In contrast to Ron, I think there are some things to be done to address the neglect...and it is important to work on this, so that function can become a reality. Positioning in the wheelchair (where the patient will spend most of his day) is very important. Use of some type of arm board, or support, so that the left arm has some weight bearing through the shoulder (also helps with the shoulder problems), provides some stimulation to this side of the body, and keeping the arm as much as possible in the visual field of the patient help the patient regain awareness of it. Consistently encourage the patient to be responsible for where his left arm/leg are, and to take care of those parts of his body. Positioning of the bed and in the bed is also important. If everything is kept to the right side in his room, and he is never positioned where he has to look to the left, then the room is just a place to be rather than the room itself being therapeutic. If he likes to watch tv, and it is able to be moved...place it in his field of vision and then day by day move it farther to the left. Encourage and educate the family to provide stimulation from the left also...
I do agree that sitting balance and trunk control are the beginning of a lot of function....so I would do a lot of work on basic bed mobility, rolling, bridging, transfers, trunk control, balance, weight shift, etc...all with functional components...while sitting you can practice grooming, dressing, etc. that all challenge balance. You can also do some higher level reaching tasks (without cones !)...by having him maybe writing on a write-on wipe off board with his good hand while balancing on the mat...and this can be encouraging the awareness of the left also...weight bearing through the left arm/hand while sitting will help with balance and increase awareness...basic NDT techniques are a lot of what I would be doing...especially to facilitate the trunk control, weight shift, balance, etc that will allow for better function... Hope that helps.. Linda Linda Stovall, OTR/L lstov...@mhg.com Program Manager Memorial Hospital at Gulfport Comprehensive Medical Rehabilitation Program 228-867-4179 228-867-5357 (fax) 228-883-8443 (beeper) A CARF (Three-Year) Accreditation was awarded to MHG for the following programs: Inpatient Rehab - Adults, Adolescents, and Children Inpatient Rehab- Stroke Specialty >>> "Miranda Hayek" <mltaylo...@hotmail.com> 8/6/2009 6:05 AM >>> Diane, you could try engaging him in very basic ADL's, such as combing hair, washing face, brushing teeth. This will focus on following one step commands, engaging in ADL's, which would hopefully improve is self-worth, maybe some neglect issues (where you would cue him to comb the left side of his head,etc. ~ Miranda ~ > From: spark...@rcn.com > To: otlist@otnow.com > Date: Thu, 6 Aug 2009 05:43:33 -0400 > Subject: [OTlist] Massive new CVA patient > > Hello, I have been given (along with 11 other patients I have) a new CVA > patient. I have never worked with someone tis impaired and i don't know > where to start. I am in a SNF and pt had been in an acute rehab for about a > month prior for therapy. He is Dependent for all ADL's and > transfers...sometimes hard to get his attention at all. Total left neglect. > Trouble following simple commands. 1 finger sublux. Just not sure where to > even begin. Goals are to increase attention to the left to perform ADL's > but is this relistic at this point and what activites can I do with him that > will encourge attention to left or attention to anything at all. Thanks > Diane > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com _________________________________________________________________ Express your personality in color! Preview and select themes for Hotmail®. http://www.windowslive-hotmail.com/LearnMore/pe rsonalize.aspx?ocid=PID23391::T:WLMTAGL:ON:WL:en-US:WM_HYGN_express:082009 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
