Reflective log: Discharge 08.05.13

1. Think of a recent therapy session or event.

I had a discussion about discharge with a patient. This patient had a LMCA infarct in his non-dominant hemisphere causing a mild flaccid dysarthria and facial weakness and some mild cognitive communication impairments. I completed the LA- trobe questionnaire with the patient and his partner. The patient and his partner identified: going over and over the same ground in conversation, and carrying on talking about things for too long in his conversations as key communication attributes that had been exaggerated by the patient’s stroke. The patient reported that premorbidly he had a tendency to be verbose when he was anxious and to repeat information. The patient also worked as a lecturer and as a performing musician. The OT and physiotherapist reported that the patient was unable to multitask and that when he talked too much and repeated information he was less productive in therapy.

2. Describe the session/experience

I spoke with the patient about speech and language therapy. The patient formed communication guidelines in his own words about how he would like therapists to give him feedback when his communication was disrupting sessions. I then spoke to the patient and we agreed that he would come to communication and newspaper group and would complete some facial weakness/ sensation exercises (for a very mild right facial weakness) but would be discharged from SLT.

3. What did this session make you feel?

I felt that by involving the patient in his discharge I was able to address his concerns and give him the information he needed about his condition.

5. What has this session has taught you?

- To consider which is the best setting to work on cognitive communication difficulties and perhaps discharge patients if I feel SLT input is not appropriate in this setting.

 – if they do not impact on therapy perhaps they are best worked on in a rehab rather than acute units or in the community.

- To ensure that the patient is able to access therapy and that their communication is not negatively impacting on other therapies (e.g. OT/PT).

- To get extensive pre-morbid communication information on patients with suspected cognitive communication impairments.