Case Study on Inpatient Rehabilitation

Running head: CASE STUDY
Part 2: Written Component
Name of the Student
Name of the University
Author Note

CASE STUDY1
Introduction
Inpatient rehabilitations are generally designed with the aim of providing assistance to
the patient for enhancing function, following a moderate or severe traumatic brain injury
(TBI) (Smith et al., 2020). TBI generally occurs when the brain suffers damage due to a
sudden injury and rehabilitation takes numerous forms, based on the preferences and needs of
the patient. Not only does rehabilitation improve functioning of the patient, but also focuses
on offering emotional and social support. This assignment will elaborate on a case study
involving a TBI patient Paula, and will elucidate on the rehabilitation goals and discharge
planning.
Three key goals
Three issues related to inpatient rehabilitation that the patient wants to accomplish at
the end of his inpatient journey are namely, (i) dysphasia, (ii) dysphagia, and (iii) impaired
mobility. Dysphasia refers to the condition that affects the capability of a patient to
understand or produce spoken language (Cipriani, Chilosi & Bottari, 2018). Though confused
with speech disorder, this language disorder typically occurs when the regions of the human
brain that are concerned with transformation of thoughts to spoken language, fail to function
in an appropriate manner. The condition is a direct manifestation of brain damage to the
region responsible for language and speech (Eaton, 2019).
The Progressive Aphasia Severity Scale will be used for addressing this goal owing to
the fact that it will facilitate gaining a sound understanding of the severity and presence of
symptoms across a range of domains related to language, speech, pragmatic, and functional
aspects of communication of the patient. Speech and language therapy will prove effective
for this patient by assisting him in management of communication. The therapy will typically
involve initial assessment of the communication problems following which the therapist will

CASE STUDY2
work on the personal communication goal (Nickels & Croot, 2017). Not only will the
intervention help in restoration of much of his language and speech, but will also increase his
participation and activity by encouraging him to converse, to the best of his expertise. The
patient will also be able to explore alternative communication strategies like aids, thereby
gradually recovering from dysphasia (Carlson et al., 2016). This intervention would require
collaboration of the occupational therapist, nurse, and speech therapist. The speech and
language therapist (SLT) will work to assess, prevent, diagnose and treat all kinds of
impairment in social communication, language, and cognitive communication faced by the
patient.
The second issue of dysphagia refers to swallowing problems and it encompasses the
sensation about problems during passage of food from mouth to stomach or absence of
pharyngeal sensation (Daniels, Huckabee & Gozdzikowska, 2019). The condition has
occurred as a result of injury to particular regions of the brain, and to the muscles located in
the face, head and neck. The primary intervention would focus on subjecting the patient to a
non-instrumental swallowing assessment that will facilitate identification of different
parameters affecting swallowing and the contextual factors acting as facilitators or barriers to
successful swallowing (Heckathorn, Speyer, Taylor & Cordier, 2016).
SLTs and dieticians will collaborate with the nurse while addressing this goal. A
range of swallowing therapy techniques shall be used for the patient, together with exercise
that will trigger swallowing reflex and promote strengthening of muscles that are used for
swallowing and chewing (Bath, Lee & Everton, 2018). Dieticians will help to overcome the
deficits occurring due insufficient nutrition and will also recommend nutritional supplements.
Feeding tubes will also help in swallowing by directly introducing the food and medicines in
the mouth (Souza et al., 2019).

CASE STUDY3
TBI generally result in decreased balance, muscle weakness, contractures, spasticity,
and poor motor skills, all of which contribute to impairment in mobility. Not only does this
impairment result in a reduction in endurance and strength, but also increases the risk of
patient to suffer from secondary complications like wounds and respiratory disorders
(Barbosa, Casagrande & de Andrade Freitas, 2018). Therefore, the primary goal would be to
conduct an assessment for activities of daily living (ADL) that will provide a clear idea about
the highest level of functioning of the patient in relation to feeding, toileting, dressing,
grooming, and physical ambulation.
Interventions would focus on providing walking aids like canes, walkers, or crutches,
subjecting the patient to physiotherapy, and passive range of motion (ROM) exercise. Not
only will physiotherapy promote self-esteem and confidence but will also create the provision
for easy navigation and quick recuperation. ROM will improve circulation, enhance muscle
strength, decrease pain, improve physical performance, and decrease stiffness (Uyar & Yakşi,
2017). Physiotherapists, occupational therapists, and nurses will collaborate while
implementing this intervention. While the nurse will look after the basic needs of patient in
rehabilitation, the occupational therapist will ensure that the patient is able to function
appropriately in the environment, with his abilities. Physiotherapist will maintain, restore and
make most of the function, mobility and wellbeing of the patient.
Discharge planning
Good discharge planning plays an important role in the recovery of patients who have
suffered from TBI. According to Ulin, Olsson, Wolf and Ekman (2016) comprehensive
discharge planning is required owing to the fact that it considers the entire domain of
healthcare needs of patients and also incorporates the feedbacks and inputs from both patients
and their family members. Discharge planning helps in decreasing the rates of preventable
readmissions that not only enhances clinical excellence but also guarantees the hospital’s