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Toni Talks about PT Today

My Little Old Man With the Brain Injury

Published August 6, 2014 3:31 PM by Toni Patt

Currently I have an elderly gentleman with a traumatic brain injury from a fall. One version says he tripped over his dogs. Another says he had a seizure. Either way he hit his head on the way down, developed a bleed and had a craniotomy. The man was clearly ambulatory and functional prior to his injury.

I'm not getting anywhere with him. It took a while for him to wake up. It took a little longer for his aphasia to improve. Lying peacefully in bed, he can speak in complete sentences most of the time. In fact he is pretty well behaved until I try to move him.

He has perceptual deficits and possibly a right visual field cut. He's a little weaker on the left compared to the right. Those are all things I can deal with. The problem is the premorbid alcoholism. According to his chart, he averaged a bottle of vodka a day. Add that to some dementia. As soon as I try to move him, he fights me.

About every third day he is relatively clear. He sits EOB with SBA. He follows commands. He even stands with assist. I could have him walking if not for the confusion and combativeness. His sitting balance is good enough for a w/c but I can't put him in one. Someone would get hurt in the process. Every day I stand in his door and try to figure out what to do.

He will discharge to a SNF, where if his behavior continues he will become bed bound. Everything I could want in an ICH patient is there except for the cognition. How many times is it the other way around? Usually I have patients who can participate but lack motor activation.

My tech is a real sport about this. He gets the brunt of the resistance. Yet he still smiles and says okay if I want to try sitting this guy up. We can't do this much longer. We're getting beaten up. Pretty soon I'm going to have to accept there is nothing I can do about this.

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had a patient on caseload with similar diagnoses recently. assuming he is no longer drinking, detox from alcohol is supposed to take 3to 4 days. in my experience it will be a few weeks before the behaviors significantly improve. after a couple of months you wouldn't even recognize the pt. my patient is now on restorative and walking up to 100 feet with R/W, min@. Is there any way you can put him on hold for a few weeks, then reassess?

Celia Byrnes, sNF - PTA, GS August 6, 2014 6:25 PM
Quad cities IL

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