Post Stroke Rehabilitation Case Study

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A stroke is one of top ten leading causes of death in the United States and one of the leading causes of long term disability. For a patient who has suffered a stroke, their post stroke rehabilitation is instrumental to regaining normal function. A physical therapist is an essential member of the rehabilitation team and their treatments are designed to treat the disabilities that result from the cerebrovascular accident (CVA). For this assignment, my PICO question is based on the following case scenario:
You are a physical therapist working in an inpatient rehabilitation clinic and have been treating a patient for four weeks who is 5 weeks out from a CVA. At her 4-week revaluation you determine she is not making the progress you expected up to this point. She is max assist during gait training, has poor balance when sitting on the edge of the bed, and has difficulty completing daily tasks that require the use of both upper extremities. Lately, your patient seems to be lacking motivation and her effort level during treatments is steadily declining.
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From the searching the current literature I would conclude, that during long term stroke rehabilitation, a patient’s motivation to relearn simple tasks can diminish. In addition, a lack of effort during treatment sessions can occur over time, and limitations of what activities one can perform in clinic could all impact a patient’s rehabilitation progress. One possible solution for these problems is the use of virtual reality training in stroke rehabilitation to achieve better functional outcomes. Based on this information my PICO question is the