Recently on a neuro prac I was treating a patient who was a 33-year-old Aboriginal man from a community up at Fitzroy Crossing. He had had a L MCA CVA four weeks prior to the first time I saw him. As this is my first neuro placement and exposure to neuro patients, I wanted to have a thorough read of his notes and idea in my mind what to expect prior to my Ax session. (this patient had previously been seen by one of the other physio’s, and had just been handed over to us students)
Being a L MCA, I assumed that there may be some language difficulties, however the notes said that there were none evident.
I went in to see this patient and outlined what I would like to do in the session. He didn’t make eye contact with me or respond verbally, and when I asked him if he understood and consented to Rx, he said ‘yeah’ and that was it.
At the start of the session, I felt like he took along time to respond to any requests I made or questions asked. I felt like he didn’t understand what I was saying as he wasn’t responding quickly. However, due to the no eye contact, I then remembered that there may be some cultural differences that may be impacting on the session. I took careful note to see whether he responded appropriately to all the questions and requests, which he did.
Later I spoke to the physio who was treating him before me, and she said he had been exactly the same with her and that nothing had changed since his admission. Therefore it was not a language or understanding difficulty, it was a cultural difference.
Being my first exposure to neuro patients, I initially assumed that being a L MCA there would be language difficulties. I now know that strokes can present COMPLETELY differently and to Ax how each individual presents. I also remembered the lecture we had on Aboriginal Health and cultural differences, and realised that I needed to be more aware of these at the start of the session and not assume limited verbal responses was due to the CVA, so I will be a lot more aware of this in the future.
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We are presented and taught a very straightforward clinical picture of L MCA strokes. What we don't find out until we are out there, is that the brain is such a complex structure and the blood supply so precise and diverse that we cannot guarantee a textbook presentation for each patient we see. I made up some sick days for my neuro prac during the tuition free week, in which every patient i treated for stroke had dysphasia. On my original prac, only one patient had difficulties with speech or comprehension. The range of severity of dysphasia is so broad, from none with a L MCA, to very severe. Guess it keeps us on our toes!
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