Jessica Garcia, BS
Medical Student
University of Washington School of Medicine
Nampa, Idaho, United States
Katrina Ngo, DO
Resident Physician
University of Washington
Seattle, Washington, United States
.jpg "Ny-Ying Lam, MD (she/her/hers) photo")
Ny-Ying Lam, MD (she/her/hers)
Associate Professor
University of Washington
Seattle, Washington, United States
Denise Li Lue, MD
Attending Physician/Inpt rehab medical director
University of Washington Medical Center
Kirkland, Washington, United States
73-year-old healthy and independent female was airlifted from Thailand to a U.S. academic hospital after she was found to have pneumococcal meningoencephalitis, resulting in bilateral lower extremity weakness, bilateral sensorineural hearing loss, bilateral CNIII palsy, and altered mentation. Although she was a candidate for intensive physical rehabilitation (IPR), communication barriers due to hearing loss and ptosis initially impeded her participation. Her left eye improved, but she had to use her left hand to support her right eyelid for vision and reading, limiting its functionality for other tasks. Various communication aids were tried, including family assistance, a whiteboard, and the Otter talk-to-text app, which faced technical issues. The most effective solution was using Apple Notes on an iPad for live voice-dictated text, enabling her to read and respond verbally. Additionally, Recreational Therapy focused on blind/deaf communication techniques, significantly improving her communication and leading to her eventual approval for IPR.
Discussions: Engaging patients with newly acquired sensorineural hearing loss and functional blindness in therapeutic activities can be challenging, yet achievable with tailored strategies. This patient benefited significantly from the proactive involvement of her spouse, who managed eyelid retraction, administered eye drops, and held the iPad. The use of an iPad, which was provided by the family rather than the hospital, proved instrumental in bridging the communication gap and enabling the patient to participate effectively in therapy. Although a cochlear implant was later attempted, it ultimately did not provide the desired benefit.
Conclusions:
This case highlights the importance of innovative and adaptable communication strategies in rehabilitating patients with complex sensory impairments. The collaborative efforts of the patient’s family and the use of accessible technology were crucial in overcoming barriers to effective participation in rehabilitation therapy.
