Dianne - RE: your CVA pt. I work with client's like this quite regularly and there is heaps you can do. I feel that there is often a period post CVA almost like an amnesiac state where pt's aren't very attentive in general. It can last for 6-8 weeks sometimes. If you have a good medical team you could chat to them about this side of things as some medications can perk people up a bit out of this state. Also get them assess mood if you think that is an issue.
The first thing I do with stroke pt's like this is to try and sort their schedule to encourage periods of rest and activity, even if activity is sitting in a chair for 15 mins, instead of lying in the bed. He will need lots of rest for his brain to heal but needs to be encouraged to refocus on the world too. So get therapists to space out their sessions. So breakfast then rest, then shower then rest, then PT then rest, then SLT then rest etc etc. And I would arrange their room so their left side faces where people approach from, this will encourage him to take note of that side. Educate the client about their neglect and show them. "See how you can't see me but I'm here because you can hear me" and get their family to approach and talk to them from that side. I disagree with Ron in that I've seen people make huge recovery in terms of left neglect, partly through brain fixing itself and partly through compensation. Google the Lighthouse Strategy for later treatment approaches. And protect that shoulder with some positioning charts, education of nurses and family and get someone (an assistant) to do daily stretches. Once you've arranged their environment, given some education and sorted their daily schedule out you can begin in earnest. Treating all stroke clients should always be hierarchical. You need to have a look at the client's vision first and try and ascertain what their visual fields, acuity and perception are. If they can't see they won't attend. Then you want to assess attention - you can get some simple attention screens off the internet. If the client can't attend then they will have difficulty learning any new skill and you should work on attention. By this I don't mean left inattention but their overall ability to attend cognitively. I'd also do a general cognitive assessment to get a baseline too. Do an ADL assessment. See them in the shower and get them to do as much as they can. I find that often these clients get to me and no-one has even asked them to attempt to wash themselves, so they are fully D. Yes they are very disabled but I don't think I've seen anyone who can't wash their face, weak arm, thighs, tummy etc with their good hand with prompting. Most people can brush their teeth, comb their hair, help with dressing. They will like that they are being asked to do it. Concentrate on what they can do and feed this back to them. Then I'd start seeing them for showering a couple of times a week if I had the time or get an assistant to do it - working on improving their I with this. Often people really perk up when they realise someone is asking them to do something and believes that they can do it. No-one wants to be fully D for personal cares. In the meantime PT should be working on their transfers, trunk and sitting balance etc. As they make improvements there challenge them more in ADL's. That should keep you going for a while, sorry for the novel!! Angela Message: 14 Date: Thu, 6 Aug 2009 05:43:33 -0400 From: "Diane Randall" <spark...@rcn.com> Subject: [OTlist] Massive new CVA patient To: <otlist@otnow.com> Message-ID: <naepimfonjplidiahhemoebhceaa.spark...@rcn.com> Content-Type: text/plain; charset="iso-8859-1" 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 ##################################################################################### Scanned by MailMarshal - Marshal8e6's comprehensive email content security solution. Download a free evaluation of MailMarshal at www.marshal.com ##################################################################################### -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
