Case Study 1

HPC: Found collapsed at her home. Investigations showed that she had suffered an Ischaemic Stroke. Initially this lady presented with significant weakness in her left arm and leg accompanied with sensory loss. Following a period of care in an acute setting she was admitted to The Dean. Upon admission residual left sided weakness remained (foot drop present), she suffered with left shoulder pain, required the assistance of two care staff for personal care/bed mobility/standing aid transfers and was dependent on an attended propelled wheelchair for mobility. She had taken a couple of steps with therapists previously but very little progress had been made to date. It was apparent that her mood/emotions (complicated by a history of ADHD, depression and anxiety) fluctuated greatly and would pose quite a challenge to her rehabilitation.

OUTCOME: This lady remained at The Dean for just over 3 months during which she received daily input from Occupational Therapy and Physiotherapy. Through liaison with the Multi-disciplinary team her medication was adjusted with marked improvement in her mood/emotional stability which optimised her participation in her rehabilitation. Upon discharge she was independent with bed mobility, required the assistance of one carer with personal care (mainly for the lower limb elements of this process but managed the vast majority independently), completed stand transfers to a wheeled walking frame, mobile with wheeled walking frame and close supervision 40-50 metres indoors/outdoors and could ascend/descend stairs with assistance of one. The left shoulder pain had improved considerably and she had recovered reasonable function of the left arm/hand. To coordinate a safe discharge for this lady and given the geographical distance from her home it was agreed amongst the team and with her, that admission to an interim step-down placement in her home location was appropriate. This would enable therapists to continue working with her on her long-term goals and support discharge home with the necessary equipment/care.

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