Case Study: Co-Treatment at the Bedside
Mrs. Denise Watkins is hospitalized after a stroke that has impaired her swallowing ability. She demonstrates right-sided weakness. A speechâlanguage pathologist (SLP) is addressing her swallowing dysfunction, and an occupational therapist (OT) is helping her learn to use her left hand to perform self-care activities. The OT and SLP on this unit work together frequently, maximizing their complementary abilities to provide optimal patient outcomes. Today the OT and SLP are meeting for a planned cotreatment session with Mrs. Watkins and her family, at her bedside. The goal of the session is to develop strategies to support Mrs. Watkins in self-feeding while avoiding choking. The SLP plans to evaluate Mrs. Watkins’ ability to swallow and assess readiness for progression of her modified diet to pureed food consistencies. They enter Mrs. Watkins’ room and explain their goal and their roles for the session. The SLP focuses on the alignment of Mrs. Watkins’ head and neck that will facilitate her ability to swallow small amounts at a time. The OT focuses on optimal positioning of Mrs. Watkins’ trunk and upper limbs to facilitate self-care activities. The OT instructs Mrs. Watkins in the use of an adaptive spoon to provide better control in bringing food toward her mouth. They alternate activities throughout the session. At the end of the session, they acknowledge the progress that Mrs. Watkins has made and determine that Mrs. Watkins needs more practice before she can attempt self-feeding. They share this with the patient and the family. The OT agrees to communicate their plan to the nurse caring for Mrs. Watkins.
Discussion Questions
- Imagine that you are the SLP caring for Mrs. Watkins. How would you communicate your role and responsibilities for Mrs. Watkins to the patient and to the family? Repeat this exercise assuming you are the OT caring for Mrs. Watkins.
- Explain how engaging another team member in a co-treatment session was more effective than providing discipline-specific care.
- Explain how the roles and responsibilities of the patient, family members, OT, SLP, dietary, and nursing staff members are interrelated in providing nutrition to Mrs. Watkins.
