Reference no: EM133408162
Cognitive - Speech
We now revisit Mr. Wanamaker but with a focus on his executive function skills.
Review
Mr. Wanamaker was beginning a new chapter in his life. He just took a job with a brand new prestigious law firm as a trial lawyer as well as was recently remarried. He and his new wife have now been married for 2 years and have four children between them (all high school age). He and his wife enjoy traveling-especially to the mountains and overseas to see Old World architecture.
Four months ago, he was in a car accident. He was in the hospital for 1 month, primarily due to mobility deficits and wound care. He received PT, OT, and ST throughout his stay and was recently discharged from the hospital's inpatient rehabilitation facility. His physical and medical deficits resolved but he is receiving outpatient speech pathology services three times a week. He wants to return to work as a trial lawyer. He demonstrates multiple cognitive deficits, including memory. At home, he forgets his daily schedule, loses track of time, and has trouble getting things completed. His spouse reports that he gets confused and forgets to do the things that he typically did at home, such as taking out the trash, feeding the dogs, and cooking.
Memory
He recalls long-term information well but has difficulty recalling complex cases from his time as a lawyer. Patient reported that when he cannot recall the details of a case, he is able to locate the information he needs in his office but has difficulties concentrating when reading his old cases. Patient reports he was able to read cases for hours at a time prior to his injury and is concerned that he is not able to do it anymore.
Executive Function
The most obvious difficulty he has socially is his lack of awareness and inhibition. He has been noted to have a short fuse and become agitated when there are changes to his daily agenda or court proceedings. He has also been quite passive-aggressive to his executive assistant to the point of making her cry. He has not picked up on these issues or made any attempt to reflect on his behavior or modify his behavior. A client recently attempted to retain his services and he could not retain all of the information provided to him by his potential client-he did not realize that he was not getting the full reality of the client's case nor make any attempt to use strategies to write down and organize the information to plan a strategy. He knew that this was a murder trial and that his client was most likely guilty. He made the judgment call to take on this client regardless of his innocence or guilt.
New Information
Attention
Mr. Wanamaker has a case coming up. He has recently become negative about his work and frequently considers retiring or going on disability. He finds it hard to maintain focus and shift attention from working on his argument to meeting with clients. He has trouble shifting his attention across people and topics in a group setting, making it increasingly difficult to participate in staff meetings (which he is expected to lead). Behaviors previously listed become increasingly evident when not in receipt of full attention from his staff or client. When working with his clients, he finds himself missing information and having to ask them to review and repeat the information they just told him. If information is presented and there is another stimuli such as a dog barking, another side conversation, or a noise somewhere else in the room, he loses concentration and will have difficulty shifting his attention back to main purpose.
- Give three compensatory or rehabilitative strategies to address attention you might utilize with Mr. Wanamaker and returning to work.
- Give two activities for each attention strategy you mentioned.
- Write two goals for Mr. Wanamaker's attention.
- What suggestions might you give his family regarding returning to work specific to attention?