Rehabilitation

This article discusses rehabilitation through two case studies. The first case study focuses on a stroke patient and explores the use of culturally appropriate assessment tools such as the Berg Balance Scale and the Nottingham Extended Activities of Daily Living Scale. The second case study highlights the involvement of a dietician, physiotherapist, and psychotherapist in supporting a patient with a compression fracture. The effectiveness of assessment data for each case study is also discussed.

Running head: REHABILITATION
Rehabilitation
Name of the student:
Name of the University:
Author’s note

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Case study 1:
The case scenario is about Meri, a 54 year old widowed Maori New Zealander based in
Rotorua, who was admitted to hospital following stroke. Her team of multi-professionals are
assisting her to move from acute unit to the rehabilitation unit. The current health concerns for
Meri include restricted mobility, fatigue, aphasia and limited use of right hand. To identify
appropriate rehabilitation needs for the case study client, there is a need to identify culturally
appropriate assessment tool as the patient is from a specific ethic background called Maori
people. Two culturally relevant assessment tool identified for Meri includes the Berg Balance
Scale and the Nottingham Extended Activities of Daily Living Scale (NEADL)
The Berg Balance scale is a tool to collect objective data related to patient’s ability to
safely balance during series of task. The tool has been developed for the population group of
patients with acute stroke and elderly patient with balance impairment. Although it was earlier
designed for quantitative assessment of balance in elderly patients, it has a now become a most
commonly used tool for assessment of safe and unsafe activities in patients after stroke (Blum &
Korner-Bitensky, 2008). The tool has is a 14 item questionnaire that only evaluates participant’s
function in different activities based on five-point ordinal scale. The equipments required for
completing this assessment involves a ruler, 2 standard chairs, step, fifteen foot walk away and
stop watch. During the test, participants are asked to maintain a position for specific time period
and a score of 56 indicates functional balance. Furthermore, score of less than 45 indicates
greater risk of falling and balance impairment (Makizako et al., 2015).
The use of this tool is appropriate for Meri because she is a patient with stroke diagnosis
and evidence shows the validity of the tools in terms of use in stroke patient. Middleton et al.
(2017) gives the evidence that individuals with chronic stroke experience difficulty in walking
and BBG data is used to evaluate level of functional impairment and walking ability in patient.
has It is a reliable tool to determine rehabilitation needs of patient as it has high internal validity
and reliability (La Porta et al., 2012). In addition, it can be used for culturally diverse client like
Meri who is Maori women because the tool does not interferes with the cultural values of the
group. There are many evidence regarding the use of the tool in culturally diverse groups such as
Greek people and the Iranian patients (Azad, Taghizadeh & Khaneghini, 2011). Hence, the tool

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can help the multidimensional team of Meri understand level of balance impairment and the way
to increase walking speed gradually.
The second tool NEADL is a tool to assess patient’s independence in activities of daily
living by analysis of four areas of daily life activities such as mobility, domestic, kitchen and
leisure activities. This scale consists of 22 items related to the four domains of daily activities
and it item is scored based on 4 point scale (0 rating for unable to do the activity and 3 rating for
ability to do the activity). High score in the tool is an indicator of greater independence in daily
life activity and the maximum score possible for the tool is 22. The significance of this tool in
rehabilitation is that it is a simple tool requiring no additional effort and just collection of data
related to mobility, domestic, kitchen and leisure scores. Taking response from participants
regarding each item is appropriate to give scores and conduct assessment of patient’s
independence level (Wales et al., 2018).
The main rationale behind using the NEADL tool for Meri is that it is an evidence based
tool that whose validity has been established in patients with stroke. Sarker et al. (2012)
compared NEADL scale and Barthel Index for comparison of extended activities of daily living
in stroke patient and revealed that NEADL scale is a concurrently valid tool with no floor and
ceiling effects. As the sensitivity of the tool has been provided, it will help the multi-professional
team of Meri understand level of independence of Meri in mobility, domestic work, leisure
activity and food preparation related work. Based on the assessment using this scale, the medical
team will able to understand how much support is required by patients during daily life activities
and rehabilitation plan can be developed accordingly. In addition, the tool is also valid
considering the cultural background of Meri because modified version of the tool is available
that addresses cultural relevance (Wu et al., 2011). Hence, as NEADL tool has been prepared
considering cultural barriers in its, it is defined a culturally relevant tool identify daily care and
rehabilitation needs of Meri.
Case study 2:
Three different health professionals to support client to achieve the goal:
The case study is about James, a 43 year old married male New Zealander, who sustained
a symptomatic compression fracture of T12 and L1 during a motocross event. Six months post

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injury, comprehensive assessment of patients reveals very high pain sensitivity, severe
catastrophizing pain and severe depression. The main goal of care for Mr. James is to improve
self-efficacy, lower the current weight range of overweight, manage his depressions and stress
levels, manage his discomfort at work and promote continuous walking for 20 minutes. To fulfil
the above goal of care, the input from three health care professionals is necessary to support
client to achieve the goal. These three professionals include dietician, psychotherapist and
physiotherapist. The following section will provide comprehensive details regarding how and
why to utilize the input from above three health care professionals.
The involvement of dietician is necessary to support James to achieve the goals because
the BMI value of James during assessment revealed a score of 27.4 indicating that he is
overweight. Hence, as one of the goals for James is to reduce Jame’s weight range into the lower
range of overweight scale, the role of dietician will be critical in preparing appropriate diet chart
and physical activity plan for the client. The dietician will play a role in improving weight
related co-morbidities, optimizing dietary intake and stabilizing eating pattern of client to ensure
that desired weight target is achieved and nutritional needs of client is met Raynor and
Champagne (2016). The dietician will be encouraged to work with James to provide age specific
and culturally appropriate advice that he can easily follow. During this collaboration, dietician’s
input will be taken regarding changes to diet and lifestyle that James need to reduce his weight.
During planning physical activity, the dietician will be informed regarding his severe pain issues
so that adequate activity plan is followed which is easy for James to follow. Bleich et al. (2015)
gives the evidence that nutrition professionals like dieticians are the most commonly identified
health professionals who can help patients lose weight and improve confidence of people in
losing weight.
The second health professionals whose contribution will be important to support James to
achieve the goals include the role of physiotherapist. They are the expert health professionals
group who are involved in carrying out physiotherapy treatment for prevention of pain,
rehabilitating any form of physical disabilities and restoring optimum movement to promote
physical health of patient (Naidoo et al., 2019). As Mr. James physical activity is affected by
fracture and pain and he is unable to socialize due to restrictions on driving sitting and walking
tolerance, his problems are relevant with the job role of physiotherapist. As the main goal for

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recovery of James is to improve his self-efficacy and catastrophizing scores and improve his
ability to mow own and walk for 20 minutes over the ground, the involvement of pain specialist
is critical to manage pain and reduce discomfort for James. The physiotherapist input can be
taken regarding the way to increase walking tolerance for Jame and increase hi ability to mow
down his lawn. The physiotherapist input regarding assisting patient to diminish pain and
training on safe movement is likely to prevent exacerbation of pain. The rationale for assisting
James in safe movement is that he was experiencing musco-skeletal pain which can worsen
quality of life and physical functioning. Along with pharmacological treatment, exercise therapy
is critical to improve his physical functioning and reduce pain (Kamada et al., 2014).
Lastly, the contribution and input of a psychotherapist is necessary to achieve the goal of
reducing depression and stress level of Mr. James. This is essential because James has been
found to suffer from severe depression and stress and mental health counsellor can work with
James to identify the cause behind depression and counsel patient regarding the best practice that
he can adapt to overcome stress and depression. The psychotherapist will be asked to give his
advice regarding type of counselling support and treatment needed for James to reduce his
depression and stress level. Their expertise and knowledge will be crucial in teaching new skills
to client and identify the best type of counselling needed to overcome depression (Sperry &
Sperry, 2017). Twomey, O’reilly and Byrne (2014) gives the evidence that cognitive behavioural
therapy delivered by clinical psychologist or psychotherapist is crucial is effective in treatment
of anxiety and depression symptoms in primary care. The advantage of this intervention is the
flexibility with which it is delivered by a psychotherapist. They can deliver it either in face-to-
face format or self-help format.
Effectiveness of the assessment data for the case study client:
From the perspective of dietician, the assessment data of BMI and functional limitation
will be useful to plan appropriate goal of care for Mr. James and enhances his effectiveness in
managing weight. For example, from the BMI data of 27.4, it is understood that Mr. James is
overweight. One of the goals for James was to lower range of the overweight scale. However as
this has not been achieved yet evidenced by BMI of 27.4, it will be necessary to prepare
appropriate diet plan for the client. This is necessary because the patient might not be aware
about food items that can reduce weight. The dietician can utilize the BMI data to develop

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appropriate diet plan that lowers BMI. This may include providing very low carbohydrate diet
and advising patient to reduce intake of processed food and sugar. The dietician may consider
providing food that supports client to consume food items with low calorie that reduces weight
and result in shifting to the lower range of the overweight category. McCarthy et al. (2015) gives
the evidence that dieticians can implement appropriate nutritional intervention to influence
dietary pattern and lifestyle pattern if patient and reduce barriers faced by patient in achieving
sustained weight loss.
From the perspective of physiotherapist, the main goal of interest is achieving 20 minutes
walk over flat ground, life 8 kg from the ground and mow lawn over two sessions and manage
his discomfort at work. However, this goal has not been achieved for Mr. James currently
because currently he is able to walk for only 5 minutes. His ability to lift is 5 kg instead of 8 kg
and currently he is unable to mow the law. The review of the scores in the area of self-efficacy
suggests that James is not able to self-manage his pain levels. Hence, the effectiveness of the
assessment data is that it will help physiotherapist to plan appropriate physiotherapy intervention
for patient. The goal has not been achieved yet because Mr. James has not used any strategy to
strengthen his muscles. Based on review of Jame’s issue, the physiotherapist can provide patient
education, positioning and specific exercise to promote function of the muscoskeletal muscle and
improve James’s ability to walk, mow down and lift weight. Tamin et al. (2018) gives the
evidence that exercise intervention can improve physical function of patient with chronic
muscoskeletal pain.
From the perspective of psychotherapist, the goal of interest relevant to his role includes
decreasing stress and depression component in DASS21 scale. Currently, Mr. James score in
depression is 13 which is severe and stress is 16 which also comes under severe category. This
has happened because Meri has developed stress due to experience of pain. In addition, inability
to socialize and lack of appropriate emotional support has affected his functional limitation thus
contributing to social isolation and risk of depression. The psychotherapist can work with the
patient to identify best counselling intervention to treat depression and reduce the severity level.
Nakagawa et al. (2017) supports that therapist follow CBT to treat patients with depression as it
challenges core belief and support patients to adapt positive thought pattern to cope with
stressors.

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