Significance of the long-term rehabilitative treatment in a hemiplegic young patient

Stroke is one of the major causes of disability. In Italy there are 250 cases/day, so it's very important to find the criteria to select patients for long-term treatments. We report here a case of a 41-year old patient, who had an ischemic stroke after a by-pass surgery for carotid occlusion. We started the rehabilitative treatment a few days after the stroke, when the patient was still in the I.C.U.; we are still continuing it two and half years after the ischemic event. At the initial evaluation the F.I.M. was 20 (16%); the rehabilitative approach has been the more integrated as possible, using different techniques to stimulate a learning process in the motor skills, and three P.T. worked together to the same project interchanging their roles. The patient reacted very well to the treatment and after one year the F.I.M. was 115 (91%). We decided to continue the treatment and we obtained a significative recovery during the second year, especially with regard to the quality of movement and to the improvement of the quality of life. The angiography-MRI showed a compensative flow to the right middle and anterior cerebral arteries through the anterior and posterior communicants ones of the same side. After two years the F.I.M. reached the maximum score; nevertheless, the treatment is still going on since we think that there can still be a possibility of further improvement especially in the automatism of the movements of the upper limb. We conclude that it's opportune to program a long-term treatment for patients with some characteristics like young age, motivation and strong will, familiar and animal support, middle-high level of culture and no cognitive deficits associated.