What is the most likely reason for R.S.’s poor performance in the morning rehabilitation sessions?


Brief History. R.S. is a 34-year-old construction worker who sustained a fracture-dislocation of the vertebral column in an automobile accident. He was admitted to an acute care facility, where a diagnosis of complete paraplegia was made at the T-12 spinal level. Surgery was performed to stabilize the vertebral column. During the next 3 weeks, his medical condition improved. At the end of 1 month, he was transferred to a rehabilitation facility to begin an intensive program of physical therapy and occupational therapy. Rehabilitation included strengthening and range-of-motion (ROM) exercises, as well as training in wheelchair mobility, transfers, and activities of daily living (ADLs). However, upon arriving at the new institution, R.S. complained of diffi culty sleeping. Flurazepam (Dalmane) was prescribed at a dosage of 30 mg administered orally each night at bedtime.

Problem/Influence of Medication. During his daily rehabilitation regimen, the therapists noted that R.S.’s performance and level of attentiveness were markedly poor during the morning sessions. He was excessively lethargic and drowsy, and his speech was slurred. These symptoms were present to a much greater extent than the normal slow start that occurs in some patients on wakening in the morning. The therapists also found that when ADL or mobility training was taught during the morning sessions, there was poor carryover from day to day regarding these activities.

1. What is the most likely reason for R.S.’s poor performance in the morning rehabilitation sessions?

2. What would be the likely solution?

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