Case Study: IPP Team Develops Rehabilitation Plan for Patient Recovering from Stroke

Work Setting: Health Care Work Setting: Private Practice

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Background

Three weeks ago, Ms. Riddle, age 78, went to the emergency department with an acute infarct to the left middle cerebral artery. Initially, Ms. Riddle’s prognosis was poor, and her family elected hospice. However, Ms. Riddle’s condition improved, and she became awake and alert. She was transferred to a nursing home and no longer qualified for hospice care. Ms. Riddle’s niece decided to pursue skilled therapy services for her aunt.

Ms. Riddle had right hemiplegia, dysphagia, and aphasia, as well as suspected apraxia of speech. She was a retired registered nurse who was widowed with no children. Ms. Riddle had been completely independent, but after the stroke, she needed assistance with all ADLs. Her nurse reported that her weight loss and skin turgor suggested dehydration, so Ms. Riddle was on a puree diet with nectar liquids.

Meet the Team

The interprofessional practice (IPP) team consisted of the following members:

How They Collaborated

At the initial meeting, the IPP team discussed and agreed on a plan to assess Ms. Riddle’s needs. The PT and OT would assess her mobility issues and ability to complete daily tasks. The SLP would complete a speech-language evaluation and set up a low-tech AAC system for Ms. Riddle to use. The RN would continue to assess Ms. Riddle’s tolerance of medications and monitor her symptoms. The team would also reach out to a social worker about obtaining the medical equipment that Ms. Riddle needed and would contact Ms. Riddle’s niece with any questions.

After the initial assessments, the team better understood Ms. Riddle’s needs; they devised a rehabilitation plan. The PT reported that Ms. Riddle lacked function in her right leg, and her left leg had natural muscle loss due to aging. Ms. Riddle was unable to self-propel her wheelchair, so the PT and SLP discussed mounting the AAC system on her wheelchair. The OT’s evaluation determined that Ms. Riddle could complete some basic daily tasks with maximum assistance. He followed up with the social worker about ordering a tray for the wheelchair. The SLP’s evaluation revealed that Ms. Riddle could follow one-step directions with occasional repetitions. She did not have functional speech but could use a low-tech AAC communication board.

Outcome

After 1 month of occupational therapy and speech-language pathology services, Ms. Riddle required moderate assistance to self-feed and required maximum assistance with toilet and bed transfers. She was successfully using the AAC board to communicate.

After 2 months, Ms. Riddle’s ability to participate in favorite activities had improved. She was able to feed herself 50% of the time. Her wheelchair enabled her to access her AAC communication board. Ms. Riddle did not have functional speech, but the SLP and the social worker collaborated to determine the viability of a speech-generating device.

At this point, the physical therapy department signed off with the plan to reevaluate Ms. Riddle after mounting the AAC device. The SLP signed off on the dysphagia aspect of treatment. The team felt that Ms. Riddle had maximum potential for chewing and swallowing. Rehabilitation would now center around helping Ms. Riddle better accomplish daily tasks and communicate using the AAC board.

Ongoing Collaboration

As Ms. Riddle’s rehabilitation continues, the OT and SLP continually reevaluate her care. They share their observations with one another and make recommendations to the team. The OT and SLP have weekly check ins and update Ms. Riddle’s niece regarding her feeding and swallowing status. The full team meets quarterly.

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