June 8, 2018 – Clock of the week

WESTBOROUGH, MA Here is the “clock of the week” drawn by a well educated 77-year old woman undergoing rehabilitation at the hospital after she sustained a fall and broke some ribs.  The clock represents her best effort at completing the 3 step problem I have described so often in these pages. Clocks are interesting and fun.  They can be used to put the patient at ease when first getting started.  Some patients become quite defensive when they are referred for neuropsychological assessment.  It is important to establish rapport prior to initiating the battery of tests so that you may obtain the best possible result.
These data are turned into the report that physicians will use to access services and needed intervention to assist with return to functional independence whenever possible.  In this case, the woman had had two prior CVA’s one on the
Bilateral_June6_18Scan
Right middle cerebral artery – effecting her visual motor integration and spatial awareness and the second stroke effecting her language area – including verbal fluency and word choice during free speech. I have also added a sample of her written language. Patients are all asked to “write a sentence” that I dictate to them.  I have used the same 2 sentences for over 20 years and find them useful.

“Baseball players are tough”

Basball_written- LangScan
The sentence reads Baseball players are tough. It illustrates the impact of CVA on written language. This interesting lady could no longer write checks or sign her name. Graphic formulation of words requires both the left and right sides of the brain for success.  The frontal lobe is also brought in automatically to initiate, plan, and execute the verbiage and organize the thoughts into a coherent message.
During the hours of assessment I learned that this patient had sustained a fall just 5 months earlier resulting in a head strike and 3-5 days of concussion-like symptoms that slowly evaporated returning her to her baseline.  This leaves her more vulnerable to cognitive change with any illness including infection or pain syndrome from fractured ribs.

 

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