Contents
Chapter 21
Overview
Charly’s occupational therapy session exposes profound left neglect, lack of voluntary movement, and worsening spasticity. Dr. Greenberg recommends electrical stimulation, which produces sensation and passive motion but no purposeful control. In group therapy with Angela, Charly misidentifies her own arm and fears amputation, highlighting her ongoing neurological and emotional challenges.
Summary
Three and a half months after the injury, occupational therapist Valerie works on grooming with Charly, who mistakes a toothbrush for a hairbrush and cannot follow the task. Dr. Greenberg arrives, notes she cannot find him on her left, and confirms she cannot voluntarily use her left arm. Valerie reports worsening tone and difficulty with care, joking inappropriately about amputation, which frightens Charly before Dr. Greenberg reassures her.
Dr. Greenberg proposes electrical stimulation to improve awareness and manage spasticity. Charly struggles to attend to explanations on her left and drifts off, underscoring persistent neglect and fatigue.
In a group e-stim session with Angela present, Valerie demonstrates the device on Angela, producing finger movements. When it is Charly’s turn, Charly fails to recognize the left arm as her own, needing reassurance from Valerie and Angela.
Valerie activates the stimulator on Charly’s left forearm and hand, producing a buzzing sensation and passive finger spread. Despite trying, Charly cannot make a voluntary fist, illustrating the disconnect between intention and motor output.
The session ends with partial success in eliciting movement via stimulation but no functional control. Charly’s misidentification of her arm and fear of amputation reveal her vulnerability and the extent of her neurological deficits, even as the team searches for strategies to improve her awareness and tone.
Who Appears
- Charlotte "Charly" McKennaPatient with severe left neglect and spasticity; misidentifies her left arm; undergoes electrical stimulation without regaining voluntary control.
- ValerieOccupational therapist leading grooming and e-stim; notes worsening tone; makes an ill-judged amputation joke; guides the session.
- Dr. GreenbergPhysician who supports Charly, assesses left-sided deficits, and recommends electrical stimulation to improve awareness and tone.
- AngelaFellow patient from Walking Group; models e-stim calmly and reassures Charly during the session.