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CASE STUDY

CASE STUDY. GEMMA GALLACHER Learning Disability Dietitian SHEFN GROUP OCTOBER 2004. Miss R Age – 33 Carers: Parents and sister lives next door Day Centre : Attends daily 9-3.30pm Does not go into respite care Diagnosis Cerebral Palsy ->Learning Disability Epilepsy (family history)

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CASE STUDY

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  1. CASE STUDY GEMMA GALLACHER Learning Disability Dietitian SHEFN GROUP OCTOBER 2004

  2. Miss R • Age – 33 • Carers: Parents and sister lives next door • Day Centre : Attends daily 9-3.30pm • Does not go into respite care • Diagnosis • Cerebral Palsy ->Learning Disability • Epilepsy (family history) • Scoliosis (congenital curvature) in her spine walks with aid

  3. While some people with CP have a learning disability many others with CP do not • Many people with CP can lead a normal life

  4. Epilepsy In Learning Disability

  5. Miss M • First 18 months – normal development • At 18 months Miss M started having seizures: held her breath for minutes • 18 months – 3years old attended a day centre for toddlers, commenced on Phenobarbitone for her epilepsy, seizures improved • At the age of 3 Miss M was diagnosed with CP at Yorkhill Hospital • Diet – until the age of 12years • Normal, 3 meals per day with snacks • Adequate fluid intake • Never over ate • No problems with appetite

  6. Age 12+ Diet History B/F – Weetabix with full cream milk CoT with milk and sugar Lunch – Beans/Ravioli with bread Drinks of full cream milk or juice Dinner – Mash potatoes with a sauce or gravy mince and potatoes Snacks – Packet of Wotsits and occ. Fortisip / Forticreme On a good day: ~1200 kcals 20-30g of protein NOTE: No dietetic input ? Weight Symptoms of anaemia – lethargy, pale gums No bloods taken – not tolerated

  7. Major Problems • Age 28+ • Chest infections • Refusing medication, seizure activity • Refusing food, poor skin integrity • Difficult to brush teeth • Choking • If Miss M had a chest infection appetite / weight loss for 2-3 weeks • Parents were told – short life expectancy • Weight = 6 stone 38kgs • Height = 1.54m • BMI = 15

  8. Turning Point • SRD working with sister recommended PEG (no dietetic input, family aware of services, but did not contact us) • Miss M only attending day centre 60 days out of the year • Discussed this with GP – against the insertion of a gastrostomy • Parents not keen felt ‘eating was the main pleasure in her life’ • ? Survival chance ? Quality of life issues September 2003 – Major chest infection PEG inserted by gastroenterologist Weight = 5 stone 7 pounds 35 kgs BMI = 13 MAMC = 12 cm (approx)

  9. Progress • Nutritional requirements = 1750 kcals, 65 g of protein • Commenced on 1 litre of Ensure Plus, providing : 1500 kcals and 60g of protein • Using Flexiflo pump (family trained), tolerating feed at 100mls / hour, all medication given through gastrostomy in a liquid form (Tegratol) • On discharge - family noticed a marked difference in miss M • Appetite improving, hydration, seizure activity, Bowels regular • When at home – pump feeding didn’t suit – pulling tube at night, pump alarm going off, Mum sleeping in with Miss M, disturbed sleeping pattern

  10. New Nutrition plan • Changed to bolus feeding

  11. Bright Future • Improved quality of life for Miss M and family • Sits up at dinner table • Eating can still be erratic, if Miss M has a good day her feed is reduced - FLEXIBLE • More alert, mobile • Attending the day centre and participates in activities eg. Outings, Sensory therapy, Music therapy, Beauty treatments • Physically developing • Happier • BMI now – 17 • MAMC 13.5 cm • Weighed every 6 weeks, good conyact with family

  12. Weight

  13. Team Approach – Community Learning Disability Team Occupational Therapist Speech and Language Therapy Dietitian FAMILY Complex Physical health Needs Nurse Physiotherapist MISS M Health Care Co-ordinator Psychologist Psychiatrist DAY CENTRE

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