Case Study: Transient Ischemic Attack (TIA)

Introduction

The patient is a 93 y.o. male who experienced a TIA 2 weeks ago. He presents with moderate balance deficits, difficulty with ambulation on even and uneven terrain, gait deviations, difficulty negotiating stairs, and he is unable to drive. He is an extremely active 93 year old and prior to his TIA he was driving, taking care of his 2 story condo, stretching daily, and

walking outside for 30 minutes which included 2 hills. He has a history of claudication which limited his walking to 30 minutes daily. He was independent with walking in the home, the community, negotiating stairs, and he had no balance deficits prior to his TIA

Goals

In 4 weeks:

• Pt. to increase dynamic gait index to 10/24

In 8 weeks:

• Negotiate over various terrain for 1500 ft. with minimal calf cramping and no LOB in 8 weeks
• Negotiate 10 steps with independence without falling in 8 weeks
• Report 1/10 pain after 20 minutes in calves and thighs in 8 weeks
• Increase BERG balance score to 41/56 in 8 weeks
• Reduce his TUG to the left to 13 seconds in 8 weeks
• Increase dynamic gait index to 18/24 to reduce risk of falling in the home 

History/Progression

Pt. exhibits:

• Increased base of support with decreased stride length.
• Dizziness when standing.
• Decreased muscular endurance with walking; quick to fatigue.
• Calf cramping with walking throughout the day.
• Pt. reports 3 incidents of near falling after returning home from hospital

Objective Data At Initial Evaluation

• Berg balance score-38/56
• Dynamic Gait Index- 6/24
• TUG (Timed up and go)- 14.51 sec (turning left), 11.91 (turning right)

The AlterG Anti-Gravity Treadmill was implemented the first week of physical therapy (2 weeks s/p TIA). See progression table for details.

Physical therapy treatment for this patient also included gait training, dynamic balance activities (with Powerplate), and other therapeutic exercises like biking and closed-kinetic chain strengthening.

Considerations

Pt. has the following co-morbidities: Transient Ischemic Attack (TIA), Peripheral Artery Disease (PAD), High Blood Pressure, Macular Degeneration in R eye, Vascular Claudication.

Results

After training on the AlterG:

• Patient stated that leg pain was relieved for the remainder of the day
• Patient able to demonstrate a reciprocal gait pattern without loss of balance on level and uneven terrain
• Patient able to turn his head, step over objects, and change his speed without loss of balance
• Patient able to ambulate safely without an assistive device with increased muscular and cardiovascular endurance and decreased symptoms
• Timed Up and Go scores improved
• At initial evaluation: 14.5 seconds turning to the left, 11.91 seconds turning to the right)
• At discharge: 8.88 seconds turning to the left, 8.81 seconds turning to the right)
• Berg balance score improved from 38/56 to 50/56
• Dynamic Gait Index score improved from 6/24 to 23/24

Patient progressed at a good pace throughout his physical therapy. At discharge, he presented with independence with household and community mobility. Vascular claudication was a limiting factor throughout the rehab process however improvements were noted following physical therapy. The

AlterG allowed the patient to train for longer periods without calf pain. Training on a regular treadmill and overground were limited due to reports of calf pain within 5 minutes of gait training. The patient was also able to work on his dynamic balance within the AlterG feeling safe and having confidence with direct carryover to overground walking.

The rehabilitation program incorporating the AlterG enabled this 93 year old patient to return to an independent active lifestyle in his home and community.