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Case Study Speech

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SPHY 202: Language Disorders (Acquired) 2

Assessment 2: Case Study

MEDICAL DIAGNOSIS: Sustained a left-sided MCA CVA involving lateral frontal lobe

TIME POST-ONSET: 6 months

SPEECH LANGUAGE DIAGNOSIS: Broca’s aphasia characterised by severe difficulties with expressive language skills involving both verbal and written modalities.

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Background
Ruby is a 39-year old woman who lives at home in the UK with her husband and two children, 9 and 7 years old. Ruby was first admitted to hospital on the 1st of February 2014 following right side weakness in upper and lower limbs, aphasia and an associated fall getting out of bed in the morning. She was found to have an acute left sided middle cerebral artery infarct involving the lateral frontal lobe. The pre-central gyrus was also involved and damage possibly extends to the lateral fissure and subcortical structures. This has resulted in a right-sided hemiplegia affecting her upper limb primarily. No preceding significant medical history.

Ruby has previously spent 2 weeks in a specialist stroke unit and then 3 months in a rehabilitation unit during which she received treatment from physio, OT and speech pathology.

Include client demographic information; include information about previous intervention details social history, premorbid level of function, and any other relevant medical or allied health intervention details to date.

Language Assessment
Ruby’s communication abilities were assessed in the areas of conversation, story telling, verbal naming, reading aloud and also repetition. Ruby’s communication impairment was assessed using both informal procedures such as a conversational sample and formal tools and procedures including the CAT: Comprehensive Aphasia Test (Swinburn, Porter & Howard, 2006), Pyramids and Palm Trees (Howard and Patterson, 1992) and the Psycholinguistic Assessments of Language Processing in Aphasia (Kay, Lesser & Colheart, 1992).

Include a few sentences describing (a) what areas of communication were assessed, (b) how the client’s communication impairment was assessed (e.g., naming informal and formal assessment tools and procedures); (c) and how the implications of the communication impairment on activities and participation was considered (e.g., observation, interview, quality of life rating scale).

The purpose of the following table is to briefly identify the nature of the assessments administered, the client’s performance and the implications of an identified strength and weakness in relation to activity/participation.

Provide a sentence introducing the reader to the purpose of the table below (e.g., the table below describes the nature of the assessments administered, the client’s performance and the implications of an identified strengths and weaknesses for activities/participation).

Language Area | Description of Performance | Implications | Conversation Ruby participated in a conversation with the clinician | Difficulties * Word finding difficulties * Inappropriate pausing * Non-fluent disjointed speech * Long phrases Strengths * Awareness of language difficulties * Comprehension at certain restricted levels * Use of gestures * Can understand and maintain topic of conversation | hypothesise the level of breakdown in language processing; briefly indicate the implications of this breakdown for activities/participation in differing contexts (e.g., home, school, therapy, work) | Story RetellRuby was asked to look at some pictures from the fairy-tale book Cinderella and to retell the story in her own words | Difficulties * Word finding difficulties * sStrengths | hypothesise the level of breakdown in language processing; briefly indicate the implications of this breakdown for activities/participation in differing contexts (e.g., home, school, therapy, work) | Verbal NamingRuby was asked to look at some sets of pictures and to name each picture | using the assessment data, in point form summarise the strengths and difficulties demonstrated for each subtask probing this language area; include scores where provided | hypothesise the level of breakdown in language processing; briefly indicate the implications of this breakdown for activities/participation in differing contexts (e.g., home, school, therapy, work) | Reading aloudadd a very brief description of the task/s here | using the assessment data, in point form summarise the strengths and difficulties demonstrated for each subtask probing this language area; include scores where provided | hypothesise the level of breakdown in language processing; briefly indicate the implications of this breakdown for activities/participation in differing contexts (e.g., home, school, therapy, work etc) | RepetitionAfter the clinician pronounced a single word Ruby was asked to repeat that word. | using the assessment data, in point form summarise the strengths and difficulties demonstrated for each subtask probing this language area; include scores where provided | hypothesise the level of breakdown in language processing; briefly indicate the implications of this breakdown for activities/participation in differing contexts (e.g., home, school, therapy, work) |

Summary

Ruby presents with Broca’s aphasia. She has severe difficulties communicating information, particularly finding the right words. Although Ruby has severe difficulties finding the right word she successfully uses gestures and can write words with her non-dominant left hand in order to be more fully understood. As a result of Ruby’s aphasia, she has difficulties reading with her children, communicating her needs to strangers,

Using a few short sentences, (a) identify the client’s type of aphasia; (b) the subjective severity of the main features of the communication impairment (c) the implications of the communication impairment for activities and participation relevant to the client and (d) immediate strategies communication partners, including members of the multidisciplinary team can use to maximise communication success.

An example of a summary could be; Donald presents with a global aphasia. He has severe difficulties understanding verbal and written information. Although Donald also has severe difficulties expressing himself, he successfully uses gestures and simple drawings to share his thoughts. As a result of his aphasia, Donald is likely to have difficulties reading bills, using the telephone, taking medications etc. Donald’s caregiver will be integral to supporting his communication success and continued social participation. Specifically, Donald’s caregiver is encouraged to use short sentences, and visual cues such as gestures, photos and calendars to supplement her verbal interactions with Donald.

Recommendations:

* Further language assessment in the area of comprehension, specifically Ruby’s understanding of longer phrases and reading comprehension * Intervention targeting word finding difficulties * Provide Ruby’s husband with further information and education about Ruby’s communication difficulties in order to increase his understanding and capabilities for support. *

Considering the domains of the ICF, the assessment data and case history information, provide 3-4 specific recommendations here. Examples of specific recommendations include; intervention targeting reading of the periodic table; further language assessment in the area of number comprehension; communication partner training for the bus driver; educate key health care providers about ways to support Donald’s communication success (e.g., one step instructions, aphasia friendly documentation).

Terissa Morgan | Dr Natalie Berg | Terissa Morgan | Dr Natalie Berg | Student Speech Pathologist | Supervising Speech Pathologist |

Cc: Client/Caregiver
Clinical Information of Outpatient Service add the name of additional professionals needing to be informed of the assessment findings; for the purposes of the assignment you can assume consent of the client; in clinical practice the consent of the client is required before dissemination of results.

Aphasia Friendly Report
Speech Pathology Management Plan Name: | Ruby | Student Speech Pathologist: | 17th October 2014 | Intervention StartDate: | | Supervising Speech Pathologist: | Dr Natalie Berg |

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SPEECH LANGUAGE DIAGNOSIS: Broca’s aphasia characterised by severe difficulties with expressive language skills involving both verbal and written modalities.

Long Term Goal 1: | Rationale: | add one long term goal here; your goal should be client focused(e.g., to read a book) | provide a rationale for your choice of long term goal here; consider the ICF framework; utilise evidence from case history, assessment data to support your choice; you may like to consider the support of literature here also *point form is acceptable but must be legible | Shorter Term Goal 1.1: | Rationale: | develop a SMART goal that will address the client’s communication impairment and will assist in the achievement of the long term goal above*despite being impairment based your goal should be client focused(e.g., if the goal is to write single words, perhaps the words could be relevant to the client) | provide a rationale for the choice of goal and the impairment based therapy approach you will utilise to attain this goal; utilise relevant case history information, assessment data and evidence from the literature (at least two peer reviewed intervention studies) to support your choice of goal and your therapy approach. *point form is acceptable but must be legible | Shorter Term Goal 1.2: | Rationale: | develop a second SMART goal that will address the client’s communication impairment and will also assist in the achievement of the long term goal above*despite being impairment based your goal should be client focused (e.g., if the goal is to read single words, perhaps the words could be relevant to the client) | provide a rationale for the choice of goal and the impairment based therapy approach you will utilise to attain this goal;; utilise relevant case history information, assessment data and evidence from the literature (at least two peer reviewed intervention studies, different to the articles used above) to support your choice of goal and your therapy approach. *point form is acceptable but must be legible |

Long Term Goal 2: | Rationale: | add one long term goal here; your goal should be client focused (e.g., to write a letter) | provide a rationale for your choice of long term goal here; consider the ICF framework; utilise evidence from case history, assessment data to support your choice; you may like to consider the support of literature here also *point form is acceptable but must be legible | Shorter Term Goal 2.1: | Rationale: | develop a SMART goal that will address the impact of aphasia on the client’s activities and participation (i.e., a goal that attempts to improve the function of the client’s communication) that will assist in the achievement of the long term goal above*if the long term goal is to improve the clients writing, a shorter term goal could be to target filling in forms, birthday cards etc) | provide a rationale for the choice of goal and the functional intervention approach you will utilise to attain this goal; utilise relevant case history information, assessment data and evidence from the literature (at least two peer reviewed intervention studies) to support your choice of goal and your therapy approach. *point form is acceptable but must be legible | Shorter Term Goal 2.2: | Rationale: | develop a SMART goal that will address the impact of aphasia on the client’s activities and participation (i.e., a goal that attempts to improve the function of the client’s communication) that will assist in the achievement of the long term goal above*if the long term goal is to improve the clients reading, a shorter term goal could be to target the client’s ability to read and comprehend Twitter messages. | provide a rationale for the choice of goal and t and the functional intervention approach you will utilise to attain this goal; utilise relevant case history information, assessment data and evidence from the literature (at least two peer reviewed intervention studies, different to the articles used above) to support your choice of goal and your therapy approach. *point form is acceptable but must be legible |

Therapy Considerations | utilising your understanding of (a) the contextual factors of the ICF (i.e., personal and environmental factors) (b) case history information and (c) aphasia therapy, indicate (in point form) what you would need to consider when undertaking the therapy you have planned * Who will be involved in the delivery of intervention?(e.g., consider is caregiver equipped to do so) * Where will therapy be delivered?(e.g., would particular contexts provide differing therapeutic impact) * How often will therapy be delivered?(e.g., what does the literature say; realistic for client) * How will therapy be delivered?(e.g., would differing service delivery models promote recovery; what does the literature say) * How outcomes will be measured?(for two of your short term goals describe how you will measure your outcomes; use an established framework and support with literature) |

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