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Capacity Assessment – Communication Support — SCE Neurology MCQ

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HardNeurorehabilitationCapacity Assessment – Communication SupportSCE Neurology

A 70-year-old man with a cerebellar stroke has persistent dysphagia requiring PEG feeding, severe dysarthria preventing verbal communication, and limb ataxia preventing writing. He appears to understand when spoken to. His family asks about his capacity to make decisions. What is the correct approach?

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Correct answer: C — Support communication fully before judging decision-specific capacity

The best answer is “Support communication fully before judging decision-specific capacity”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Infer incapacity from inability to speak or write”, “Use family preference as a substitute for patient communication”, “Apply a global incapacity label after the stroke”, “Delay all decisions until verbal speech returns” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/