Date of Award

5-2024

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Steven Halcrow

Keywords

Stroke, Acute Kidney Injury, Proprioceptive Neuromuscular Facilitation, Neurological Rehabilitation Physical Therapy

Abstract

Background and Purpose: Cerebrovascular accidents (CVA) are common and are estimated to affect around 795,000 people in the United States every year. Cerebrovascular accidents can be detrimental to one’s health and have a wide range of complications including death and decreased independence. Current evidence-based practice supports exercise and movement through physical therapy to restore function and independence. However, current guidelines do not exist for patients with acute kidney injury during stroke recovery.

Case Description: In this case study, we examine a 63-year-old male with a diagnosis of acute ischemic stroke further complicated by severe rhabdomyolysis. Upon initial evaluation and examination, the patient is given a physical therapy diagnosis of right sided hemiparesis with sensory loss.

Outcomes: Over the course of his hospital stay, the patient demonstrated improved functional mobility and strength in the right upper and lower extremities. All physical therapy goals were met and exceeded; however, due to residual deficits the patient was discharged to an inpatient rehabilitation facility for further physical therapy.

Discussion: The physical therapy team was challenged by current recommendations for acute stroke and acute kidney injury. Ultimately, the team decided to carry out gentle mobility, avoid aggressive interventions, and progress the patient as kidney function improves. The purpose of this case study was to provide an in-depth understanding of the clinical decision making in the absence of clinical guidelines. Future research must focus on the effectiveness and parameters for treatment in the case of acute stroke complicated by acute kidney injury.

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