Rehabilitation of a hemiplegic patient with cardiac assistive device

IntroductionPossible admission to a PRM unit of a hemiplegic patient equipped with a left ventricular assistance device (LVAD) may constitute a cause for concern. We are reporting our observation on the subject.ObservationA 30-year-old hemiplegic patient presented with left hemiparesis secondary to a right middle cerebral artery (MCA) ischemic stroke having occurred during cardiopulmonary arrest. Persistence of major left ventricle dysfunction necessitated installation on 8 November 2011 of a mono-ventricular HEART-MATE II assistive device. Possible later recourse to cardiac transplantation would depend on clinical development. When admitted to a PRM unit on 18 January 2012, the patient presented with left hemiparesis and cognitive disorders. Virtually all members of the attendant medical and paramedical team were given instruction on the functioning of electrical power assistance systems. In spite of the complexity of the logistics, and notwithstanding the difficulty of managing potentially worrisome medical problems, multidisciplinary rehabilitation efforts were successful. The patient's improved condition led to the decision to undertake heart transplantation, which was carried out on 27 October 2012.Discussion and conclusionThis observation illustrates the undeniable role of PRM in decision-making and, more generally, in the opportunities that may arise in sensitive and challenging situations.