Case Study: Team Uses Therapy and Smartphone App to Help a Woman Recover After a Fall
Work Setting: Health Care Work Setting: Private Practice
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Summary
A 65-year-old woman experienced general weakness, balance issues, and speaking difficulties after a fall. A team of professionals developed a plan, which explored low-cost options for increasing intelligibility and providing strategies for communication. The team helped her use a speech intelligibility smartphone app to improve her pitch, volume, and overall intelligibility. After 4 weeks in a rehabilitation facility, the woman’s communication skills returned to their previous levels.
Background
Georgia was a 65-year-old woman who lived independently with her husband. She reported not feeling well during the first week of April. On April 19, she fell in her home, was found unconscious by her husband, and was admitted to a hospital. Medical evaluation revealed no broken bones. She was diagnosed with a urinary tract infection (UTI). Doctors determined that confusion resulting from the development of the UTI caused the fall. Georgia was transferred to a skilled rehabilitation facility.
Georgia’s family—her husband and daughter—had never experienced this type of traumatic event before. Although they understood that the rehabilitation process was necessary, they were anxious for her to return home.
Georgia experienced pain and had severe bruising from the fall. Her family and the staff at the rehabilitation facility was especially concerned about the fall’s impact on intelligibility of her speech. Two certified nursing assistants (CNAs) reported that Georgia verbally communicated very little about her wants and needs. Georgia’s family members reported that she was comfortable using a smartphone to communicate with her grandchildren and to participate in social media such as Facebook.
The speech-language pathologist (SLP) knew that she needed to obtain additional information—beyond the motor speech and cognitive communication evaluations—in order to provide Georgia with a full diagnosis and treatment recommendations. However, the SLP found herself in a frustrating situation. The skilled nursing facility had no funding to support an additional assessment related to speech intelligibility. And the SLP did not want to settle for a diagnosis of “cognitive decline.” The SLP decided to reach out to a speech scientist at the local university, to explore low-cost options for assessing Georgia’s speech production. The goal was to increase Georgia’s intelligibility and provide her with strategies for communication. The SLP shared this plan with the IPP team.
Meet the Team
The initial team that reviewed Georgia’s medical and family histories and developed the skilled therapy assessment plan included the following professionals:
How They Collaborated
The IPP team met to share the findings of their initial assessments. In general, these revealed that Georgia’s receptive language and expressive language were within normal limits, as were her measures of cognition, cognitive communication, and oral mechanism. Georgia showed good skills as related to turn-taking and following instructions. During an acoustic analysis of Georgia’s speech sample, the speech scientist found that there were limited performance ranges of pitch and volume that negatively impacted speech intelligibility. The OT reported that Georgia showed no difficulty with basic fine-motor skills (e.g., eating, manipulating small items), had good fine-motor sequencing, and experienced difficulty with body positioning for activities of daily living (ADL; due to pain and soreness). The PT found that Georgia’s general weakness limited standing and walking to short periods of time. She had difficulty with balance but showed good awareness in following multistep directions.
After sharing their assessments, the members agreed upon a set of recommendations, all of which included the participation of Georgia and her family. The SLP and speech scientist recommended identifying and teaching Georgia to use speech intelligibility apps. These would help Georgia increase her pitch and volume for better intelligibility. The SLP would use the app as a therapy tool. The OT and PT would incorporate balance and self-help skills into their plan for Georgia, and the SLP and OT would work together to develop her fine-motor skills for using the apps.
The entire team discussed and identified activities and situations in which Georgia could use the therapy goals in optimal ways throughout the day.
Outcome
Over 4 weeks, Georgia made consistent progress on her skilled speech-language pathology, occupational therapy, and physical therapy goals. All of Georgia’s skills returned to their pre-fall levels. Initially, Georgia did not want to use a smartphone because she said it would be “too hard.” However, after working with the SLP and her daughter during the initial session, the IPP team reached consensus that it would be a good idea to try. After she began using the smartphone apps, Georgia’s speech intelligibility improved relatively quickly.
The family was encouraged by Georgia’s progress and asked for additional online resources, which included informational reading and interactive software. This would enable Georgia and her family to continue her treatment following Georgia’s discharge from the facility. The SLP and the speech scientist developed a list of free online resources for the family. Both the OT and the PT provided informational resources related to balance and self-awareness.
Ongoing Collaboration
During Georgia’s stay in the rehabilitation facility, the IPP team met weekly to monitor her progress and update her family about her areas of improvement. However, after Georgia met her therapy goals, she was discharged from the facility and returned home with her husband. The IPP team did not meet again after her discharge.
