John Whelan Solicitor with specialist expertise in Stroke Medical Negligence gives a case example of Inadequate Post Stroke Rehabilitation.
An example of a case involving an inadequate post stroke rehabilitation plan, which led to suboptimal recovery for the Patient:
Case Example: Inadequate Post-Stroke Rehabilitation Plan
Patient suffered an ischemic stroke affecting the right side of the brain, resulting in left sided weakness (hemiparesis) and mild cognitive impairment. The Patient was treated with tPA (tissue plasminogen activator) shortly after arriving at the hospital and stabilised during the initial hospital stay.
Hospitalisation and Initial Treatment:
a) After acute treatment, the Patient remained in the hospital for a few days under observation. The left sided weakness improved slightly but the Patient still had significant difficulty walking, as well as trouble using the left hand. The Patients family also noticed mild memory problems and occasional confusion.
b) The hospital staff recommended rehabilitation therapy after discharge, but a comprehensive plan was not fully developed.
Discharge and Inadequate Rehabilitation Plan:
a) Limited Therapy Referral: At the time of discharge, the Patient was given a referral for outpatient physical therapy two times a week but was not referred to occupational therapy or speech therapy, despite lingering cognitive deficits and difficulties with daily tasks such as dressing and eating. The need for speech language therapy to address cognitive issues was not discussed.
b) Lack of In Home Services: The Patient was discharged to home without an assessment of the living situation. No home health services were arranged, even though the Patient had limited mobility, increasing risk of falls and injuries. The family, who were unfamiliar with stroke care, struggled to provide the necessary support.
c) No Follow Up Neurological Evaluation: While the Patient’s condition was stable at discharge, there was no plan for follow up with a neurologist to assess the Patient’s progress or adjust the rehabilitation plan based on the Patients evolving needs. The hospital’s stroke care team did not set up a clear timeline for reassessment.
Consequences of Inadequate Rehabilitation Plan:
a) After a few weeks of limited therapy, the Patient’s progress plateaued. The physical therapy sessions focused only on the Patient’s walking and gross motor skills, while the Patient’s fine motor control in the left hand remained poor. The Patient continued to have trouble with basic activities like dressing, cooking, and using utensils, as the Patient received no occupational therapy to help with these tasks.
b) The Patient’s cognitive impairments, particularly memory issues and trouble concentrating, persisted. Since no cognitive or speech therapy had been arranged, these deficits went unaddressed.
c) Without proper in home support, the Patient suffered a fall while trying to move around the house, leading to a hip injury, which further set back his physical recovery.
d) The Patient’s family felt overwhelmed, unsure of how to help, and frustrated by the lack of guidance.
Reevaluation and Delayed Care:
Three months later, after little improvement, the Patients primary care physician recommended a more comprehensive assessment by a stroke rehabilitation specialist. This evaluation revealed that the Patient should have been receiving occupational therapy, speech-language therapy, and cognitive rehabilitation from the beginning. His rehabilitation plan was revised to include these services, but by this time, much of the Patient’s recovery potential had been lost due to the delay.
Outcome:
a) Although the Patient eventually received the appropriate therapies, the delay resulted in permanent functional impairments. The Patient continued to struggle with daily activities and never regained full use of the left hand. The Patient’s cognitive and speech difficulties also persisted, leading to long term challenges in the Patient’s independence and quality of life.
b) With a more comprehensive rehabilitation plan from the start, the Patient might have experienced better recovery and avoided the setbacks caused by inadequate therapy.
Important Points of the Case:
Incomplete Rehabilitation Plan.
Lack of In Home Support.
Missed Opportunities for Early Intervention.
For more detailed insights into how Stroke Medical Negligence and Patient Safety impacts you and how Whelan Law can support you, please visit our Patient Safety Rights Legal Advice Page.