Case Study: Mr. Dan McLennan

Dan McLennan, a 49 year old mechanic, was tightening the last nut on the gearbox he was installing when his right arm felt weak and the spanner dropped from his hand. His attempts to pick it up were unsuccessful. He dragged himself out from under the car and his work colleagues noticed something was wrong when he couldn’t stand and was not speaking clearly. An ambulance was called and he was transferred to the Emergency Department.

Upon admission to the ED he underwent a CT scan. He was diagnosed as ischaemic (L) CVA with hemiplegia, expressive aphasia and swallowing difficulties. Dan’s blood pressure on admission was 205/105. He was commenced on Irbesartan and Aspirin.

Mr. Dan McLennan was transferred to the stroke unit 6 hours after admission and commenced the acute phase of his rehabilitation.

His health history identifies he smokes 15 cigarettes a day. He works shift work, regularly does overtime and has limited exercise opportunities. His wife passed away in a car accident two years ago, leaving him to care for his three school aged children, currently aged 14, 10, and 9 years. The oldest child has adopted a carer role since the death of their mother. The 9 year old is struggling at school and Dan spends a lot of time tutoring this child and assisting with homework. Dan has a mortgage. He has a small social and support network which includes his elderly mother, who is in fair health and is actively involved in the children’s care, his sister and her family.

One week into his rehabilitation, he became increasingly withdrawn, lethargic, disinterested in his food and began to refuse to participate in therapy sessions. He no longer wanted his family or friends to visit.