DRS Testing Vignette

Closed head injury status post all-terrain vehicle accident on October 18, 2004 with right hemiparesis, dysarthria and agitation. The patient is a 17 year old female without a previous significant medical history. She is a high school junior, and lives with her family.

Patient was initially unconscious at the scene but was moving all four extremities during transport to the hospital. She was intubated and mechanically ventilated and was noted to have right side posturing and asymmetric pupils.

Admission

On admission to rehabilitation at Valley Medical on 10.30.04 it was noted that there was some improvement in the cognitive status of the patient. She was noted as having poor attention and often being disoriented to time, place, and situation. She did not always recognize her family members when they came to visit. She was up out of bed and in her wheelchair, being able to tolerate this for 30 minutes to an hour. The patient assisted somewhat in her transfers by lifting herself from a sitting or lying position. The patient was maximum assist with all ADLs. The patient seemed to have some recognition of the tasks involved in grooming but would not initiate them and could not execute without a helper doing most of the work. On admission, she was able to ambulate five steps with maximum assist. She was incontinent of bowel and bladder and wore diapers, with her nurse being completely responsible for her perineal hygiene. Nutritionally, she was being fed via NG tube, being unable to take food by mouth. She was on one-on-one supervision due to her safety risk.

Please rate Admission DRS

1. Eye Opening:

2. Communication Ability:

3. Motor Response:

4. Feeding:

5. Toileting:

6. Grooming:

7. Level of Functioning:

8. Employability:

Discharge

By discharge from this facility, on December 13, 2004, the patient showed considerable improvement in both cognitive functioning and in functional mobility. She was able to speak with only a slightly reduced rate. The patient was oriented, often using environmental cues to respond appropriately. She rarely required help to express her basic needs. The patient was supervised on a bowel and bladder management program, and was able to manage her own perineal hygiene with supervision. She was now in a regular diet, and had no problem with swallowing. She was still impulsive and deemed a safety judgment risk. The patient was still supervised for all ADLs, with only occasional frustration. She could be counted on to initiate her ADLs, with only occasional reminders. The patient continued to use a memory book for times when she was unsure of what she was doing. She was ambulating long distances with supervision and a right knee brace. The patient needed contact guarding to be able to go up or down 20 stairs. She was now independent in all of her transfers. She would often be unable to complete tasks that lasted longer than ten minutes. The patient was reading at approximately 5th grade level, but had mild difficulty with abstractions. She was routinely able to solve simple problems, but would be easily distracted if the problem taxed her abilities. With help from therapists, she was able to write brief letters to her friends and family. She participated in structured activities through the Therapeutic Recreation program, but would get distracted if a game or situation got too exciting. The patient wishes to return to school, but this may not be appropriate at this time due to her distractibility.

Please rate Discharge DRS

1. Eye Opening:

2. Communication Ability:

3. Motor Response:

4. Feeding:

5. Toileting:

6. Grooming:

7. Level of Functioning:

8. Employability:

Follow-Up

The patient was discharged from Valley Medical to South Valley Ranch for post-acute rehabilitation. On 4.13.05 she was evaluated as part of a six month follow-up. She has continued to improve cognitively, and temper outbursts, due to frustration, are now rare.

While at South Valley she has interacted appropriately with the staff and other patients. The patient is now fully independent in all ADLs. The patient is planning on returning home and finishing high school. However, there is still some concern about her distractibility, especially with complex information. She requires extra time to come to decisions involving complex problems, and sometimes she requires supervision with new activities. The patient still relies on environmental cues to orient herself to time, situation, and place. She now reads at a 10 grade level (with minor retention problems), but can only stay on-task for 30 minutes. The patient is able to communicate complex ideas, but only with extra time. She is able to write effectively, but often has many spelling errors.

Her mother will be available to help her in the mornings and evenings if needed, and also take her to and from school. For other transportation sometimes she needs cueing to plan effectively. Her parents are hiring a tutor to help her in all of her classes. The patient is able to walk independently, but must continue to use a brace. The patient is concerned that because she walks strangely and talks slowly, people always stare at her. Because of this she occasionally has refused to go on outings.

Please rate Follow-up DRS

1. Eye Opening:

2. Communication Ability:

3. Motor Response:

4. Feeding:

5. Toileting:

6. Grooming:

7. Level of Functioning:

8. Employability:

Comments?

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Print your responses and Fax them to:

Arshad Ali
FAX (408) 793-6434

You will typically receive the results from your test within 1-2 weeks.