L is a 50-year-old man with a variety of complex needs.
L came to us with gastro-oesophageal reflux disease (GORD), epilepsy, oesophagitis, iron deficiency, anaemia, schizophrenia and long-term cognitive problems since childhood.
L was admitted to A & E in December 2019 with progressive ascending weakness in all four limbs and had a tonic clonic (epileptic) seizure. A CT scan confirmed generalised atrophy. He was admitted to intensive care for intubation and ventilation. In February 2020, L had neurological rehabilitation.
He was admitted to Oakleaf, Cunningham House Unit on 7th July 2020.
On admission to Oakleaf L presented with the following conditions:
He was unable to verbally communicate, he had a RIG tube (small feeding tube) in place with a supplemental feed regime and was Nil by Mouth. L also had a limited bilateral upper limb function, reduced shoulder flexion; limited wheelchair tolerance of less than two hours.
Verbal Communication Issues
L was supplied with a Grid Pad, a dedicated communication aid, built with a high spec computer and compatible with all major eye gaze cameras. With intervention from the Specialist Senior Team, improvement was noted with his visual scanning abilities and switch control timing. This has enabled L to communicate his needs more effectively. He prefers using an ABC chart and responds well to written sentences.
With daily intervention, L has achieved phonation and tried to say some words e.g. hello, thank you and individual speech sounds. His spelling has also improved to 90% accuracy. Since his tracheostomy removal, L is utilising his vocal cords and is now able to project single words.
From Nil by Mouth to learning to eat again
Once the tracheostomy tube was removed team member Kerry was able to commence L on oral water trials of 15mls – 20mls twice a day.
On the 20th November, L had a videofluoscopy (x-ray of his swallowing capabilities) and due to his significant improvements was able to trial Level 2 fluids and a puree diet. With daily intervention, he has now progressed from small spoonfulls of food and fluid to three full meals a day. He commenced a trial of minced and moist food on the 8th December, which was successful and another amazing achievement.
Getting L moving again
During his hospital admission, L’s upper limb function was limited and he was only able to bring his right hand up to his face and return it back to a resting position. He was bed bathed daily and had a poor wheelchair tolerance.
With daily intervention by Sophy Humphries, Occupational Therapist, and the team, L can now shower daily and is able to independently partake in 21 steps of his morning hygiene programme. These include washing the front of his hair, his upper torso, arms and upper thighs. His daily wheelchair tolerance is now more than four hours and he actively participates in communal sessions such as bingo, dominoes, chair aerobics, and arts and crafts.
This success story is a shining beacon of effective collaboration between the whole Cunningham Unit’s Multi Disciplinary Team. L’s physical and psychological well-being has progressed significantly due to the team’s expertise, diligence and hard work.
Contact Us
