62-year old male presenting with communication and cognitive difficulties after suffering from a left hemisphere stroke on the 8th of February. At the time of his stroke he was a self-employed painter and decorator and was living with his adult son. He liked to be busy, living an active social life with friends as well as his partner and would often go to watch his favourite football team Southampton FC. Other hobbies included reading, selling football memorabilia at auctions and car boot sales, and walking his dog.
●Moderate cognitive impairment impacting higher level executive functioning as well as working memory and attention
●Limited insight into the future
●Receptive and expressive aphasia impacting his ability to hold everyday social conversations
●Difficulty with comprehension of written and spoken words
●Unable to consistently express correct words and phrases
●Unable to copy written letters
●Required assistance using unfamiliar objects in new environments, going shopping, making a microwave meal and following instructions
●Required assistance with money management
●Reduced ability to recognise problems and evaluate them appropriately
●Support with making breakfast, hot drinks and meals
●Apraxic tendencies when completing functional tasks with difficulties following instructions
Clinical Neuropsychology
●Cognitive assessments completed
●Cognitive rehabilitation
●Brain injury education for him and his family with the focus of improving their understanding of his impairments
●Process training for attention and working memory deficits
●Practicing and implementing compensatory cognitive strategies with a focus on increasing independence in functional home and community-based tasks
●Assessment and monitoring of mood
●Supporting emotional adjustment to living with stroke impairments
Speech and Language Therapy
●Practice of functional numeracy skills, worked jointly with Clinical Neuropsychology to improve fluency and accuracy of numbers
●Practice and implementation of using speech assistant app to support communication
●Practise using Tactus app to practice language
●Practice and implementation of using paper and pen to support verbal communication
●Practiced use of alphabet chart to self-prompt expressive language
●Role playing including phone calls to GP and scenarios around buying/selling at car boot sale and community scenarios
●Practicing and implementing strategies for writing emails and text messages
●Introduced strategies to support word finding difficulties e.g. ‘talking around’ words, using gestures
Occupational Therapy
●Meal preparation practice
●Road safety assessments
●Functional use of money
●Graded support using public transport moving towards independence
●Multiple errands tasks
●Self medication practice
●Joint process training with Clinical Neuropsychology
●Graded discharge including increased time at home with functional tasks (meal preparation, laundry, hot drinks, computer access, etc)
Physiotherapy
●Initial assessment completed
●Patient was fully mobile and independent therefore did not require intensive physiotherapy input
Functional Ability on Discharge
●Improved insight into cognitive difficulties and was able to implement cognitive compensatory strategies
●Improved ability to self-initiate, plan, problem-solve and organise to successfully complete functional activities independently
●Accessing the community independently using public transport
●Independently caring for pets at home
●Independent in completing domestic activities of daily living including laundry, meal preparation, shopping, walking the dog and logging onto online therapy sessions
●Independent with all appliances at home
●Able to hold improved conversations with friends and other members of the communityhttps://hobbsrehabilitation.co.uk/case-study/14062/
●Able to read short newspaper articles in his head and answer questions by verbally reporting back
●Increased confidence using speech and language compensatory strategies in the community
●Developing more consistent ability to say complex numbers which has improved his money management
