Biomedical Engineering Reference
In-Depth Information
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OT and SLP will discuss with parents options for a communication device and
skills needed for ZA to be successful in this area. The parents have expressed
an interest in using a device, and ZA seems motivated by voice output.
•
Complete AAC assessment with the SLP to determine the need for an AAC
device.
•
Trial the recommended AAC device and make a determination on the basis
of the trial results. Discuss funding options with parents and AAC company.
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Training plan for AAC device to ensure optimal use in all settings.
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Transitional needs
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ECI team to coordinate transitional AT needs when ZA is ready to attend the
preschool program for children with disabilities offered through her local spe-
cial education agency.
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Training of others involved in the care of ZA.
11.5.2 Case Study number 2: AB
11.5.2.1 Person
AB is a 59-year-old male who presented to the hospital with a left middle cerebral artery
(MCA) ischemic stroke. He was having dinner with his wife when he suddenly slumped
in his chair and was unable to move his right side and could not speak. The wife phoned
EMS and the patient was admitted to the local hospital. Upon admission, the physi-
cian reported a facial droop, complete paralysis in arm and leg, flaccid in arm and leg,
and global aphasia. The patient also appeared to have a visual field cut. The computed
tomography (CT) scan showed early MCA regional changes indicative of a large isch-
emic stroke. The patient's NIHSS was 2.3, and he received tPA at 2.35 h poststroke with
only minimal improvements noted. A referral was made to the rehabilitation team 24 h
after tPA.
Upon assessment by the OT and PT, AB was able to make some incomprehensible words,
understand gestures, and only inconsistently follow simple (one-step) commands. His
wife was present and stated that he was healthy before admission, playing golf in the
summer and indoor soccer during the winter. They have three adult children and two
grandchildren and are a close family. AB always enjoyed spending time (on an almost-
daily basis) with his grandchildren who live close by. AB works as a supervisor for a con-
struction company and spends most of his day in the office, but at times he is required
to drive to the various construction sites. His wife works part-time as an administrative
assistant at a local school and cares for both grandchildren each Wednesday and Saturday.
She appears to be having difficulty coping with her husband's illness and is worried about
the future because they were both looking forward to retirement and spending more time
w it h f a m i ly.
A physical evaluation showed that AB had difficulty with a shoulder shrug, and upon
testing the therapist was able to feel some resistance in the biceps, although the hand
remained flaccid. On the Chedoke assessment, the patient scored arm = 2 and the hand = 1.
With assistance, AB was able to roll to his right side by using the bedrail and only required
assistance from one person. During moving from lying to sitting, AB required a two-per-
son assist. He was unable to maintain his core sitting balance but once placed in midline
he could maintain his sitting for approximately 30 s. During therapy, AB fatigued after
approximately 10 min and was required to be transferred to a high-back wheelchair using
