Case Study: Regaining Mental Capacity Through Innovative Behavioral Intervention in Neurorehabilitation (77107)
Session Chair: Maya Kagan
Friday, 29 March 2024 10:50
Session: Session 2
Room: Room E (Live Stream)
Presentation Type: Live-Stream Presentation
Jess, a single mother of four, suffered a stroke at the age of 48, resulting in fronto-temporal brain damage and left-sided paralysis. Subsequently, she experienced a right subclavian artery thrombosis, leading to the amputation of her right upper limb. Jess also had chronic neuropathic pain, tonic-clonic seizures, and a mild mood disorder. Initially deemed unsuitable for rehabilitation due to her limited engagement in acute treatment, Jess's reluctance stemmed from fear of falling and pain avoidance. A subsequent assessment revealed her strong motivation for improvement despite negative self-image and low self-efficacy. Jess was admitted to rehabilitation 8 months after her brain injury, with fluctuating mental capacity due to emotional regulation deficits. Neuropsychology assistant designed a behavioral intervention focusing on improving engagement, fear management, and building psychological resilience. This included an innovative Advance Consent Form (ACF) for Jess to pre-select transfer days, combined with motivational interviewing; second and third-wave therapy approaches for adjusting to change; and a team-based desensitization and positive reinforcement strategy. Family played a vital role in her successful discharge home. The intervention employed a multiple-baseline-across-behaviors design, resulting in significant improvements over 9 months and maintained after ACF removal: Hoist Transfers Frequency (HTF) increased from once/monthly to once/daily, refusals of therapies and care decreased, new goals achieved weekly across different domains. 4-month follow up reported HTF as 1/week with associated contextual barriers. The outlined approach assisted Jess to overcome her barriers, regain mental capacity, increased her locus of control and resilience, and achieved her primary goal of returning home.
Authors:
Dayana Georgieva, Hollanden Park Hospital, Renovo Care, United Kingdom
About the Presenter(s)
Ms Dayana Georgieva is is currently working at Hollanden Park Hospital, Renovo care in United Kingdom
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