{Karlton Bontrager}

This meeting was called to renew Karlton’s plan for therapies. In a sense, it seemed to have marked another turning point for Karlton’s recovery as well.

The speech and language therapist started the meeting by stating that the staff had recently begun to question whether Karlton valued the individual therapies. Then, in the previous week, he had made statements indicating the value he saw in his steps to recovery. In her opinion, he has turned a corner in terms of body awareness, that is, in terms of what needs to be done and why as well as in carrying the information over into other areas.

The occupational therapist was next to speak. She commented that Karlton is making slow, steady progress with his left hand. He needs less prompting to remember to use his left. Moreover, he knows all the exercises and theory involved. When highly motivated, he can initiate appropriately. At other times, however, he is much less effective. In the weekly excursions to local restaurants, he now successfully inhibits inappropriate comments. Her goals for his continued occupational therapy are initiation, follow through, and time management.

The physical therapist reported on using electric stimulation or e-stim on Karlton’s ankle to activate and exercise the muscles. She reported that he is beginning to accept the fact that his stride may never be what it once was. At the same time, Karlton can carry through with walking as proscribed when he is consciously paying attention. But his attention easily wanders, and he needs prompting. Posture is another area that needs continued focus. Karlton tends to lean to the left. The physical therapist?s goal is to make the conscious unconscious. That is, to help him to form new habits in posture and walking so that he no longer needs to focus such concentrated attention on those areas to carry them out correctly. Her continued emphasis will be on walking, running, and cardio-vascular exercise, including jumping.

The discussion again came to the speech and language therapist. She noted the progress Karlton has made in the cooking group. He is now using his left arm more functionally, generalizing the instruction he has had from specific situations to more areas of his life. He is now aware, she reported, of the need to involve his left in all kinds of activities. She also praised Karlton’s decision to take a course at the community college this past fall semester. She saw that as a practical, concrete opportunity to practice many of the goals she has been focusing on. In particular, he has had to use study strategies. At times, she stated, his attention shuts down. Yet he is becoming more aware of when that occurs and is using strategies in note taking to accommodate for that. She emphasized his need to “practice mindfulness.” By that she said she meant requesting assitance in specific areas.

The next meeting with the Sargent staff should be in mid- to late February.