Felicia Gomez

DOB: 5/6/43
Sex: F
Post-onset: 6 months
Referral: primary physician
 
 

Pertinent Medical History (PMH):	ETOH  HTN  COPD  tibia fracture s/p MVA 5/92
Social history:	Tobacco: 76 pack year history, still smokes 2 packs per day  Alcohol: 5-6 mixed drinks daily, more on the weekend  Nursing home supervisor
Family history:	Father: ETOH, died s/p CVA age 73  Mother: HTN
Surgical history:	tibia repair  tubal ligation 1977
Current complaints:	people say I slur my words

Interview: (Questions quoted from Duffy (1995) Motor Speech Disorders)
 

ONSET & COURSE
1. Do you have any difficulty with your speech? If not, has anyone else commented on a change or problem with your speech?	I guess so. I don’t think it’s as clear as it should be. Some of my nurses had asked me about my speech last month.
2. When did the speech problem begin?  Did it begin suddenly or gradually?  Who noticed it first, you or someone else?	Well, I haven’t really noticed it that much but I would think just since last spring after I had a horrible cold. Yeah, seems like it started then.
3. Did you develop any other difficulties when your speech problem began?  Were other problems present before your speech problem began?  Did other problems develop after the speech problem began?	Nope, just that cold
4. Has the speech problem changed?  Better, worse, stable, better-than-stable, fluctuating?	I think it might be getting a bit worse.
5. Has your speech ever returned to normal?  If so, when and for how long?	I think some days are better, but probably not normal. My voice is hoarse pretty much all the time.
ASSOCIATED DEFICITS
1. Have you had any difficulty with chewing? drooling?	no
2. Is it difficult to move food around in your mouth? Why?	no
3. Does food get stuck in your cheeks or in the roof of your mouth?  Do you have to remove it with your finger or a fork?	no
4. Do you have trouble moving food back in your mouth to get a swallow started?	no
5. Do you have trouble with swallowing?  Food or liquid?  Do you have trouble getting a swallow started?  Do you lose food or liquid out of your mouth?  Does food or liquid ever get into or out of your nose when you swallow?  Does food or liquid go down before you swallow and cause coughing or choking?  Do you gag or choke when swallowing?  Do you cough or choke when completing a swallow?  Have you had to modify your diet because of these problems?  Have you lost weight?	no
6. Have you had any change in your emotional expression?  Do you cry or laugh more easily or less easily than in the past?	no
7. Are you taking any medications that seem to affect your speech?	no
PATIENTS PERCEPTION OF THE PROBLEM:
1. What did your speech sound like when the problem began?  Did anything feel different when you spoke?	I guess it seems just a little slurred. No, it doesn’t feel any different
2. Describe your current speech difficulty. How does it sound to you?  How does it feel to speak?  Is it faster or slower?  Louder or slower?  Less precise?  Is speaking effortful?	see above
3. Have you noticed any change in the appearance or feeling in your face or mouth?	no
CONSEQUENCES OF THE DISORDER:
1. Do people ever have trouble understanding you?  When? What do you do if that happens?	1. Sometimes, especially on the phone, people will ask me if something’s wrong, but they can usually understand me OK.
2. Do you ever have to write to make yourself understood?  Has your speech problem affected your work?  Does it prevent you from doing anything?	no
MANAGEMENT
1. What have you done to compensate for your speech difficulty?  Have you had any help for your speech?  When?  For how long?  What was done?  Did it help?	I try to speak really carefully, you know. Really pronounce things carefully. I think it helps.
2. Do you think you need help with your speech now?	I don’t know. I guess I’d like to know what’s wrong—and I sure don’t want it to get worse.
AWARENESS OF DIAGNOSIS AND PROGNOSIS:
1. What have you been told is the cause of this problem?	no
2. In view of this diagnosis, what is going to happen?	n/a

Report of Handicap
(Adapted from Verdolini (1994) "Voice Disorders" in Tomblin et al. (Eds) Diagnosis in Speech-language Pathology
 

Area	No Impact	Very little impact	Some impact	Significant Impact	Profound (can't perform in this area)
Professional		x
Social	x
Communicative			x
Physical	x
Emotional		x

Name: Felicia Gomez

DOB: 5/6/43

Medical Diagnosis:

Date of testing: 11/2/96

Respiration:
 

- Good  Fair  Fair  Good

Ability to sustain /s/ on exhalation (11 seconds) Ability to "crescendo" on /s/ Ability to "diminuendo" on /s/ Ability to repeat series of /s/ (arrhythmic) Ability to synchronize respiration with phonation

Descriptive information:  Respiration at rest is : Normal Speed of respiration at rest is : Normal Respiration during speech is: Shallow Speed of respiration during speech is: Normal Patient speaks on: Exhalation Respiration occurs

Phonation:
 

Normal  -  Normal  Normal  Fair  Good  Good  Fair  Good  Fair  Normal  Poor

Ability to initiate /a:/  Ability to sustain /a:/ (9 seconds) Ability to say /a:/ very loudly  Ability to "crescendo" on /a:/  Ability to "diminuendo" on /a:/  Ability to repeat a series of /a:/  Ability to raise pitch on /a:/  Ability to lower pitch on /a:/  Ability to glide up scale on /a:/  Ability to glide down scale on /a:/  Ability to maintain adequate volume in speech  Quality of voice

Descriptive Information:  Pitch of voice for speech is: Normal Pitch breaks: Do not occur Intonation for speech is: Inappropriate Tone of voice is: Normal Voice quality is: Hoarse Frequent cough and throat clearing

Facial Musculature:
 

Normal

All tasks of this section

Descriptive Information:  At rest face: - During smile face: - Tone of lips appears: Normal At rest tongue appears: Normal Tone of tongue appears: Normal At rest soft palate is: Normal During phonation soft palate is: Normal

 

Diadochokinesis & Descriptive Information:
 
 

Derive from descriptive information

Ability to open and close mouth rapidly Ability to protrude and retract lips rapidly Ability to elevate and lower tongue tip rapidly Ability to move tongue rapidly from side to side Ability to repeat "oo-ee" rapidly Ability to repeat "pa-pa" rapidly Ability to repeat "ta-ta" rapidly Ability to repeat "ka-ka" rapidly Ability to repeat "ka-la" rapidly Ability to repeat "puhtuhkuh" rapidly

Open/close mouth Protrude/retract lips Protrude/retract tongue Elevate/lower tongue Lateral tongue "oo-ee" "pa" "ta" "ka" "ka-la" "p-t-k"

13  9  9  11  17  14  16  17  13  8  4

Reflexes:
 

Normal

All tasks for this section

 

VI. Articulation
 
 

Derive from descriptive information

Ability to repeat consonants Accuracy of vowel sounds Ability to repeat consonant clusters Ability to repeat polysyllabic words Ability to repeat phrases

 

VII. Intelligibility
 
 

Normal Normal Good Normal Normal Good

Intelligibility of reading to therapist Intelligibility of reading to relative/friend Intelligibility of reading to stranger Intelligibility of speech to therapist Intelligibility of speech to relative/friend Intelligibility of speech to stranger

VIII. Prosody/Rate
 
 

Fair Good Fair Fair Normal

Ability to maintain appropriate rate Ability to increase rate Ability to maintain appropriate rhythm Ability to use appropriate intonation Ability to imitate different stress patterns

Descriptive Information for section VI (Articulation)
 
 

Pie Boy Tar Day Car Go Four Via Thaw The Sea Zoo Shoe Chew Jar Lie Row We How You Me No  Total

+ + + + + + + + + + + + + + + + + + + + + +

Plate Bread Tree Clock Queen Grape Flower Frog Three Spoon Smoke Star Sky Slide Splash Straw Scream Finger Birthday Lamps  Total

+ + + + + + + + + + + + + + + + + + + +

Calendar Peppermint Caterpillar Monotonous Examination Autobiography Total

+ + + + - -

Open the door Come in and sit down Would you like a cup of tea? Do you take sugar ? Total

+ +   +    -

Descriptive Information for Section VIII (Prosody/Rate)

Rate of speech is: too slow
Rhythm of speech is: with prolongations
 
 

Name: Felicia Gomez
Age: ____
Date: ______
Examiner: _______
Onset: ________
Etiology: ________

Subtest I:
 

Syllable Combinations /puh tuh/ /tuh kuh/ /puh tuh kuh/

Seconds    3  3  6

Trial 1   6  5  3

Trial  2   7  7  2

Trial  3   6  6  2

 

Subtest II:
 

1-syllable Thick  Zip  Jab  Please  Love  Hard  Jig  Strength  Hope  Soft

Score 2  2  2  2  2  2  2  2  2  2

2-syllable Thicken  Zipper  Jabber  Pleasing Loving  Harden Jiggle  Strengthen  Hopeful  soften

Score 2  2  2  2  2  2  2  1  2  2

3-syllable Thickening  Zippering  Jabbering  Pleasingly  Lovingly  Hardening  Jiggling  Strengthening  Hopefully  Softening

Score 2  2  2  2  2  2  2  1  2  2

Subtest III:
 

Stimuli Make a fist  Wave goodbye  Snap your fingers  Make an OK sign  Indicate someone is crazy  Make a hitch-hiking sign  Make a pointing sign  Salute  Play the piano  scratch

SB

Score 5  5  5  5  5  5  5  5  5  5

Stimuli Stick out your tongue  Whistle  Puff out your cheeks  Kiss a baby  Clear your throat  Bite your lower lip Show me your teeth  Take a deep breath and hold it  Lick your lips  Open your mouth

SB

Score 5  0  5  5  5  5  5  5  5  5

 

Subtest IV:
 

Plate Ashtray Living room  Newspaper  Banana  Cigarette  Potatoes  Butterfly  Coffeepot  Typewriter Refrigerator

Latency Time 0  0  0  0  0  0  0  0  0  0

Utterance Time .71  1.0  1.1  .8  .8  1.2 1.2  1.0  1.1  1.8

Subtest V:
 

Plate Ashtray  Living room  Newspaper  Banana  Cigarette  Potatoes  Butterfly  Coffeepot Typewriter  refrigerator

Trial 1 0 0  1  0  0  0  0  0  0  0

Trial 2 0  0  0  0  0  0  0  0  0  1

Trial 3 0  0  0  0  0  0  0  0  0  0

 

Subtest VI:
 
 

exhibits phonemic anticipatory exhibits phonemic perseverative errors exhibits phonemic transposition exhibits phonemic voicing errors exhibits phonemic vowel errors exhibits visible/audible searching exhibits numerous and varied off-target attempts at the word  errors are highly inconsistent increase as phonemic sequence increases exhibits fewer error in automatic speech than in volitional speech  exhibits marked difficulty initiating speech intrudes a schwa sound between syllables or in consonant cluster  exhibits abnormal prosodic features exhibits awareness of errors, and inability to correct them. exhibits a receptive-expressive gap.

No  No  No  No  No  No  No No  No  No  No  No  Yes  Yes  Yes