Pontine-Medullary Stroke Recovery Progress Tracker | Cavernous Malformation Hemorrhage Worksheet

Pontine-Medullary Stroke Recovery Progress Tracker | Mark Zauss, LMHC

Pontine-Medullary Hemorrhagic Stroke Recovery Progress Tracker

For stroke recovery after pontine-medullary hemorrhage due to cavernous malformation, ICU care, and surgery.

This worksheet tracks physical, neurological, cognitive, emotional, behavioral, and daily-function changes over time. It is designed to help clients, caregivers, therapists, and medical providers notice patterns, measure progress, and identify symptoms that may need medical follow-up.

Mark Zauss, LMHC, LPC, CCMHC, NBCC, BC-TMC, ASDCS, NATC, CCTP, CCTP II, ADHD-CCSP, C-DBT, C-PD
Double Board Certified Licensed Clinical Psychotherapist

How to Use This Worksheet

Scoring: Rate each symptom twice: Last Check-In and Today. A lower score means fewer symptoms or less impairment. Repeating this worksheet weekly can show whether the person is improving, stable, fluctuating, or worsening.

Score	Meaning
0	No difficulty / not present
1	Mild difficulty; noticeable but manageable
2	Moderate difficulty; interferes with functioning
3	Significant difficulty; requires help, rest, or accommodation
4	Severe difficulty; unsafe, disabling, or requires urgent provider attention

Clinical note: This worksheet is educational and does not replace medical care, neurology, neurosurgery, rehabilitation, emergency evaluation, or medication guidance. New or worsening neurological symptoms after brainstem hemorrhage should be treated seriously.

Worksheet Sections

Profile Red Flags Physical / Neurological Speech / Swallowing / Vision Fatigue / Sleep / Autonomic Cognitive Psychological Daily Function Goals Scores Sources

Patient / Recovery Profile

Patient Name Date of Stroke / Hemorrhage Date of Surgery Current Date / Check-In Date Current Recovery Setting

Current Care Team and Supports

Neurologist / Neurosurgeon Current Therapies Caregiver / Support Person Medication / Medical Restrictions to Remember

Emergency and Provider Follow-Up Checklist

Call emergency services or seek urgent medical care for sudden new weakness, facial droop, new or worsening double vision, severe dizziness with inability to walk, new slurred speech, choking or inability to swallow, sudden severe headache, confusion, loss of consciousness, trouble breathing, seizure, or rapid worsening of prior stroke symptoms.

Symptom / Concern	Check if Present	Notes / Date / Action Taken
New or worsening weakness, numbness, facial droop, or coordination loss
New swallowing difficulty, choking, coughing with meals, or aspiration concern
New breathing changes, sleep apnea concern, chest pain, or fainting
Sudden severe headache, seizure, confusion, or altered consciousness
Falls, near-falls, unsafe walking, or worsening vertigo
Severe depression, hopelessness, self-harm thoughts, panic, or trauma symptoms

Physical and Neurological Recovery Tracking

Domain A

This section tracks symptoms commonly associated with brainstem stroke, pontine-medullary injury, post-surgical recovery, and neurological rehabilitation.

Symptom or Function	Last Check-In	Today	Notes
Arm or hand weakness
Leg weakness or heaviness
Balance problems / unsteady walking
Falls or near-falls
Coordination, clumsiness, or tremor
Muscle stiffness, spasticity, or spasms
Numbness, tingling, burning, altered sensation
Headache, pressure, or post-surgical discomfort
Pain interfering with movement, sleep, or therapy

Speech, Swallowing, Vision, and Vestibular Symptoms

Domain B

Symptom or Function	Last Check-In	Today	Notes
Slurred speech or reduced speech clarity
Voice weakness, hoarseness, or reduced projection
Difficulty swallowing liquids, food, or pills
Coughing/choking during meals or aspiration concern
Double vision, blurry vision, or eye tracking problems
Nystagmus, eye movement discomfort, or reading difficulty
Dizziness, vertigo, motion sensitivity, nausea with movement
Sensitivity to light, noise, busy environments, or visual motion

Fatigue, Sleep, Autonomic, and Medical Regulation

Domain C

Symptom or Function	Last Check-In	Today	Notes
Physical fatigue / reduced endurance
Brain fatigue after conversation, screens, or appointments
Sleep disruption, insomnia, nightmares, or poor sleep quality
Breathing concerns, snoring/apnea concern, or shortness of breath
Blood pressure, heart rate, dizziness when standing, or faintness
Temperature sensitivity, sweating changes, or heat intolerance
Appetite, hydration, nausea, constipation, or medication tolerance

Cognitive and Communication Recovery

Domain D

Symptom or Function	Last Check-In	Today	Notes
Attention and concentration
Short-term memory and recall
Processing speed / mental slowness
Word-finding, organizing thoughts, or following conversation
Planning, sequencing, problem-solving, or task completion
Screen tolerance, reading tolerance, or cognitive overload

Psychological, Emotional, and Trauma Recovery

Domain E

A stroke, ICU stay, sudden loss of function, and surgery can create emotional trauma even when the person is medically improving.

Symptom or Function	Last Check-In	Today	Notes
Anxiety, fear of symptoms, or fear of another hemorrhage
Panic symptoms or body-based fear sensations
Depression, sadness, grief, or loss of identity
Irritability, frustration, anger, or emotional outbursts
PTSD symptoms: intrusive memories, nightmares, ICU memories, medical trauma
Hopelessness, helplessness, shame, or feeling like a burden
Motivation, confidence, willingness to practice rehab exercises
Social withdrawal, isolation, or reduced connection with others

Daily Living, Independence, and Family Function

Domain F

Symptom or Function	Last Check-In	Today	Notes
Bathing, dressing, grooming, toileting
Eating, drinking, meal preparation, or nutrition consistency
Walking inside the home safely
Walking outside, stairs, uneven surfaces, or community mobility
Household tasks, chores, medication organization, appointments
Work, school, driving readiness, or major role responsibilities
Caregiver stress, family communication, and support needs

Weekly Recovery Goals

1. Physical / Rehab Goal 2. Speech / Swallow / Vision Goal 3. Emotional Recovery Goal

Pattern Tracking

What improved since the last check-in? What worsened or fluctuated? What triggers symptom increases? What helps symptoms calm down?

Score Results

Total Last Check-In Score: 0

Total Today Score: 0

Change: 0

Progress Status: Not calculated

Interpretation: Lower scores indicate fewer symptoms or less impairment. A negative change means improvement. A positive change means symptoms are worse compared with the last check-in. Scores should be interpreted with medical context, not in isolation.

Domain Scores

Clinical Reflection

What should be shared with the physician, neurologist, neurosurgeon, or rehab team? What accommodations or supports are needed this week?

Patient-Friendly Summary of Pontine-Medullary Hemorrhage Recovery

A pontine-medullary hemorrhage affects the lower brainstem, an area involved in movement pathways, balance, eye movement, swallowing, voice, breathing regulation, blood pressure regulation, arousal, and communication between the brain and body. When the cause is a cavernous malformation, the bleeding comes from a cluster of fragile abnormal blood vessels. After ICU care and surgery, recovery may include improvement in strength, walking, swallowing, speech, vision, dizziness, fatigue, mood, and daily independence. Progress can be uneven. Good days and difficult days can both be part of recovery.

This tracker is designed to document small but meaningful changes, including physical function, psychological adjustment, medical trauma, fear of recurrence, fatigue, cognitive overload, and caregiver stress.

Educational Sources

American Stroke Association. Effects of Stroke. https://www.stroke.org/en/about-stroke/effects-of-stroke
American Stroke Association. Emotional and Behavioral Changes After Stroke. https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects
American Stroke Association. Cognitive Effects of Stroke. https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-effects
Winstein CJ, et al. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke. 2016. https://www.ahajournals.org/doi/10.1161/STR.0000000000000098
Alliance to Cure Cavernous Malformation. Rehabilitation. https://www.alliancetocure.org/care-community/care/rehabilitation/
Devereux N, et al. Evaluation and Treatment of Psychological Effects of Stroke. Continuum. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10494802/