Relevant History

Review medical chart, as we would most likely see this person in acute inpatient. Look for etiology, evaluations/treatments conducted by additional professionals, previous imaging, positioning and/or diet restrictions, nutritional status, and reported arousal and alertness levels. Consult with the nurse and family members that may be present regarding the current patient status.

* the following interaction with the patient will be audiotaped.

* estimated length of session is two 15-30 minute sessions conducted over 36 hours.

Informal Assessment

We will start by asking the patient a few questions in order to gather further history and assess orientation, receptive language, auditory comprehension, expressive language, speech production, and voice.

Questions:

· Do you know why you are here?

· Do you know where you are?

· Do you have any concerns about your speech and language?

· Do you have any trouble with eating and swallowing?

· When did the problems start?

· How long have they persisted?

· Do the problems start and stop, or are they consistent?

· Do you have problems remembering things, people, and places?

· Do you have difficulty following commands and directions?

· Do you ever have difficulty producing the right sound?

· Do you have difficulty reading or writing?

We do not expect this patient to demonstrate severe swallowing difficulties, however we would conduct a brief oral mech screening (refer to the Dworkin & Culatta oral motor exam). We will also conduct a bedside swallowing using the consistencies of juice, pudding, and a cookie. A referral would include a modified barium swallow or FEES examination if necessary.

If we feel that voice is compromised, we will use the Darley, Aronson, & Brown perceptual scales (1983) to further assess speech production and voice.

Formal Assessment

Revised Token Test will be used to assess auditory comprehension. This will best predict her everyday functioning. The full test will not be administered due to the time constraints and fatigue. 1-2 questions from every subtest will be administered until the patient consistently answers incorrectly, then testing will stop.

Western Aphasia Battery will be used to assess reading. The full test will not be administered. We will begin at the one word level, which requires the patient to point to the correct written word (given two choices) of the object presented. If successful, we will continue to the sentence level, which requires the patient to read a presented sentence orally. If successful, we will have the patient read the grandfather passage, thus moving to the paragraph level.

DIAGNOSTIC REPORT

Name: Bethany Pergerson DOB: 8/28/1921 Referral: Dr. Mack

History: Ms. Pergerson was referred by Dr. Martin Mack, her primary physician, because of concerns regarding receptive language. Medical history is significant for recent CVA. Her husband, Mr. Pergerson reports that difficulty was first noted two days ago, immediately after her stroke, and that slight change has occurred since the episode. He reports that Mrs. Pergerson is beginning to comprehend single words accompanied by gestures, but has difficulty comprehending 2-3 word utterances and following simple commands. It should be noted that Ms. Pergerson’s reading ability has not been observed due to lack of orientation.

Evaluation: The Revised Token Test and the reading subtest of the Western Aphasia Battery were administered. Due to lack of orientation and time constraints, several questions from each subtest of the Revised Token Test were administered. Performance on the Revised Token Test indicated moderate deficits in the area of receptive language. Ms. Pergerson gave correct responses through subtest 4, after which she began to fatigue and present varying levels of incorrect responses. Performance on the Western Aphasia Battery indicated significant difficulties with comprehension of written sentences, paragraphs, and commands, however comprehension of single words was relatively intact.

Impressions: Ms. Pergerson exhibits a moderate delay in receptive oral language and a severe delay in reading comprehension.

Recommendations:

1) Beginning immediately, if patient wishes, treatment will be provided to address Ms. Pergerson’s deficits in receptive oral language and reading comprehension using the following goals:

a) facilitate improved auditory comprehension using 2-3 word commands involving the body, and having the patient point to familiar items following a one word stimulus, and

. b) facilitate improved reading comprehension through matching activities involving written stimuli.

2) Referral for outpatient therapy immediately following discharge from hospital.

Nicole Carver SLP, CCC-SLP