I am at the hospital cafeteria having lunch and my 43 year old patient is on my mind. The speech-language evaluation I just completed left me feeling like I needed more time with her to help her emotionally and cognitively.
Our interaction was brief and a non-standardized assessment was completed. There were notable executive functioning, memory, complex attention and pragmatic deficits. She described her deficits as “I just can’t remember things” and “I am not left alone at all”. Her awareness was mostly related to her memory. When asked how she compensates, she showed me the alarms on her phone and notepad to write passwords and take notes. As she was talking, she became frazzled and said “I have to go to the bathroom, but the bed alarm is on!”. And within the same fraction of a second she placed her feet on the ground and of course the alarm went off.
After she got help, I couldn’t help to notice her sheer sadness of being back in the hospital with another stroke. She had been through this before with therapy and had not seen a rehab clinician in 2 years. She talked about how she worked in hotel management and was now living with her brother’s family and watched TV all day.
The outpatient notes indicated that she just never came back. She stated that it wasn’t working for her and there were financial constraints.
What would you have done in therapy with her?
What would you do now?
What emotional support could we have given her after having a CVA at 40 years old?
I’m sure there’s a lot to give.
I am using this case not only critique but to show the cause and effect of how important the patient is in this scenario. Also, focusing on the research helps us potentially have better outcomes.
Let’s take a peak at the previous documentation:
The history and summary did not mention her interests, personal life or vocation.
A a goal centered approach could have tied in her cognitive goals to a function.
CLQT identified mild deficits in all areas except for moderate to severe memory deficits. Tasks such as generative naming and recalling 4 items in 5 minutes were addressed.
With memory this severe, Errorless learning and external aids with work on awareness is most recommended.
Lastly, her depression toward this situation and apathy was disconcerting. I gave her all I had available to me, active listening and the reassurance that counseling and cognitive therapy may help. I also messaged the doctor and case management and expressed my concerns.
After this situation, I got in contact with a mental health counselor that helps patients with neuro impairments cope, understand their diagnosis and improve their cognitive function. Jennifer Bommer M.A., LPC, CBIS owns Texas Neuro Trauma in Austin, Tx and she was a great resource and support. I will have the details of her interview soon.
