case_images: PMC11447270_01
case_images: MRI performed in April 2019, 5.5 years poststroke and 4 months after the end of guided self-rehabilitation contract (GSC). (A) Axial flair: right middle cerebral artery infarct. (B) Axial T1: right midbrain atrophy.
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case_images: PMC11447270_01_fresc-05-1385483-g001.jpg
case_images: F1
case_images: A 44-year-old woman with no prior medical history suffered a carotid dissection leading to a large superficial and deep right middle cerebral stroke in October 2013 (Figures 1A,B), despite undergoing thrombolysis and thrombectomy.
case_images: Guided self-rehabilitation contract (GSC) with excerpts from the prescription and from the patient's diary. (A) GSC prescription showing, on the left, the antagonist muscles to be stretched (daily time and frequency) and, on the right, the series of active exercises to be performed against each of these antagonist muscles; here examples of the long head of triceps and flexors of digits II and III (daily time and frequency) prescription. Working against the resistance of each selected antagonist muscle implies alternating between stretching time and a training series, with the patient starting and finishing with a stretching time. (B) Photo of patient's diary: on the left, the patient recorded the number of minutes static self-stretch was performed daily against the selected antagonist, and on the right, the number of active maximal efforts performed in each series against the resistance of the selected antagonist.
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case_images: PMC11447270_01_fresc-05-1385483-g002.jpg
case_images: F2
case_images: The exercise techniques were explained and demonstrated to her during the first clinic visit, and she was given the GSC manual together with a paper GSC prescription (Figure 2). Figures 2A,B show the excerpts of the prescription and of the diary later turned in by the patient.
case_images: Individual data:exemplary work. (A) Static self-stretch time per muscle (min/day). (B) Number of movements/day. (C) Modified Frenchay Scale (MFS).
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case_images: PMC11447270_01_fresc-05-1385483-g003.jpg
case_images: F3
case_images: During the second part of the GSC follow-up, pronators and wrist and finger flexor muscles gradually took over most of the guided self-rehabilitation efforts, with 30 min per day of self-stretch for finger flexors and more than 120 efforts per day of hand opening (Figures 3A,B).