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  • Patient Uses Cogitative Reintegration Aid to Restore Communication

    February 14, 2013
    By Margaret Schmidt

    Prior to successful interdisciplinary care with RehabCare, George, 77, spent four previously discouraging weeks at an acute rehabilitation facility and faced the prospect of long-term care. George had lived at home with his wife and family nearby, but he experienced a rapid cognitive decline that impaired his communication and resulted in debilitating confusion and anxiety. In addition, George suffered back pain from osteomyelitis of the spine, had poor nutritional intake and was diagnosed with hypoglycemia due to medication mismanagement. Without intervention, George was at risk for exacerbated cognitive decline and anorexia. His family feared for his safety.

    Then George came to RehabCare, where our speech therapy team took the lead and coordinated care with occupational and physical therapists. The long-term goal was to return George to his former levels of performance so he could be safely discharged to home. The challenges were many: improve George’s orientation to the immediate environment, increase his ability to follow safety commands and treatment tasks and enable him to demonstrate judgment appropriate for activities of daily living.

    Therapists implemented strategies within the Quality of Life Actualization principle and used a cogitative reintegration aid (CRA), or memory book, to improve George’s episodic memory. The book included a calendar, staff photos, a rehab schedule, a visitor log, medication purposes, administration times and a journal. Importantly, topics George cared about most – baseball, family and home – were incorporated into treatment to improve attention and follow through.

    At discharge, George was able to use his CRA to manage his medications, recall safety strategies and use a telephone. His communication had improved to his prior level of functioning. The family was thrilled with his progress, and George was able to return home with his wife.

    George's story is a prime example of how critical it can be to personalize therapy to motivate patients to recover to their optimal functioning. George's experience also demonstrates the importance of teams working well together internally to ensure the best outcomes for medically complex patients.

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