Therapist’s Application, Stroke – Jim’s Story

Therapy Blog

Because of a stroke (Left CVA), Jim was sent to Valley View Rehab Center for 2 months including rehabilitation by Occupational, Physical and Speech Therapy. Based on Tug (Timed up and Go balance Test), Modified Clinical Test of Sensory Integration in Balance (mCTSB), PT increased his walking balance from a Moderate Fall Risk to a Low Fall Risk. Occupational Therapy advanced him to Stand by Assist for toileting and he progressed in needing only occasional verbal instructions for basic Activities of Daily Living and Safety. At this point, Jim lacked gross and fine motor grasp and release of right hand, per 9-hole peg test and Fugl-Meyer Test (FMT). The ACL (Allen Cognitive Level Screen) was performed along with recommendations.

     Speech Therapy progressed him to regular food and thin liquids for swallowing precautions, and cognitive rehab was done with improvements seen in CLQT (Cognitive Linguistic Quick Test), ALFA (Assessment of Language-Related Functional Activities) and the MOCA (Montreal Cognitive Assessment).

     Motivational Interviewing was key in revealing his yearning to return home with his lovely wife and his desire to pursue more fun times with his grandkids. When the therapists learned of Jim’s affinity for playing and enjoying games, a Vertical Checkers game was designed and played from a standing position. Initially, a 2-person assist (PT and OT) was required for safety and standing balance. As his balance improved, demands, intensity and frequency on the therapeutic activity of how he moved were adjusted to be more challenging with game and game pieces strategically placed. Neuro Re-Education techniques were facilitated. A stopwatch was crucial in providing Jim with valuable feedback on duration of time he stood the previous day and to encourage him to predict how long he was going to stand in the current therapy session. YeeHa! The joy of victory was evident in his smile which stretched nearly the width of his face when the results surpassed even Kathy, the PT. He wasn’t shy in announcing his win in the Checker game, either, but no one seemed to mind.

     Originally, Jim required rest breaks every 3 minutes, and Speech along with dietary had nutritious snacks available, which Jim enjoyed as part of the social nature of playing games. Nursing was pleased as he was gaining weight. The RUG category of very high for insurance minutes was met for skilled treatment because Jim was engaged and motivated to improve his therapy scores and get home!

        In separate sessions, Speech Therapy was able to use the card game, “Go Fish” to increase receptive and expressive language skills and cognitive rehab. He was also encouraged to participate in “singing” music programs provided by the Activity Department. The therapist informed the nurse’s aides and family of the times and to use an ORANGE HIGHLIGHTER on the posted Activity Calendar. The stroke affected his vision and reading the calendar was easier due to “layout” modifications including “narrow” margins allowing for Larger print done in “Ariel” font.

The Resident Care Manager was informed and made these a part of his personalized, individualized care plan.