GOS Testing Materials

Please rate the two case studies: Ann Yurism (admission only) & M.A. Thrasher (admission & follow-up)

CASE STUDY: ANN YURISM

Introduction:
Ann Y. is a 71 year old white female who was admitted to St. James Hospital with a left brain stroke. She remained there for two weeks and was subsequently transferred to a nearby free standing rehabilitation unit for a comprehensive stroke rehabilitation program. She was admitted with right flaccid hemiplegia and mild speech impairments.

Admission Assessment

Eating
After setup, Ann feeds herself, taking a bit longer because she uses her left (non-dominant) hand. She is not left alone due to occasional choking.

Grooming and Bathing
The nurse brings Ann a basin and all items needed for grooming and bathing because of Ann's hemiplegia. Ann washes her face and right hand. She also combs her hair, removes and places her dentures in the solution prepared by the nurse and replaces her dentures after the nurse rinses them. Ann needs help to wash her left (non-affected) hand.

Ann washes and dries only her right axilla and arm.

Dressing Upper and Lower Body
The nurse brings Ann her clothing from the closet. Ann indicates what she would like to wear each day. Her typical dress is: underwear and slacks, a blouse, socks and shoes. She also wears a sling, ankle-foot orthosis (AFO) and antiembolic stockings. While in bed, the nurse dresses Ann from the waist, down. The nurse puts on Ann's bra for her. Ann places the blouse over her right hand and pulls it up to the shoulder. The nurse brings it around her back and holds it in place while Ann puts her left arm into the sleeve. The nurse brings the front of the blouse together, does the buttoning and applies the sling.

Toileting
Ann is unable to cleanse and adjust her clothing before and after using the toilet.

Bladder and Bowel Management
Ann requires a set up for use of the toilet during the day and the bed pan at night. She tells the nurse when she needs to use the bathroom. She had one accident in the past three days, while sleeping.

Ann takes a stool softener and has had no bowel accidents.

Bed-Wheelchair Transfer
Ann is assisted to a standing position with some lifting assistance. Once standing, the nurse gives Ann steadying assistance to pivot and lower herself into the wheelchair.

Toilet and Shower Transfer
Ann propels her hemi-chair (one arm drive) into the bathroom. The nurse helps Ann to position the wheelchair correctly and lock it. The nurse helps Ann to transfer to the toilet by giving some lifting assistance. Ann is able to pivot and lower herself with steadying assistance. She returns with the same level of assistance.

She does not transfer to the shower or bath tub.

Locomotion and Stairs
Ann propels her wheelchair for short distances independently (50 feet). She does not take the stairs.

Comprehension and Expression
She understands both complex and abstract information, that is, television news programs, conversations, newspaper articles, multi-step directions etc. She has mild difficulty expressing complex information but is successful, given time.

Social Interaction, Problem Solving and Memory
Ann is cooperative in therapy and socially appropriate most of the time, but she is medicated with an antidepressant. She makes routine decisions regarding her personal care but she does not participate in making complex decisions, such as those required for handling household finances. She recognizes her therapists and follows directions, but requires a written schedule for remembering non-routine daily events.

Please rate Admission GOS:

CASE STUDY: M.A. THRASHER

REHABILITATION ADMISSION PHYSICAL AND HISTORY

Mr. Thrasher is an 18 year old Hispanic male status post closed head injury, April 13, 1995. He was apparently thrown from the motorcycle he was driving. He was unconscious and unresponsive at the scene of the crash. Following the crash he was taken to San Jose Health Center where he remained until his transfer here, May 7, 1995.

At the time of his admission to our acute rehabilitation unit, he was noted to be making minimal responses to commands, such as movement of mouth. Mr. Thrasher was examined in bed. An NG tube was in place. Restraints were placed on all 4 extremities and both hands were wrapped to prevent his pulling out the NG tube. At first he was noted to be sleeping and did not immediately respond to his name. In a short while, he did awaken and was able to follow some minimal commands. He would move his extremities to command and grip the examiner's finger with his right hand. He opened his mouth on command. He kept his eyes open during the entire examination, once awakened. There was no verbal response during the examination. Throughout the examination the patient continued to thrash about in bed. However, he did quiet down with verbal encouragement.

Pupils were bilaterally dilated with only the left pupil being found reactive to light. A delayed gag response was present. Response to sensory testing appeared to be delayed with respect to pain. There was no measurable response to light touch.

This young man has continued to make improvement. He appears to be cooperative, however, it is difficult at this time to fully assess his comprehension. According to his mother, he has been following many more commands in the presence of his family.

Please rate Admission GOS:

FOLLOW-UP EVALUATION

Mr. Thrasher returned for a full evaluation five years after his injury, on May 5, 2000. He is now 23 years of age and continues to live with his parents. The patient attends the Evergreen Community College Special Education Program part-time. He lifts weights four or five times a week at a local health club. He states he would like to be able to run again, and walk with a cup of coffee without spilling it. He indicates no need or desire to obtain a job.

Manuel is independent in all ADLs and mobility skills with occasional coaching to catch details of good grooming, e.g shave his neck well. He uses public transportation for selected routes. He can cook a simple meal with minimal to moderate difficulty due to functional cognitive deficits. He apparently has his own checking account but reports that he bounces checks because "I don't pay attention."

Reading, language, and writing skills are functional. However, evaluation of cognitive skills indicates mild to moderate impairment. Significant problems are noted in his ability to sequence, to recognize relevant from irrelevant detail, to analyze information for completeness and accuracy, and to draw appropriate, logical conclusions. Behavior is impulsive, which further compounds these problems, and Mr. Thrasher does not recheck or re-evaluate his work.

Recommendations are that Manuel continue his course work at the college, and receive supervision for his money management problems. Should he desire to work in the future, it will be appropriate for him to receive Department of Rehabilitation assistance for job training and for placement in a position that provides structure and supervision.

Please rate Follow-up GOS:

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