thrombosis in the lateral striate branches occupational, and speech therapy follows of the left MCA. to identify progress in all aspects of Functional assessment rehabilitation. CH's mental status was reported on Case History the day of the stroke as alert. He was able to follow one step commands with 50% Anatomical assessment accuracy. CH demonstrated vocalization but minimal verbalization with respect to A series of tests helped locate the discrete words. He manifested expressive exact origin of the CVA. A computerized aphasia and mild right side neglect. tomography (CT) scan showed minimal Physically, CH had right hemiparesis, increase in cortical sulci, within normal right hemisensory deficits, decreased limits for age, and no midline shift, mass sitting and standing balance, and mild effect, hemorrhage, abnormal hypodensity dysphasia. The diagnosis was a severe or hyperdensity. A carotid imaging test stroke with "fair" prognosis from the with doppler presented no rehabilitation team. CH began hemodynamically significant stenosis. A rehabilitation four DPS. 22 MODERN PSYCHOLOGICAL STUDIES RECOVERY FROM STROKE Physical Therapy functional approach, based on completion of tasks, and the neuromuscular Three aspects of therapy were facilitation approach, aimed at recovery employed to increase his level of through sensory cues. In the first few days functioning: physical therapy, of physical therapy, bed mobility and occupational therapy, and speech therapy. static sitting were emphasized. Training CH was treated with a comprehensive CH to walk (gait training) was attempted remobilization program on four DPS to on 10 DPS. Muscles were retrained for increase his bed mobility and ambulation. gait through slow, deliberate movements His physical therapy progress is detailed to enlist intact motor and sensory cyclic in Table 1. This treatment involved the systems. Ambulation is normally begun when the patient can understand three-step Table 1 commands, can maintain standing balance, lacks hip, ankle or knee CH's Physical Therapy Progress. contracture, and has normal voluntary motor function of the hip, knee, and ankle DPS Progress of Therapy (Jann, Rusin, & Kovan, 1992). Because 1 CH was not this advanced at 10 DPS- he 2 began walking with a straight cane. As is 3 common in early gait training (Jann et al., 4 5 1992), CH performed shorter steps when 6 walking, exhibited longer duration stance, 7 MNA sitting bedside and had a shorter swing phase during gait. 8 Also characteristic was his circumduction 9 of the affected limb, knee flexion, and a 10 Sitting IND, MDA gait with cane decrease in ankle mobility. Subsequently, 11 he showed toe