67 year old female s/p (status post) repair of basal aneurysm resulting in ataxia.

Current and past medical history was obtained from medical charts at Watauga Medical Center in Boone, NC. She is currently in inpatient rehabilitation.

• Review nurses notes (admit and discharge notes)

• Review progress notes

• Review reports (procedures and consultations)

Other ways to obtain relevant history include interviewing the patient, patient's family/primary caregiver, individuals in social group, and other medical personnel. Possible interview questions:

• Do you know why you are here?
• Can you describe to me the difficulty that you are having?
• What kinds of things would you like to work on pertaining to your speech? Are there any things that you were able to do before your surgery that you are unable to do now that you would like to work on?
• Are you able to understand what others are saying, and do you know if others have difficulty understanding you?
• Do you feel tired or ill?
• Do you feel strong emotions because of your impairments?

Questions specific to family or caregiver

• Can you describe some of the difficulties that Sue is experiencing with her speech?
• Are there specific goals that you would like Sue to obtain?
• Do you have any scheduling difficulties that may conflict with caring for Sue? (transportation, homework, supervision)

The following areas should be assessed:

• Oral mech (will be assessed via the Frenchay Dysarthria Assessment)
• Speech production

• Intelligibility
• Prosody (AMRs will be assessed)

Sue Jones will be formally assessed using the Frenchay Dysarthria Assessment (Enderby, 1983)

Informal observations were noted during the initial appointment with the patient.

The following areas were observed:

• Receptive language
• Expressive language

• Orientation

Alertness and Responsiveness

1. eye contact
2. tracking

1. visual
2. auditory

• Cognition
• Dysphagia

• Hearing screening

1. Responds to environmental noises
2. Responds to conversational voice levels
3. Appears to hear high frequencies
4. Family reports hearing loss

2 - 50 minute sessions within 2 days.

Patient: Sue Jones DOB: 10/8/35

Referral: Dr. Edward Smith

History

Sue Jones was referred by Dr. Edward Smith, the surgeon who repaired her basal aneurysm. He had concerns about the ataxia resulting from the surgery. Medical history is significant for hypertension. Mrs. Jones is currently taking HCTC and is also on a low salt, low fat, low cholesterol diet to reduce the high blood pressure. Sue Jones revealed that she had difficulty speaking after her surgery.

Evaluation:

The Frenchay Dysarthria Assessment was administered. Performance on the following subtests were rated age-appropriate: reflex, jaw, soft palate. Significant deficits were noted for respiration, tongue, lips, laryngeal, and intelligibility. Deficits in these areas impacted intelligibility and prosody.

Impressions:

Sue Jones exhibits moderate ataxic dysarthria due to damage to the cerebellar control circuit during surgery to repair a basal aneurysm.

Recommendations:

1. Following initial speech and language assessment, if Mrs. Jones wishes to address her speech deficits, treatment could be provided here, twice per week for 3-4 weeks, with the following goals:

1. To improve natural speech melody
2. To improve intelligibility in specific contexts
3. To improve self-monitoring intelligibility

Tiffani Bender Kristin Cerati Whitley Maner

Graduate Clinician Graduate Clinician Graduate Clinician