Twenty-five year old (DOB: 10/15/74) Mr. S is a Caucasian male who is status post electrocution. Gleaning from records, on July 26, 1999, while plugging in a play station to the back of a VCR lightening struck the power line and surged through the family home resulting in the client's electrocution injury. Initial diagnosis was vertricular fibrillation, cardiac arrest and a brain injury. He was transferred to Columbia Raulerson Hospital Emergency Room where he was resuscitated, intubated and placed on a mechanical ventilator. He was transferred to Tampa General Hospital for a 6-week stay and during this period he was comatose for "over two weeks." Diagnoses included anoxic encephalopathy (absence of oxygen) or hypoxia (decrease in concentraion of oxygen) secondary to cardiopulmonary arrest, electrocution and CNS injury. He underwent placement for a gastrostomy feeding tube during his stay. He developed deep venous thrombosis of both upper extremities, more on the right than the left. He was transferred to Health South Rehabilitation where he had physical, occupational and speech therapy. His brain injury resulted in motor, sensory, cognitive/behavioral deficits.

During his recovery period at Health South Rehabilitation, Mr.S was alert but unable to communicate and follow commands. He had "significant increased tone and spacticity in all four extremities. The patient demonstrated myoclonic seizures, and labile emotions. His Phenobarbital was tapered off and an EEG was done to ascertain seizure disorder. A modified barium swallow test demonstrated difficulties in swallowing necessitating a therapy regiment for dysphagia.

Mr. S is appropriate for a 30-60 day intensive neurocognitive evaluation and treatment course at the Florida Institute for Neurologic Rehabilitation. During his stay he will be evaluated, treated and followed by the neurologist and neuropsychiatrist. The neuropsychologist will assess for higher cortical dysfunction using standardized instruments and make recommendations based on cognitive strengths and weaknesses for future treatment and vocational planning.

A comprehensive treatment plan will be developed based on recommendations from speech and language pathology, occupational and physical therapy. The department of vocational rehabilitation will evaluate him for avocational and employment interests and future possibilities. He will have a behavioral protocol to increase appropriate pro-social behavior and decrease aggression, delusions and his demanding nature.

• Health. Mr. S has moderate difficulty with bladder and bowel management. He will need a bladder and bowel program whereby he is reinforced for achieving steps towards volitional control. He is on a peg-tube that will require monitoring. Because of his disinterest in eating and weight loss his nutritional status will require monitoring.

• Personal and self-care. Mr. S can accomplish some self-help skills but needs help with others. He can wash his face and hands but needs assistance shaving. Despite having a peg-tube, he is able to feed himself especially when proctored. He will need assistance for dressing, toileting, and while in the shower or bathtub.

• Physical functioning and mobility. Mr. S is able to move around while sleeping in aim of seeking comfort. He can walk with maximal assistance but uses the wheelchair to locomote. He will need assistance to transfer from the car, wheelchair and toilet. Mr. S will benefit from physical therapy to potentiate his strengths, balance, coordination and endurance.

• Cognitive skills. Mr. S achieved a high school diploma and has no medical problems prior to his accident. He will require a neuropsychological evaluation to delineate residual sequelae commensurate with his electrocution injury. Standardized testing will explain his cognitive strengths and weaknesses for future vocational planning. His assessment, because there is no previous neurocognitive assessment, will cover a full range of brain function. Based on medical records, his level of functioning is moderately to severely impaired.

  He has severely impaired decision-making ability for social, personal and financial. He is alert but cannot sustain attention past a few moments. He is oriented to person only and can recognize family members. He is unaware of the date and time of day. He cannot sustain attention for complex conversations, learning or processing sophisticated information. His ability for anterograde memory is severely impaired as evidenced in his difficulty in storing and retrieving information that would have been recently processed.

• Community integration. Mr. S is totally dependent on others for basic entertainment and leisure time activities. He is unable to manage and organize a budget or petty cash. He is unable to plan and prepare meals or snacks. His skills for cleaning house or performing chores are severely compromised.

  Occupational therapy will, based on an evaluation, plan a course to actualize his skills for independent living.

• Communication. Mr. S comprehends some conversations and can convey his feelings, needs and some simple thoughts. It seems his reading and writing was only moderately compromised by the anoxic encephalopathy. According to records his speech is mildly impaired with regards to articulation. He will have an assessment with the speech department for a plan to improve his thought formation and articulation.

• Behavioral adjustment and Psychosocial. His wife reports that he manipulates her into caring for him. He is generally both verbally and physically aggressive. His impulsivity preempts his judgement and insight; therefore he can be combative when angry. He has diminished frustration tolerance and ability to delay gratification. He is anxious and concomitantly depressed for which he receives anti-depressant medication.

  Mr. S will have a behavior protocol to increase his frustration tolerance, impulse control and social participation. The protocol will include decreasing arguing, self-injurious behavior and general emotional lability.

  In addition, a family education program will be developed in order to ensure generalization of therapy goals and techniques to the home setting.