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| 4.4e
Strategies to compensate for cognitive changes: Case
study C Q |
Case
study C: 20-year-old-man
This
20-year-old man suffered a hypoxic brain injury** as a result of attempted
hanging. At the time of his injury he had been working full-time as
a truck driver and was living on his own.
When
seen for assessment he was very polite, friendly and cooperative. He
answered questions simply, followed instructions precisely, and sometimes
needed additional prompting to continue with a task. (Essentially he
did exactly what he was told to do without question). This man wanted
to get better and believed that rehabilitation was helping him a lot.
A
neuropsychological assessment indicated that he:
-
had significant and generalised cognitive impairment
-
had a very short attention span
-
could not keep track of things
-
was very slow
-
registered only a small amount of information and repeating things
did not help him to learn more
-
was very poor problem solving
-
was disorganised
-
had a concrete thinking style
-
had severe executive dysfunction (cognitive inflexibility, poor self-monitoring
eg. rule breaking, limited generation of new ideas)
-
was poor at initiation
-
had limited insight about his cognitive difficulties.
However
he;
-
was able to follow simple, direct instructions
-
could remember the very small amount of information that he initially
registered
-
could complete simple problem solving and simple calculations.
**
Hypoxic Brain Injury occurs when the brain has been deprived of oxygen
to some degree. The person would be likely to suffer memory impairment
and severely slowed processing speed, with flexibility, self-monitoring
and visual deficits. They might also have a generalised dulling of cognitive
functions, and 'flat' or lack of emotions.
Questions
What
strategies could be suggested to assist therapy staff with this man’s
rehabilitation?
His
goal is to eventually live independently. What could you suggest to
help him achieve this goal?
Check your answers here
Strategies
for case study C: 20-year-old man
To
assist with his rehabilitation:
- Tasks will need
to be short and simple
- The ultimate
goal, or end point, should be broken down into smaller components
- Repetitive activities
to assist learning (procedural learning)
- Allowances made
for slow speed of processing
- He can only
engage in one activity at a time (don’t ask him questions during
meal
preparation)
- Keep instructions
short, or pause after specific points to ensure he is following
- Frequent reminders
may be necessary
- Have a daily
timetable which needs to be checked regularly
- He is likely
to require prompting to initiate a task and also intermittent prompting
to
persist with an activity (need will probably decline with time)
- Have clear guidelines,
or plan, for each activity that he can easily follow
- Possibly a period
of assessment and rehabilitation with a Transitional Living Unit.
Once
home he will need:
- some ongoing
assistance (meals, house keeping, carer hours)
- a regular daily/weekly
timetable of activities so a routine is established
- names of people
involved and location of activity written on timetable
- a white board
for important information and reminders
- a well organised
household – everything has its place
- a system for
paying bills (automatic, family, guardian)
- a system for
taking medication (e.g. blister packs, alarm, part of daily routine,
pill box).
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