Case Study: Team Helps Head Injury Patient Address Hearing and Memory Issues
Work Setting: Health Care Work Setting: Private Practice
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Summary
An interprofessional practice (IPP) rehabilitation team developed a treatment plan for a 55-year-old man with memory and hearing loss, tinnitus, episodic vertigo, and headaches following a closed head injury. By working across specialties, the team created and executed a plan that helped resolve the man’s dizziness and address his hearing and memory problems.
Background
Mr. Roy, age 55, came to Edgewood Clinic after being diagnosed with a head injury. Mr. Roy fell out of a tree while boar hunting 2 months prior. He sustained a closed head injury and lost consciousness for 20 minutes. His symptoms, which he felt had worsened since his injury, included memory loss, word-finding problems, high-frequency tinnitus, difficulty understanding speech in noise, hearing loss, episodic vertigo, and headaches. He completed inpatient rehabilitation and was discharged to his home.
Meet the Team
The IPP team included the following members:
How They Collaborated
Each member of the IPP rehabilitation team evaluated Mr. Roy according to their specialty, with the PCP serving as the team facilitator. After they completed their assessments, the team members met to review the results together.
The audiologist found that Mr. Roy had hearing loss, moderate difficulty with speech in noise, and benign paroxysmal positional vertigo (BPPV). The SLP determined that Mr. Roy struggled with word finding and experienced memory deficits that were consistent with mild traumatic brain injury (mTBI). The neurologist reported that Mr. Roy’s CT scan was normal and that his MRI was consistent with changes typical of aging. His EEG was abnormal. The PT found that Mr. Roy had normal functional balance and that he tested positive for right posterior canalithiasis. The PT recommended a referral to an OT for tree safety education.
After discussing their assessments, the team developed a plan to resolve Mr. Roy’s dizziness, improve his hearing, address his memory and word-finding issues, and help him avoid future hunting accidents.
As part of the plan’s execution, the audiologist enrolled Mr. Roy in integrated sound therapy for tinnitus management and fit him for hearing aids. Mr. Roy’s hearing aids were also programmed with a secondary setting just for hunting. Mr. Roy also attended weekly 45-minute sessions with the SLP for 3 months and focused on word-finding and memory strategies. The neurologist followed up with Mr. Roy as needed, and the PT conducted repositioning therapy for right posterior canalithiasis. The OT worked with Mr. Roy on tree safety education and helped him obtain a harness to prevent future falls.
Outcome
The team followed up with Mr. Roy 3 months, after the first evaluation, to assess his progress. Mr. Roy reported satisfaction in using his hearing aids while hunting and playing poker and with his tinnitus treatment. He showed improved word-finding ability as well as improved quality of life using memory aides and other strategies.
Ongoing Collaboration
As the team facilitator, the primary care physician follows up as needed and communicates assessment results and plans with the other team members. The team meets weekly to discuss care coordination for several patients.
