Great patient to work with. At this point, there is nothing YOU can do to SIGNIFICANTLY increase his awareness. I would educate him, if appropriate, and family, if available, about visual and verbal cueing, but I would NOT waste a lot of time doing this. Over time, the neglect may subside but I believe this is one of those areas that takes a great deal of time and sort of spontaneous recovery.
Are you a COTA or OT (this is why I ask people to include their credentials in messages). If you are the OT, I would change the goal to: "Patient will perform basic ADL's...". Don't limit the patient and your treatment to the neglect. Surely there are other things inhibiting the patient's independence. Make a list of the patient's "problems": physical, mental, emotional, environmental. Prioritize which of these problems are most significant AND that you have the ability to significantly improve. There is no use working on something that will not likely show significant change. My suspicion, is that you should be working on sitting balance. If the patient can sit, then work on standing balance, if the patient can stand, work on mobility. And no matter what, you must address the patient's emotional needs to be in control and have self-worth and dignity. In my opinion, this is best done through an honest therapeutic relationship. I believe that in "complicated" situations, the therapist MUST organize available information in a manner that allows them to address the most salient issues. We only have limited time with patients, so we MUST make best use of that time by addressing those issues which most impair patient's occupations. Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Diane Randall <spark...@rcn.com> Sent: Thursday, August 06, 2009 To: otlist@otnow.com <otlist@otnow.com> Subj: [OTlist] Massive new CVA patient DR> Hello, I have been given (along with 11 other patients I have) a new CVA DR> patient. I have never worked with someone tis impaired and i don't know DR> where to start. I am in a SNF and pt had been in an acute rehab for about a DR> month prior for therapy. He is Dependent for all ADL's and DR> transfers...sometimes hard to get his attention at all. Total left neglect. DR> Trouble following simple commands. 1 finger sublux. Just not sure where to DR> even begin. Goals are to increase attention to the left to perform ADL's DR> but is this relistic at this point and what activites can I do with him that DR> will encourge attention to left or attention to anything at all. Thanks DR> Diane DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com