The

Curious
Case of:
Herb
Franks

By:Alyssa
Hazlegrove &
Emily Perevuznik
MEET HERB

49 years old
Hispanic-originally from Cuba
Married with 6 children
Associates Degree in food services
Local food vendor since the age of 30
Outgoing
Significantly Overweight
High Blood Pressure
Incipient Type 2 Diabetes
Family History of stroke and heart
attack
 Herb Franks, a curious human,
snooped into a row home that was
being renovated to take a look.
Upon entry, Herb begins to feel an
onset of headache, weakness in
his left arm and leg, vision
changes, and confusion. Herb then
collapses on the floor of the home
under construction. He lies there
unattended for 30 minutes before
he is found by construction
workers. After being rushed to the
hospital, it was determined that
Franks sustained a lesion in the
right hemisphere of his brain.
Stroke:
"10% of Cuban's deaths are related to stroke" (NCBI)

Herb Franks stroke was sustained in the right hemisphere of

his brain in the frontal and fronto-temporal areas.

What kind of deficits should be

expected?
Right Hemisphere Disorder:
-Gestures
-Facial expressions
-Perception of emotions
-Prosody
-Expression of emotions
-Left side neglect
-Attention
-Memory
-Anomia

Lesion in the Frontal area:

- Impaired social behavior

Lesion in the fronto-temporal

area:
- Impulse Control
Cuban Heritage
as it Affects
Treatment
Herb Franks is originally from Cuba which affects him
in a variety of ways.

Social:
The relationship with the rehabilitation professional/therapist is almost as
important or even more important than what the therapist actually does
(Masin, 1999).

Beliefs:
illness-Beliefs about illness or disabilities can often be attributed to
external causes among Cuban Americans (Brice, 2002)
Some Cuban Americans believe that if a family member falls ill to
disability that the family is being punished for their sins.
Some may see disability as part of God's divine plan and may refuse
services.

Family:
Klovern, Maderra and Nardonne (1974) said that Cubans "value highly
family ties and their family units, which extend in many cases to include
grandparents, cousins, aunts and uncles" (p. 255).

Treatment:
implementing a family-oriented rehabilitation plan may ease tension
from family toward services.
Characteristics may include:
1. Team members share common goals
2. All members contribute equally
3. Leadership is distributed equally
4. Responsibility for implementing team decisions is shared

Income and Education:

More Hispanics live in poverty (22.8 percent) than those in the white,
non–Hispanic U.S. population (7.7 percent) according to the U.S. Bureau
of the Census, 2000 figures.
Lack of opportunities for education contribute to the poverty issue
although Cuban Americans are more closely approximated education
levels of non-hispanic U.S. population.
Diving Concomitant Medical Conditions:

into Herb's case history sets up possibilities for concomitant

medical conditions ranging from cultural to typical

Therapy
disorders associated with a right hemisphere stroke.

Some examples of concomitant conditions may be:

Left Side Neglect
Dysarthria
Dysphagia
Diabetes

Procedures for Evaluating Herb Franks:

The SLP may use some of these procedures when
evaluating...
informal observation
CLQT Clock Drawing subtest
-will help determine LS neglect, attention, and
memory
-will assess impulsivity using observation and
conversation
Case History/spouse interview
(finding out how he functioned before to compare
against deficits now)
Treatment
Focus:
The SLP will  focus on the areas of weakness and
need.

Areas pertinent to Mr.Franks will be:

Attention and memory--need to have good

attention and memory to make therapy
beneficial (recovery)

Left Side Neglect--make sure that he is eating

well and weight isn’t affected due to poor PO
intake (be conscious of dysphagia)

Impulsive behavior--to get him back on

track/recover to get back to work and social
activities

Organization--executive functioning skill that

may need to be targeted in running his own
business and home life (keeping track of time,
especially with 6 kids)

Mr.Franks Long-Term and Short-Term Goals:

Objectives: Over the coming months, Herb will

target increased impulse control, attention to the left
side of his visual field, and word finding strategies.

Long Term Goal: Herb will effectively use

visuospatial skills to improve awareness of his left
side during daily functional activities, such as eating
and reading the newspaper, with boundary markers
and verbal prompts with 80% accuracy (8/10
opportunities).

Short Term Goals:

1a. Herb will scan his entire visual field while reading the newspaper with 60%
accuracy, given visual boundaries and two verbal prompts.
1b. Herb will scan his entire visual field while reading the newspaper with 70%
accuracy, given visual boundaries and one verbal prompt.

2a. Herb will recognize food on the left side of his visual field with 60% accuracy
given two verbal prompts.
2b. Herb will recognize food on the left side of his visual field with 70% accuracy
give one verbal prompt.
 Life after Rehab
Herb's prognosis is primarily
determined by his motivation toward
therapy.
When moving from rehabilitation therapy to home
Herb may employ techniques to aid in his recovery:

Scanning his visual field (specifically on the left)

Using a planner to keep track of dates, times,

events, and general information for organization

Engaging in help from family

References:
American Speech-Language-Hearing Association (n.d.). Right hemisphere damage: Treatment.
Retrieved from https://www.asha.org/PRPSpecificTopic.aspx?
folderid=8589943798&section=Treatment

American Speech-Language-Hearing Association. (n.d.). Right hemisphere brain damage (RHBD).

Retrieved from https://www.asha.org/public/speech/disorders/Right-Hemisphere-Brain-Damage/

Brice, A. (2002). An introduction to cuban culture for rehabilitation service providers. Retrieved
from http://cirrie-sphhp.webapps.buffalo.edu/culture/monographs/cuba.php

Brice, A. (2002). The Hispanic child: Speech, language, culture and education. Boston, MA: Allyn
and Bacon.

Cooper, R.S., Ordunez, P., Iraola Ferrer, M.D., Bernal Munoz, J.L., & Espinosa-Brito, A. (2006).
Cardiovascular disease and associated risk factors in Cuba: Prospects for prevention and control.
American Journal of Public Health, 96, 94-101. doi: 10.2105/AJPH.2004.051417

Johns, C.L., Tooley, K.M., & Traxler, M.J. (2015). Discourse impairments following right hemisphere
brain damage: A critical review. Language Linguist Compass, 2, 1038-1062. doi: 10.1111/j.1749-
818X.2008.00094.x.

Klovern, M., Madera, M., & Nardone, S. (1974). Counseling the Cuban child. Elementary School
Guidance and Counseling, 8 (4), 255–260.

Masin, H. (1999). Cross–cultural parent education and early intervention: Cuban and African–
American families in Miami, Florida, U.S.A.. In R. Leavitt (Editor), Cross–cultural health care: An
international perspective for rehabilitation professionals (339–350). London, England: W.B.
Saunders.