CD 5732
Assessment
Presentation
Mairel Bettes
(Murray)
Elizabeth
Fenner
Melanie Hicks
Ashley Jones
Case:
A 42-year-old woman with a recent diagnosis of ALS;
Based on her recent diagnosis of ALS she will be seen as an outpatient.
Progression of this disease may possibly lead to home health.
Process
for obtaining Relevant Medical History:
- Review
Medical Chart
- Interview
Patient and Family
Formal
Observations:
Due to motor degeneralization being a primary characteristic of ALS two formal
assessments are being used to observe the underlying structure and
function of the oral mechanism.
- Complete
oral motor exam
- Oral
motor portion of the Dysarthria Profile
Swallowing function is another area of concern that is prominent in patients
with ALS due to their motor impairments.
- Complete
clinicial swallow
- Barium
Swallow - lateral and A&P views
Cognitive deficits are secondary to ALS because of stress level the patient
may exhibit. Therefore, a formal assessment would not be necessary.
Informal
Observations:
- Screening
for expressive and receptive language
- Screening
for orientation
Estimated
Length of Session:
- 2/50
minute sessions (1st session: Swallowing; 2nd session: Speech)
*Assessment should be ongoing
during therapy due to the degenerative nature of this disease.
Extra Credit Report: June 4, 2002
Patient: Barbara Waters DOB: 06-04-60
Referral: Dr. Clark, Family Phys.
History:
Mrs. Waters was referred by Dr. Clark, her family physician, because of her
recent diagnosis of Amyotrophic Lateral Sclerosis (ALS). Medical history
is significant for hypertonia, muscle twitches, and slower prosody. Mrs.
Waters reports that difficulty was first noted a year prior to diagnosis
and has noticed a slowly progressing change. She also reports that
some swallowing difficulties occur during the pharyngeal phase of swallowing.
Evaluation:
The Dysarthria Profile was administered. Mrs. Waters exhibits age-appropriate
performance on the two subtests of respiration and articulation. Deficits
were apparent in phonation, facial musculature, prosody, and rate. A
Modified Barium Swallow (MBS) was also administered. Vallecular residue was
evident indicating delayed laryngeal elevation.
Impressions:
Mrs. Waters exhibits slight mixed flaccid/spastic dysarthria due to her recent
diagnosis of ALS. The observations taken from the MBS indicated difficulty
during the pharyngeal phase of swallowing.
Recommendations:
1. Mrs. Waters is recommended for motor speech and swallowing therapy
twice weekly on an outpatient basis.
2. Continuous assessment throughout therapy as ALS progresses.
Melanie Hicks, MA CCC-SLP
Elizabeth Fenner, MA, CCC-SLP
Ashley Jones, MA, CCC-SLP
Mairel Bettes, MA, CCC-SLP