MPAI Resources For Stroke
Case Studies
Case #1 Admission
Antonio
Man
76 years old
Retired. No kids, never married
Major ischemic stroke to the left cerebral hemisphere five months ago
Admitted to outpatient rehabilitation
Question 1: mobility
Antonio is not confident in using his new cane to get around. He has stopped doing some of his activities further from his house because he does not want to walk that far on his own.
Question 2: use of hands
Antonio is right-handed and currently struggles to write legibly. Otherwise, he can struggle with small buttons but otherwise manages most other tasks with adaptations.
Question 3: vision
Antonio has worn glasses for several years and he has no problems seeing when he wears his glasses.
Question 4: audition
Antonio has no problems with his hearing.
Question 5: dizziness
Antonio hasn’t reported any issues and I haven’t seen any indication that he is unsteady while I’ve observed him.
Question 6: motor speech
Much of the time Antonio can have trouble making himself understood because of his slurred speech, and sometimes, people need to ask him to repeat himself to understand him.
Question 7A: verbal communication
Antonio does seem to have some difficulty with more complex words, but can converse conversationally most of the time.
Question 7B: nonverbal communication
Antonio does not express any impairment in organizing his language and non-language communications, turn-taking in conversation or in modulation in verbal or nonverbal expressions.
Question 8: attention and concentration
At first, I didn’t think that Antonio had any issues paying attention, but it became apparent that there were occasional lapses during my clinical work with him. It doesn’t appear to affect him so that he notices it in his everyday life.
Question 9: memory
Antonio has complained of some small memory lapses, where he remembers parts of more recent events clearly enough to know that he has forgotten an important piece of information. These lapses do not affect his safety.
Question 10: fund of information
For his age, Antonio has no problems remembering general information. Similar to his more recent memories, he does have some difficulty remembering details about himself and his family from years ago.
Question 11: novel problem-solving
Antonio needs some help identifying solutions to his problems. This problem-solving does interfere with his daily activities, especially in relation to him going to his social club. Some help is also required for long-term planning, such as potentially selling his house.
Question 12: visuospatial abilities
Antonio has no problems drawing, assembling things, route-finding and being visually aware on both the left and right sides.
Part A | Score |
1. mobility | |
2. use of hands | |
3. vision | |
4. audition | |
5. dizziness | |
6. motor speech | |
7A. verbal communication | |
7B. nonverbal communication | |
8. attention and concentration | |
9. memory | |
10. Fund of information | |
11. Novel problem-solving | |
12. Visuospatial abilities |
Question 13: anxiety
Antonio has not mentioned any nightmares or flashbacks. He is anxious about making progress in rehabilitation.
Question 14: depression
Antonio does not feel sad, blue, or hopeless. He has a good appetite or reports sleeping well. However, he does sometimes worry overmuch, and can be a little hard on himself.
Question 15: irritability, anger and aggression
Antonio can be irritable and show aggression on the days where he was unable to perform an that activity that he was looking forward to due to his post-stroke symptoms. This is a regular occurrence right now, as his lack confidence in his ability to get to his social club has meant that most days there is an event there that he cannot attend. When asked about the event specifically, he will often start ranting or raising his voice in anger directed towards his post-stroke symptoms.
Question 16: pain and headache
Antonio sometimes winces in pain when he does some movements, but when prompted he says that it doesn’t really hurt, that he just moved the wrong way. This pain occurs only sometimes and doesn’t seem to interfere with his activities.
Question 17: fatigue
Antonio has complained of tiring easily and being unable to walk to his social club and spending the day with his friends there. This is an activity that he did prior to his stroke many days of the week. Since his stroke, he has not been back to his social club however his friends will visit him at home. He reports that he cannot spend as much time with them as he has in the past because he gets too tired.
Question 18: sensitivity to mild symptoms
Antonio has complained of tiring easily when walking to his social club and spending the day with his friends there. This is an activity that he did prior to his stroke many days of the week. Now, he only goes a couple days a week and doesn’t stay as long as he used to. This appears to be in part due to genuine fatigue, but based on his energy in rehabilitation, it seems also be due to his worry about his symptoms.
Question 19: inappropriate social interactions
Antonio does not act childish, silly or rude. He always behaves appropriately.
Question 20: impaired self-awareness
Antonio is aware of his deficits and does consistently compensate for them. For example, he always uses his cane when walking.
Question 21: family or significant relationships
Antonio was never married and has no children. However, he is very close with his nephew and has close friends at his social club. Before his stroke he saw friends nearly every day and his nephew a couple times a week. His nephew and friends still see him the same amount of time as before, but now they do different activities to help support him post-stroke. For example, helping with yard work or maintenance projects. His nephew has reported that this has not placed undue stress on him.
Part B | Score |
13. anxiety | |
14. depression | |
15. irritability, anger and aggression | |
16. pain and headache | |
17. fatigue | |
18. sensitivity to mild symptoms | |
19. inappropriate social interactions | |
20. impaired self-awareness | |
21. family or significant relationships |
Question 22: initiation
Antonio wants to participate in all the activities that he used to and often tries to do so, but physically he isn’t always able to. Antonio reports particular regret when he can’t attend the social club gatherings and volunteer activities but is happy that his core group of friends from the social club visit him at home.
Question 23: social contact with family, friends, colleagues or professionals
Antonio was a very active and social person prior to his stroke. He still sees his nephew and close friends for about the same amount of time each week, but their activities have changed from purely social to providing some support (e.g., helping with yard work). Antonio expresses some dissatisfaction with this change, as he feels like a burden or obligation to his friends and family.
Question 24: leisure and recreational activities
Antonio’s nephew mentioned that he is still playing chess with him. However, Antonio now gets easily frustrated when he’s losing. Antonio goes to the social club less than he did pre-stroke and the activities that he does with his friends tend not to be purely social in nature now, but also about supporting Antonio. Otherwise, he used to spend a lot of his time fishing, but hasn’t yet tried the activity post-stroke.
Question 25 self-care
Antonio is able to take care of himself, except when fine motor movements are required with his right (dominant) hand. This only affects him when doing small movements, like doing up small buttons. Otherwise, Antonio does not need help in eating or dressing. Antonio typically uses a device provided to him to help him in and out of the shower.
Question 26: residence
At home, Antonio needs some assistance to cook and do house chores. A personal support worker comes in every few days for a couple of hours to provide assistance. If there are emergencies or larger yard work or home repairs are needed, his nephew or friends provide support.
Question 27: transportation
Antonio does not know how to drive. He always used to walk to get around. Now, because of his foot and the risk of falling, he is not confident walking outside his home by himself. He can only safely do so with the supervision of someone or using his quad cane.
Question 28B: Other employment – retired
Antonio is retired. He spends much of his time doing social activities, either with his nephew or his friends. He is currently adapting many of the activities he used to do post-stroke such as not going to his social club but instead having his friends to his house. However, others, such as fishing or volunteering at his social club, he has not returned to.
Question 29: managing money and finances
Antonio still manages his financial affairs, however his nephew reports that he is concerned about Antonio making large financial decisions such as selling his house.
Part C | Score |
22. Initiation | |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | |
24. Leisure and recreational activities | |
25. Self-care | |
26. Residence | |
27. *Transportation | |
28A. *Paid Employment | |
28B. *Other employment | |
29. Managing money and finances |
Part A | Admission score |
1. mobility | 2 |
2. use of hands | 2 |
3. vision | 0 |
4. audition | 0 |
5. dizziness | 0 |
6. motor speech | 3 |
7A. verbal communication | 2 |
7B. nonverbal communication | 0 |
8. attention and concentration | 1 |
9. memory | 1 |
10. Fund of information | 1 |
11. Novel problem-solving | 2 |
12. Visuospatial abilities | 0 |
Part B | Admission score |
13. anxiety | 1 |
14. depression | 1 |
15. irritability, anger and aggression | 3 |
16. pain and headache | 1 |
17. fatigue | 3 |
18. sensitivity to mild symptoms | 2 |
19. inappropriate social interactions | 0 |
20. impaired self-awareness | 1 |
21. family or significant relationships | 1 |
Part C | Admission score |
22. Initiation | 0 |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | 2 |
24. Leisure and recreational activities | 3 |
25. Self-care | 1 |
26. Residence | 3 |
27. *Transportation | 3 |
28A. *Paid Employment | |
28B. *Other employment | 3 |
29. Managing money and finances | 1 |
Case #1 Discharge
Antonio
Man
76 years old
Retired. No kids, never married
Major ischemic stroke to the left cerebral hemisphere ten months ago
Plan to discharge in about a week following 5 months of outpatient rehabilitation
Question 1: mobility
Antonio doesn’t have any issues related to mobility interfering with his daily activities when he uses a cane.
Question 2: use of hands
Antonio is right-handed and currently struggles to write legibly. Otherwise, he can struggle with small buttons but otherwise manages most other tasks with adaptations.
Question 3: vision
Antonio has worn glasses for several years and he has no problems seeing when he wears his glasses.
Question 4: audition
Antonio has no problems with his hearing.
Question 5: dizziness
Antonio hasn’t reported any issues and I haven’t seen any indication that he is unsteady while I’ve observed him.
Question 6: motor speech
Some of the time Antonio can have trouble making himself understood because of his slurred speech, and sometimes, people need to ask him to repeat himself to understand him.
Question 7A: verbal communication
Antonio does seem to have some difficulty with more complex words, but can converse conversationally most of the time.
Question 7B: nonverbal communication
Antonio does not express any impairment in organizing his language and non-language communications, turn-taking in conversation or in modulation in verbal or nonverbal expressions.
Question 8: attention and concentration
At first, I didn’t think that Antonio had any issues paying attention, but it became apparent that there were occasional lapses during my clinical work with him. It doesn’t appear to affect him so that he notices it in his everyday life.
Question 9: memory
Antonio has complained of some small memory lapses, where he remembers parts of more recent events clearly enough to know that he has forgotten an important piece of information. These lapses do not affect his safety.
Question 10: fund of information
For his age, Antonio has no problems remembering general information. Similar to his more recent memories, he does have some difficulty remembering details about himself and his family from years ago.
Question 11: novel problem-solving
Antonio needs some help identifying solutions to his problems and plan for the future. This problem-solving doesn’t interfere with his daily activities or his safety, but instead are for long-term planning such as potentially selling his house.
Question 12: visuospatial abilities
Antonio has no problems drawing, assembling things, route-finding and being visually aware on both the left and right sides.
Part A | Score |
1. mobility | |
2. use of hands | |
3. vision | |
4. audition | |
5. dizziness | |
6. motor speech | |
7A. verbal communication | |
7B. nonverbal communication | |
8. attention and concentration | |
9. memory | |
10. Fund of information | |
11. Novel problem-solving | |
12. Visuospatial abilities |
Question 13: anxiety
Antonio has not mentioned any nightmares or flashbacks. However, he is a little anxious about being discharged from rehabilitation.
Question 14: depression
Antonio does not feel sad, blue, or hopeless. He has a good appetite or reports sleeping well. However, he does sometimes worry overmuch, and can be a little hard on himself.
Question 15: irritability, anger and aggression
Antonio can sometimes be irritable following a day where he was unable to perform an activity that he was looking forward to due to his post-stroke symptoms. For example, if wasn’t able to attend the weekly dinner event at his social club because he was feeling too tired that day.
Question 16: pain and headache
Antonio sometimes winces in pain when he does some movements, but when prompted he says that it doesn’t really hurt, that he just moved the wrong way. This pain occurs only sometimes and doesn’t seem to interfere with his activities.
Question 17: fatigue
Antonio does have some concerns about his post-stroke fatigue, but his concern did not limit him from pushing himself in his rehabilitation nor does it interfere with his activities.
Question 18: sensitivity to mild symptoms
Antonio does have some concerns about his post-stroke fatigue, but his concern did not limit him from pushing himself in his rehabilitation. However, his worry does seem to be interfering with his activities.
Question 19: inappropriate social interactions
Antonio does not act childish, silly or rude. He always behaves appropriately.
Question 20: impaired self-awareness
Antonio is aware of his deficits and is able to consistently compensate for them. For example, he always uses his cane when walking.
Question 21: family or significant relationships
Antonio was never married and has no children. However, he is very close with his nephew and has close friends at his social club. Before his stroke he saw friends nearly every day and his nephew a couple times a week. His nephew and friends still see him the same amount of time as before, but now they do different activities to help support him post-stroke. For example, helping with yard work or maintenance projects.
Part B | Score |
13. anxiety | |
14. depression | |
15. irritability, anger and aggression | |
16. pain and headache | |
17. fatigue | |
18. sensitivity to mild symptoms | |
19. inappropriate social interactions | |
20. impaired self-awareness | |
21. family or significant relationships |
Question 22: initiation
Antonio wants to participate in all the activities that he used to and often tries to do so, but he isn’t always able to. Antonio reports particular regret when he can’t attend the social club gatherings because he thinks that they are too tiring for him.
Question 23: social contact with family, friends, colleagues or professionals
Antonio was a very active and social person prior to his stroke. He still sees his nephew and close friends for about the same amount of time each week, but their activities have changed from purely social to providing some support (e.g., helping with yard work). Antonio expresses some dissatisfaction with this change, as he feels like a burden or obligation to his friends and family.
Question 24: leisure and recreational activities
Antonio continues to enjoy playing chess with his nephew. He goes to the social club less than he did pre-stroke, but now his friends will visit him at home. Otherwise, he used to spend a lot of his time fishing, but hasn’t yet tried the activity post-stroke.
Question 25 self-care
Antonio is able to take care of himself, except when fine motor movements are required with his right (dominant) hand. This only affects him when doing small movements, like doing up small buttons. Otherwise, he is capable of caring for himself.
Question 26: residence
Antonio has been maintaining his residence, and can manage the responsibilities of independent living and homemaking including meal preparation and personal health maintenance beyond basic hygiene such as medication management. He has some support to complete basic larger yard work and home repairs tasks from friends and his nephew.
Question 27: transportation
Antonio does not have a car and never learned to drive. He always used to walk and take the metro to get around. Now, he is happy to walk shorter distances but is still wary of taking the metro. The few times when he needs to go to a further location, either his nephew or a friend will drive him.
Question 28B: Other employment – retired
Antonio is retired. He spends much of his time doing social activities, either with his nephew or his friends. He can accomplish most of the activities he enjoyed doing pre-stroke without support. The only activity he hasn’t gone back to yet is fishing, although he has recently expressed interest in trying to do so.
Question 29: managing money and finances
Antonio has no issues managing his money for everyday expenses. However, he does need help for larger money matters such as potentially selling his house.
Part C | Score |
22. Initiation | |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | |
24. Leisure and recreational activities | |
25. Self-care | |
26. Residence | |
27. *Transportation | |
28A. *Paid Employment | |
28B. *Other employment | |
29. Managing money and finances |
Part A | Discharge score |
1. mobility | 1 |
2. use of hands | 2 |
3. vision | 0 |
4. audition | 0 |
5. dizziness | 0 |
6. motor speech | 2 |
7A. verbal communication | 2 |
7B. nonverbal communication | 0 |
8. attention and concentration | 1 |
9. memory | 1 |
10. Fund of information | 1 |
11. Novel problem-solving | 1 |
12. Visuospatial abilities | 0 |
Part B | Discharge score |
13. anxiety | 1 |
14. depression | 1 |
15. irritability, anger and aggression | 1 |
16. pain and headache | 1 |
17. fatigue | 2 |
18. sensitivity to mild symptoms | 1 |
19. inappropriate social interactions | 0 |
20. impaired self-awareness | 0 |
21. family or significant relationships | 1 |
Part C | Discharge score |
22. Initiation | 0 |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | 1 |
24. Leisure and recreational activities | 0 |
25. Self-care | 1 |
26. Residence | 2 |
27. *Transportation | 2 |
28A. *Paid Employment | |
28B. *Other employment | 1 |
29. Managing money and finances | 0 |
Case #2 Admission (Participation Scale Only)
Woman
61 years old
Employed
Claudia is a married, 61-year-old woman with two adult children. She is an executive manager in sales for a technology company. 4 months ago, she suffered a stroke in her left cerebral hemisphere. She currently has left hemiplegia in her right upper limb.
Before her stroke, Claudia was physically active and employed full-time. However, since the stroke, she has been moved to remote work by her company on part-time hours. Claudia’s energy is lower and she complains that her hemiplegic arm interferes with household activities or those in her job such as typing. While she is able to complete all of these tasks, her inability to do these tasks as efficiently as she could pre-stroke discourages her so much that she sometimes doesn’t even attempt them. Her husband has taken on new household responsibilities by helping Claudia with household tasks such as preparing dinner. Claudia often complains and feels embarrassed when she needs to cut something during meals or when she is getting dressed. However, her husband says that she learned fast how to manage these tasks and, with encouragement from him, she does do them.
Claudia is not able to drive following her stroke, however she has adapted to this by taking public transit. She will go to the gym, grocery store and to visit friends using public transit, but isn’t always motivated to do so. When it’s time to hang out with her friends, Claudia’s husband mentions that sometimes she does not want to get out of her room and see anyone because how she sees herself has changed. This is especially true when Claudia needs some help with her makeup or getting dressed.
However, with some encouragement Claudia will usually be convinced to continue with her plans. While she doesn’t see her friends as much as she did prior to her stroke, Claudia does see them on the weekend and at least a couple times during the week. Claudia enjoys her time with them, especially when she invites them over or goes to one of their houses, or meets up at the gym with them. The one activity that Claudia has not returned to is shopping in person. She has avoided going to the mall but instead shops online only now.
Part C | Scores |
22. Initiation | |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | |
24. Leisure and recreational activities | |
25. Self-care | |
26. Residence | |
27. *Transportation | |
28A. *Paid Employment | |
28B. *Other employment | |
29. Managing money and finances |
Part C | scores |
22. Initiation | 2 |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | 1 |
24. Leisure and recreational activities | 1 |
25. Self-care | 1 |
26. Residence | 2 |
27. *Transportation | 2 |
28A. *Paid Employment | 1 |
28B. *Other employment | |
29. Managing money and finances | 0 |
Case #2 Discharge (Participation Scale Only)
Woman
61 years old
Employed
Claudia will be discharged in about a week after two and a half months of outpatient rehabilitation.
Claudia’s mood and mindset seem to have improved a lot. Her husband did not report any more cases of her stating that she just wants to stay in her room. Claudia is happily meeting her friends using public transportation safely or hosting them at the house. Claudia is slowly increasing her hours and is almost back to full-time but is still working remotely. She has asked the company to determine a plan with her so that she can transition to hybrid work. She knows that to do this, she will likely need to get her driver’s license back. She is worried about driving again but is willing and motivated to try to regain that ability.
Even if she needs help, Claudia finds ways to assist in cooking and house chores. She is more enthusiastic about trying to find solutions to do what she can, even if sometimes she still avoids or gets frustrated with some tasks. Her husband reports that he sometimes helps her with trickier clothes, but otherwise she is independent.
She is also able to dress up without any help, but she still needs little help during meals. Her husband mentioned that she recently renewed her gym plan for the year and she is not back to going nearly everyday as she did before her stroke but has progressed to going 3x/week.
Part C | Scores |
22. Initiation | |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | |
24. Leisure and recreational activities | |
25. Self-care | |
26. Residence | |
27. *Transportation | |
28A. *Paid Employment | |
28B. *Other employment | |
29. Managing money and finances |
Part C | scores |
22. Initiation | 1 |
23. Social contact with friends, work associates, and other people who are not family, significant others, or professionals | 1 |
24. Leisure and recreational activities | 1 |
25. Self-care | 1 |
26. Residence | 2 |
27. *Transportation | 1 |
28A. *Paid Employment | 1 |
28B. *Other employment | |
29. Managing money and finances | 0 |