Acute stroke/vestibular rehab

We spent the morning in the Acute Stroke Unit, going over cases and seeing treatment. Going through charts has been pretty interesting, since it’s usually half in Thai and half in English and sometimes they’ll switch language mid-sentence when documenting. Also, their documentation is half on the computer and half on paper, so we were reading paper charts but able to look up imaging results on the computer.

This wing was the first I’d seen that had individual patient rooms! It had six on one side that were what they called “a mini ICU” and then 8 down the other hallway that had patients who were less severely affected.

One case we spent a lot of time going over was a 70 year old woman who had been brought in immediately after a stroke, within the time limits to get rtPA. However, she was one of the patients who ended up having a severe bleed in her brain post rtPA treatment, and was at the point where there wasn’t really anything that could be done to help her. We then got into a discussion about rtPA and how selective they are when deciding which patients can receive it (CT scan being among the criteria). They also strictly follow the 24 no mobilizing/activity rule post rtPA administration. This was pretty interesting to me because it seems all I’ve learned is to mobilize as soon as possible after stroke, and after doing a little research, it look so like there are several studies that are questioning if that rule needs to be in place. So it was cool to be able to see it firsthand and to talk about the clinical significance of bedrest from therapists who specialize in acute stroke.

The afternoon was spent with “vestibular rehab” and I say it that way because it really ended up being general balance training for patients who were unable to find a medical diagnosis as a source for their problems. Drew and I got to jump in with several activities to challenge balance, and even had to recommend an assistive device for one patient due to safety concerns. The very next patient after that ended up being a patient who we could clear from having to her assistive device, so it was great to see someone on the upswing!