Co-Treatment at the Bedside

Case Study:

Mrs. Denise Watkins is hospitalized after a stroke that has impaired her swallowing ability. She demonstrates right-sided weakness. A speech–language 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

1. 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.
2. Explain how engaging another team member in a co-treatment session was more effective than providing discipline-specific care.
3. 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.

1. As the SLP: To communicate my role and responsibilities to Mrs. Watkins and her family, I would start by introducing myself and explaining my expertise in addressing swallowing dysfunction and ensuring safe and effective swallowing. I would emphasize that my primary goal is to help Mrs. Watkins regain her ability to swallow safely and comfortably. Here’s how I might communicate this:
   • “Hello, I’m [Your Name], the speech-language pathologist working with Mrs. Watkins. My role here is to assess and address any issues related to her ability to swallow safely and effectively. Given her recent stroke, we want to make sure she can enjoy meals without the risk of choking or aspiration.”
   • “During today’s session, I’ll be closely observing Mrs. Watkins’ swallowing abilities. I will also guide her in maintaining the proper head and neck alignment, which is crucial for safe swallowing. We’ll work together to identify any difficulties she may be experiencing during the process.”
   • “Additionally, I’ll assess her readiness for progressing from her current diet to pureed food consistencies. This assessment will help us determine when she can safely transition to different textures of food.”
   • “Our ultimate goal is to ensure that Mrs. Watkins can regain her independence in eating and reduce the risk of choking, so she can enjoy her meals comfortably.”
2. As the OT: To communicate my role and responsibilities as the occupational therapist to Mrs. Watkins and her family, I would emphasize my expertise in helping her regain independence in self-care activities. I would explain how my role complements the SLP’s efforts and contributes to Mrs. Watkins’ overall recovery. Here’s how I might communicate this:
   • “Hello, I’m [Your Name], the occupational therapist working with Mrs. Watkins. My primary focus is to help her regain the ability to perform self-care activities independently, particularly using her left hand, which can be a valuable skill in her daily life.”
   • “Today, during our session, I’ll be concentrating on optimizing Mrs. Watkins’ trunk and upper limb positioning to make self-feeding and other self-care activities easier for her. We want her to feel more comfortable and confident in these tasks.”
   • “I’ll also introduce her to an adaptive spoon that can enhance her control while bringing food toward her mouth. We’ll practice using this tool to improve her self-feeding skills.”
   • “The collaborative effort between the SLP and myself is essential for Mrs. Watkins’ overall progress. While the SLP works on her swallowing abilities, I focus on improving her ability to perform daily activities independently.”
   • “Our shared goal is to help Mrs. Watkins regain her quality of life and independence in various activities, including eating.”
3. The roles and responsibilities of the patient, family members, OT, SLP, dietary staff, and nursing staff are highly interrelated in providing nutrition to Mrs. Watkins:
   • Patient: Mrs. Watkins plays a central role in her own care. She needs to actively participate in therapy sessions, follow instructions from healthcare providers, and communicate her comfort levels, preferences, and any difficulties she experiences while eating.
   • Family Members: Family members provide emotional support, assist with decision-making, and potentially assist with feeding or meal preparation when appropriate. They can also serve as advocates for the patient’s needs and preferences.
   • OT and SLP: The occupational therapist and speech-language pathologist work together to address different aspects of Mrs. Watkins’ condition. While the OT focuses on improving her self-feeding abilities and overall self-care, the SLP assesses and manages her swallowing dysfunction to ensure safe and effective eating.
   • Dietary Staff: Dietary staff members collaborate with the SLP to create appropriate meal plans and textures for Mrs. Watkins. They ensure that the food provided aligns with her dietary restrictions and progress in her swallowing abilities.
   • Nursing Staff: Nurses are responsible for implementing the care plan, monitoring the patient’s condition, and ensuring that any recommendations from the OT and SLP are carried out. They play a crucial role in maintaining patient safety and well-being.

Overall, the success of Mrs. Watkins’ nutrition and rehabilitation depends on the seamless coordination and communication among all these stakeholders. Each team member’s contributions are essential to ensure her holistic care and recovery.