Case study left CVA
Daytime Home care Services / Assistance
A home care service provider could be a valuable resource for this patient and their family since the patient has to be home alone until her daughter gets off of work at 5:30. Services that are available would include; 1) Personal care assistance with activities of daily living (ADLs) such as hygiene, bathing and grooming; 2) dressing, transferring, positioning, and mobility/ walking; 3) using the toilet/ incontinence, 4) eating, 5)Personal care assistance with instrumental activities of daily living (IADLs) such as meal planning, cooking, light housekeeping, laundry, pet and plant care, transportation, errands, shopping, doctor and other appointments. 6) Lastly companionship ? encouragement, interpersonal cognitive stimulation, facilitation of physical activity, and intervention for loneliness and depression.
Left CVA Receptive Aphasia (Fluent)
Also referred to as Wernicke's aphasia because of the area of the brain affected, receptive aphasia is demonstrated when the person can hear or read a language but is unable to comprehend the meaning behind it. Sometimes their own speech gets churned into non-sense sentence structures or they take speech very literally
Left CVA CAREGIVER IN FORMATION
Aphasia Aphasia is a language disorder that can result in a wide variety of deficits. Expressive aphasia otherwise known Broca's aphasia results in difficulty speaking but has no effect on the ability to understand the speech of others. Be patient-Reduce environmental distractions-Ask yes or no, or forced choice questions Allow adequate response time to questions without interrupting Observe and respond to nonverbal communications (body language, gestures)- Let the individual know you do not understand, take a break if needed to avoid causing unnecessary frustration.
Adaptive equipment
Bedside commode extended reacher rocker knife Dycem pads-plates with rim guards-one handed cutting board alphabet and picture boards for aphasia Front wheeled walker
Left CVA
Bedside commode extended reacher rocker knife Dycem pads-plates with rim guards-one handed cutting board alphabet and picture boards for aphasia Front wheeled walker
Left CVA treatment /aphasia
Focus on the Cognitive Deficits Without neglecting other impairments, the OT needs to make the cognitive deficits a priority. Pull out relevant standardized tests that you are comfortable with administering to your patient. Bring out compensatory strategies such as picture books, communication boards, and auditory aids.
Left CVA HOM E M ODIFICATION S & SAFETY
Keep commonly used items at counter top level and within easy reach-make sure all areas have good lighting Keep phones, cordless if possible, within easy reach Keep any needed assistive devices such as walkers within reach Ensure doors are wide enough (32 inches) and hallways (36 inches) to allow easy wheelchair access-lower cuppards or move items closer to counter top level-remove floor covering that could be a hazard such as throw rugs
Left CVA
PRECAUTION S-Falls Poor balance due to right sided weakness or Hemiparesis (partial motor loss) Sensory deficits Individuals may neglect or be less aware of the affected side of their body putting them at risk for injury (Getting hand caught, burns, etc.). Stroke patients can be prone to impulsivity and may disregard safety rules or attempt actions they are not ready for such as walking that can put them at risk for an injury (More common with RCVA patients).
Global Aphasia Left CVA
The affected person has a severely limited capacity for reading, writing, and speaking. The damage is extensive and often occurs to both Wernicke's and Broca's area of the brain. Although people with global aphasia can improve, the rate and extent of improvement really depend on the severity of the brain damage
Left CVA Bed positioning-Supine (On the back)
The head should be well supported on a pillow. The affected arm should be supported on a pillow as well with the palm facing down and the arm slightly away from the body. The affected hand should be elevated with a pillow to avoid swelling. If the affected leg is stiff a towel may be placed under the knee. The affected foot can also be supported if it is weak.
Left CVA Aphasia is a language disorder
The intelligence is still completely there it is just kinda useless because of the fact that the communication cannot come out correctly. Having conversation back and forth, Use picture board and let the patient identify pictures and shapes. Knowing words saying words, even understanding words. If it is very severe we need to use a communicating device. Drawing, gestures, and writing can all help therapist communicate with aphasia patient.
Anomic Aphasia Left CVA
The person struggles or is unable to find the right words for speaking or for writing. Typically, they can't seem to find nouns and verbs and frequently use vague, filler words ("thing", "stuff", etc.). The person will sometimes demonstrate circumlocution, in which they start describing the word they are trying to identify
Left CVA Expressive Aphasia (Non-fluent)
This is also referred to as Broca's aphasia. The affected person knows, in their mind, what they want or what they want to say but when it is communicated the words (verbal and written) come out in shards. Commonly, the patient will utter single syllable sounds/words or sometimes nothing at all.
Left CVA Transferring the Patient
To perform a squat transfer prepare the wheelchair, bedside commode, etc. and move it as close to the transfer surface as possible. Have the patient assume a sitting position by rolling onto her side and then swinging her legs over the edge of the bed. Have her scoot to the edge of the bed so that her feet are firmly planted on the floor. Support the affected arm at the elbow and have her extend her lower back. Next provide support with the knees on both of her sides and stand with one foot forward. Shift your weight backwards and pivot towards the desired surface rocking forward to set the patient down.
Exercise Program left CVA
1. Knee extensions From a seated position, extend your left leg until it ?s parallel to the floor. Avoid locking your knee. Then, slowly bring your foot back down to the floor.Repeat with your right leg, alternating back and forth between legs for a total of 20 repetitions (10 on each leg). 2. Knee to chest-From a comfortable lying position, bring you right leg into your chest. At the top, give your core squeeze, then bring your leg back down.Focus on engaging your core to do this movement instead of your leg. Repeat on each leg a total of 10 times. 3. Bicep Curls-Start with your elbow on a table with your arm bent at 90 degrees. Then, curl your arm up just a little, and then release it back down just a little. Slowly repeat 10 times.The upward motion activates your bicep, and the downward motion activates your triceps. Both are equally important, so focus on them equally, too. 4. Weight Bearing Lean- From a seated position, prop yourself up on your affected arm about one foot away from your body. Then lean into it.If it feels good, feel the stretch for 10 seconds or so. And if it doesn't feel good, stop the stretch immediately. After 10 seconds or so, place your other arm out beside you so that you?re supported by both arms. Then rock from side to side, shifting your weight from one arm to the next. 5. Pen Spin- Place a pen on the table and use your affected fingers to spin it. Try not to use your shoulder during this movement. If you can, try to spin the pen quickly 15 times.
Left CVA Aphasia Modify Their Own Communication Style
Make sure you have the person's attention before you start. Minimize or eliminate background noise (TV, radio, other people). Keep your own voice at a normal level, unless the person has indicated otherwise. Keep communication simple, but adult. Simplify your own sentence structure and reduce your rate of speech. Emphasize key words. Don't "talk down" to the person with aphasia. Give them time to speak. Resist the urge to finish sentences or offer words. Communicate with drawings, gestures, writing and facial expressions in addition to speech. Confirm that you are communicating successfully with "yes" and "no" questions. Praise all attempts to speak and downplay any errors. Avoid insisting that that each word be produced perfectly. Engage in normal activities whenever possible. Do not shield people with aphasia from family or ignore them in a group conversation. Rather, try to involve them in family decision-making as much as possible. Keep them informed of events but avoid burdening them with day to day details. Encourage independence and avoid being overprotective.
CLIENT DESCRIPTIONPatient is a non-am bulatory 66-year-old fem ale. She suffered a stroke 5 weeks ago and is being discharged home with her 45 year old daughter after spending that time in rehab. He daughter works during the day but is home by 5:30 every night to assist with her mother. Her m other needs to be able to make her breakfast and lunch and toilet herself when her daughter is out. She is expressive aphasic. She was a professional cook prior to the CVA and has no cognitive deficits.
W HAT TO EXPECT The left hemisphere of the brain is primarily responsible for language, time concepts, and analytical thinking. Individuals with left sided brain damage will often experience aphasia (loss of ability to understand or express speech) and apraxia (inability to perform particular motor actions). L CVA patients often achieve self care independence sooner than individuals with Right sided dam age however, they are at a greater risk for developing depression.
