Stroke case

First session of the day. What do you check first?

A 62-year-old woman, 16 days after Right MCA, cortical-subcortical infarct (NIHSS 6).

NeuroDash

The case

Patient62F, subacute phase
LesionRight MCA, cortical-subcortical infarct
SeverityNIHSS 6
Before the strokeIndependent community ambulator, no aids. Works part-time.
Also on the chartHypertension; Type 2 diabetes
NeuroDash

The decision

First session of the day. What do you check first?

Sitting balance and weight-bearing symmetry to the left
10-metre walk speed
Passive shoulder range of motion
Repeat the MoCA

Choose before you scroll.

NeuroDash

The tempting answer

10-metre walk speed

She is not yet walking independently, so a gait-speed test has no floor to start from. A measure she cannot attempt yields nothing the plan can use and risks a fall in the first five minutes.

NeuroDash

The evidence

Sitting balance and weight-bearing symmetry to the left

Standing and gait are built on trunk control and symmetrical loading, and her balance findings are the documented limiter. Today’s plan is decided by them, so they are re-checked first — everything else on the list is either intact or untestable today.

Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008;88(5):559–566. Winstein CJ et al. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke. 2016;47(6):e98–e169.

NeuroDash

The pearl

Foundations first: trunk control and symmetry before gait.

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