I agree with what the other posts have suggested. It is difficult when there is very little response from the patient. I would start with making sure his environment is therapeutic to him. Inculding wheelchair positioning, bed positioning, room changes, education to patient, family, and staff to encourage patients attention to the left. Activities that encourage crossing midline with the right side of his body, even if this is done passively. Sitting balance, weightbearing through the shoulder, tactile stimulation to the left side of his body, visual tracking exercises. During dressing he may be dependent, but verbal education throughout making him a part of the activity is important. Instead of having staff doing stuff TO him, they will be doing these activities FOR him. Make sure there is good lines of communication between all staff and family.
Hope everyones suggestions gives you somewhere to start, let us know if you have any other specific questions as time goes on. :) Amber > Date: Thu, 6 Aug 2009 07:44:45 -0500 > From: lstov...@mhg.com > To: otlist@OTnow.com > Subject: Re: [OTlist] Massive new CVA patient > > 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! 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