Person centered stroke rehabilitation in a low-resource country: A three-track reasoning case on dysphagia and cognitive recovery

Stroke remains one of the most common causes of long-term disability, and, in particular, the complications of oropharyngeal dysphagia and cognitive deficits pose unique challenges of dysphagia, disability, and communication. This case study describes the clinical reasoning of a speech and language therapist with a 40-year-old Bangladeshi woman who had oropharyngeal dysphagia and cognitive impairment due to left-hemispheric ischemic stroke. This study aims to apply structured three-track clinical reasoning to assess and manage post-stroke oropharyngeal dysphagia and cognitive impairment in a low-resource setting, focusing on accurate evaluation, patient-centered interventions, and functional recovery. After acute care she was referred to the Centre for the Rehabilitation of the Paralysed (CRP)-Mirpur for rehabilitation. The case study did not have access to instrumental diagnostic and therapeutic facilities which necessitated instrumental clinical reasoning and structural reasoning frameworks. A speech and language therapist applied three track reasoning comprised of procedural, interactive, and conditional reasoning for evaluation and intervention planning. Therapist did oral motor assessment, food screening and cognitive screening through informal screening. Interactive reasoning was used enable and encourages participation. Conditional reasoning facilitated addressing broader sociocultural and functional contextual dimensions. The therapy was matched to the situational requirements. Food texture adjustment and compensatory techniques were part of swallowing rehabilitation; cognitive activities were included into relevant tasks such meal planning and sequence of home chores. Over 6 weeks, the patient went from complete reliance to partially supervised intake of changed diets and enhanced functional memory and attentiveness. These successes let her start some home chores once again, hence enhancing her self-esteem and family assimilation.