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Twenty-five year old (DOB: 10/15/74) Mr. S is a
Caucasian male who is status post electrocution. Gleaning from records, on
July 26, 1999, while plugging in a play station to the back of a VCR
lightening struck the power line and surged through the family home
resulting in the client's electrocution injury. Initial diagnosis was
vertricular fibrillation, cardiac arrest and a brain injury. He was
transferred to Columbia Raulerson Hospital Emergency Room where he was
resuscitated, intubated and placed on a mechanical ventilator. He was
transferred to Tampa General Hospital for a 6-week stay and during this
period he was comatose for "over two weeks." Diagnoses included
anoxic encephalopathy (absence of oxygen) or hypoxia (decrease in
concentraion of oxygen) secondary to cardiopulmonary arrest, electrocution
and CNS injury. He underwent placement for a gastrostomy feeding tube
during his stay. He developed deep venous thrombosis of both upper
extremities, more on the right than the left. He was transferred to Health
South Rehabilitation where he had physical, occupational and speech
therapy. His brain injury resulted in motor, sensory, cognitive/behavioral
deficits.
During his recovery period at Health South
Rehabilitation, Mr.S was alert but unable to communicate and follow
commands. He had "significant increased tone and spacticity in all
four extremities. The patient demonstrated myoclonic seizures, and labile
emotions. His Phenobarbital was tapered off and an EEG was done to
ascertain seizure disorder. A modified barium swallow test demonstrated
difficulties in swallowing necessitating a therapy regiment for dysphagia.
Mr. S is appropriate for a 30-60 day intensive
neurocognitive evaluation and treatment course at the Florida Institute
for Neurologic Rehabilitation. During his stay he will be evaluated,
treated and followed by the neurologist and neuropsychiatrist. The
neuropsychologist will assess for higher cortical dysfunction using
standardized instruments and make recommendations based on cognitive
strengths and weaknesses for future treatment and vocational planning.
A comprehensive treatment plan will be developed based
on recommendations from speech and language pathology, occupational and
physical therapy. The department of vocational rehabilitation will
evaluate him for avocational and employment interests and future
possibilities. He will have a behavioral protocol to increase appropriate
pro-social behavior and decrease aggression, delusions and his demanding
nature.
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Health. Mr. S has moderate difficulty with
bladder and bowel management. He will need a bladder and bowel program
whereby he is reinforced for achieving steps towards volitional
control. He is on a peg-tube that will require monitoring. Because of
his disinterest in eating and weight loss his nutritional status will
require monitoring.
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Personal and self-care. Mr. S can accomplish
some self-help skills but needs help with others. He can wash his face
and hands but needs assistance shaving. Despite having a peg-tube, he
is able to feed himself especially when proctored. He will need
assistance for dressing, toileting, and while in the shower or
bathtub.
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Physical functioning and mobility. Mr. S is
able to move around while sleeping in aim of seeking comfort. He can
walk with maximal assistance but uses the wheelchair to locomote. He
will need assistance to transfer from the car, wheelchair and toilet. Mr. S will benefit from physical therapy to potentiate
his strengths, balance, coordination and endurance.
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Cognitive skills. Mr. S achieved a high school diploma
and has no medical problems prior to his accident. He will require a
neuropsychological evaluation to delineate residual sequelae commensurate
with his electrocution injury. Standardized testing will explain his
cognitive strengths and weaknesses for future vocational planning. His
assessment, because there is no previous neurocognitive assessment, will
cover a full range of brain function. Based on medical records, his level
of functioning is moderately to severely impaired.
He has severely impaired decision-making ability for
social, personal and financial. He is alert but cannot sustain attention
past a few moments. He is oriented to person only and can recognize family
members. He is unaware of the date and time of day. He cannot sustain
attention for complex conversations, learning or processing sophisticated
information. His ability for anterograde memory is severely impaired as
evidenced in his difficulty in storing and retrieving information that
would have been recently processed.
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Community integration. Mr. S is totally dependent on
others for basic entertainment and leisure time activities. He is unable
to manage and organize a budget or petty cash. He is unable to plan and
prepare meals or snacks. His skills for cleaning house or performing
chores are severely compromised.
Occupational therapy will, based on an evaluation, plan
a course to actualize his skills for independent living.
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Communication. Mr. S comprehends some conversations and
can convey his feelings, needs and some simple thoughts. It seems his
reading and writing was only moderately compromised by the anoxic
encephalopathy. According to records his speech is mildly impaired with
regards to articulation. He will have an assessment with the speech
department for a plan to improve his thought formation and articulation.
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Behavioral adjustment and Psychosocial. His wife
reports that he manipulates her into caring for him. He is generally both
verbally and physically aggressive. His impulsivity preempts his judgement
and insight; therefore he can be combative when angry. He has diminished
frustration tolerance and ability to delay gratification. He is anxious
and concomitantly depressed for which he receives anti-depressant
medication.
Mr. S will have a behavior protocol to increase his
frustration tolerance, impulse control and social participation. The
protocol will include decreasing arguing, self-injurious behavior and
general emotional lability.
In addition, a family education program will be developed in order to
ensure generalization of therapy goals and techniques to the home setting.
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