CASE STUDY 24-1 Mr. L Mr. L. is a right-handed 57-year-old male who recently retired from the police force. Mr. L. is divorced and lives in a single family home that he owns with his daughter, Maria. Since his retirement 6 months ago, Mr. L. has been enjoying his newfound free time by completing a variety of small home improvement projects that he had been putting off because of his former work schedule. Three days ago, Mr. L. woke up with a headache; at breakfast that same morning Maria noticed that Mr. L.’s speech was slurred and that he was dragging his left foot when he walked. She immediately took him to the hospital emergency room. Medical work-up revealed Mr. L. had suffered a right CVA with left hemiplegia and he was admitted to the stroke unit. His medical history is significant for high blood pressure and cigarette smoking. Mr. L’s daughter Maria reported to the medical team that her father has not been compliant with taking his blood pressure medicine and still smokes a pack of cigarettes a day. The stroke team evaluated Mr. L., and a referral to rehabilitation was made. The occupational therapist completed an initial evaluation and determined that Mr. L. had significant problems in all areas of occupation, including eating, personal hygiene, showering, dressing, and functional mobility. Mr. L. was not ambulatory and was using a wheelchair for mobility on the stroke unit. The occupational therapist’s assessment of performance skills revealed that Mr. L. had deficits in both motor and process skills. Specifically, he demonstrated decreased balance, which contributed to an asymmetrical posture while he was sitting and standing. Mr. L.’s left UE had flaccid muscle tone and no active range of motion. Tactile sensation was, however, intact throughout his entire left side. Cognitively, Mr. L. was alert and oriented X 3 and followed directions. When fatigued, however, he became easily distracted. During functional activities, Mr. L. exhibited a decreased awareness of his left side; as a result, his left arm was often dangling at his side. The occupational therapist noted that Mr. L. was motivated for therapy and expressed interest in improving his ability to perform personal self-care. When discussing his problems, Mr. L. became tearful and expressed sadness about the amount of assistance he needed to perform simple tasks like shaving. When Mr. L. is ready for discharge from the hospital, the current plan is for him to return home with home care services. Mr. L. agrees with this plan but is concerned about how he would manage at home while his daughter was at work. 1.How might Mr. L.’s balance problems be affecting his ability to perform self-care activities, especially dressing and bathing? What compensatory techniques could he learn to increase independence in these areas? 2.What are some potential complications of Mr. L.’s having a flaccid arm? What preventive strategies could address these complications? Should he be provided with a sling? Why or why not? 3.How might Mr. L.’s decreased awareness of his left arm affect his safety during performance of functional mobility? 4.What information would you need about Mr. L.’s home environment to assist with planning for discharge? 5.How would you involve Mr. L’s daughter in his OT program at this time? 6.How might you incorporate health management and stroke prevention education into MR. L’s OT program?