Psych aspects

Hello all,
I have come across an interesting patient on my neuro placement that I thought I would share with you. The patient is a lady in her 60s who has had a right cerebellar stroke.
She presented quite stangely for a cerebellar stroke patient- on testing there was no dysmetria or dysdiadochokinesia, but an obvious slowing of all movement (eg with finger-nose). She had a slight right sided tremor but only very occasionally. There appeared to be right sided weakness especially during gait- reduced foot clearance and step length, however on my initial assessment the difference between sides was only very slight.
Anyway- the patient was about 4 weeks post stroke and really hadn't been showing any improvements, in fact she seemed to be deteriorating (when the physio did an initial assessment on her straight after her stroke, 2 wks prior to me commencing this placement, there was no tremor and her finger-nose was a lot quicker). There also appeared to be anxiety issues, she was becoming increasingly teary and seemed very frightened about going home. When I got the patient into supine to re-test her right lower limb strength she could not even lift her leg off the plinth and would actively resist us if we tried to passively move the limb. The patient appeared to be in pain also- so we begun questioning whether perhaps there was some lumbar spine pathology. A CT scan was performed and showed nothing significant- so we were back to square-one. One day the patient would be lifting her right foot 15cm up onto a step, and the next day she could only lift it 2cm when asked, and would drag it during gait- there was just no consistency!
Anyway it was discussed at the team-meeting and the general consensus was that perhaps this patient's issues were more about psychology as opposed to physical. Her anxiety, day to day variation and apparent depression is now the team's primary focus.
Just goes to show that when things aren't adding up- we need to be prepared to take a step back and view the patient as a whole and collaborate with the other members of the medical team to determine what is really going on. We should never under-estimate the influence of a patient's psychological well-being as a barrier to rehab.