"there is nothing YOU can do to SIGNIFICANTLY increase
his awareness."
Agree with everything except this statement, because of what research
has taught us. Check out strokengine.com for specific evidence based
reviews on neglect training.
Chris Nahrwold MS, OTR
-----Original Message-----
From: Ron Carson <rdcar...@otnow.com>
To: Diane Randall <OTlist@OTnow.com>
Sent: Thu, Aug 6, 2009 6:59 am
Subject: Re: [OTlist] Massive new CVA patient
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
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