Patient case study: bilateral, sub-arachnoid stroke

At the age of 72, Esme suffered a bilateral, sub-arachnoid stroke, which caused her fall and be admitted to her local NHS hospital. The following month she was transferred to Circle Rehabilitation for an intensive programme of multidisciplinary, rehabilitation.

A subarachnoid haemorrhage is caused by bleeding on the surface of the brain. Whilst it is an uncommon type of stroke it is a very serious condition and can be fatal. There are usually no warning signs, but such a haemorrhage tends to happen during physical effort or straining.

• a sudden severe headache unlike anything you’ve experienced before
• a stiff neck
• feeling and being sick
• sensitivity to light (photophobia)
• blurred or double vision
• stroke-like symptoms; slurred speech, weakness on one side of the body
• loss of consciousness or convulsions.

Up until this point Esme had lead a fully independent life, living in her house with an upstairs bedroom. Determined to get back to a similar lifestyle, this helped shape her rehabilitation goals during her stay with Circle. She stayed with us for 77 nights in total, which saw significant improvements in her ability to function. Initially she was admitted requiring moderate levels of care support but after her stay with us she was discharged with low care requirements.

‘Functional Independence Measure’, also known as ‘FIM’, is way in which we measure a patient’s rehabilitation progress. These assessments are internationally approved outcome measures used to accurately measure disability in the UK. The assessments have a set list of criteria which are used regularly before, during and after treatment. That way we can accurately see changes in how a patient is responding to rehabilitation in real-time and adjust the treatment plan if needed.

A FIM score is based on a scale of 0 to 7, whereby 0 means total dependence and 7 means independence.

A complete list of scores for the FIM is as follows:

1. Total assist needed
2. Maximal assist (you can perform 25 percent of the task)
3. Moderate assist (you can perform 50 percent of the task)
4. Minimal assist (you can perform 75 percent of the task)
5. Supervision needed
6. Modified independence (you use an assistive device)
7. Independence in performing the task

This scale is used to measure 18 separate tasks, including eating, bathing, toileting, walking and social interaction, to name a few.

To learn more about these assessment measures and our overall outcomes across Circle Rehabilitation click on the button below.

Upon admission, Esme’s average FIM score was just 2.22, meaning she required a significant care where she was close to complete dependence. As a result of Circle Rehabilitation’s high intensity rehabilitation approach she was discharged with a FIM score of 6.3. In other words, when she was discharged she was close to being back to complete independence.

As a result of her stay at Circle Rehabilitation, Esme was able to mobilise without an aid but still had supervision, as she continued to progress in her own home.

*Some patient details have been changed to ensure patient privacy.

Through an intense programme of physiotherapy and occupational therapy (OT), significant improvements were made to Esme’s condition, both physically and cognitively. Her program of care was overseen by Dr. Sultan, a consultant in Neurological Rehabilitation at Circle Rehabilitation. Activities and goals were continually assessed to ensure the best possible clinical outcomes specific to Esme.

Activities, such as mobility practice, a review by a dietician, psychology sessions, family meetings, walking, obstacle training, speech and language therapy and a home assessment, assisted her progress. This program helped identify the adapted needs for Esme’s return home.

A typical day in rehabilitation will include some of the following activities, but is not restricted to just these:

Patients are helped to get ready for the day and have several menu options to choose from for breakfast, lunch and dinner.

Vital to the recovery of patients, our skilled staff provide physiotherapy or hydrotherapy.

Ward rounds:
Staff visit patients at regular intervals to check and discuss their progress.

Consultant visits:
The patient’s consultant also checks in to monitor the progress and success of treatment.

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Circle Health Group, 1st Floor, 30 Cannon Street, London, EC4M 6XH