Case History #4 Esther

Background 72 year old female suffered a left CVA July 5 th, year old female suffered a left CVA July 5 th, 1999 Received speech therapy at Polinsky from August to December 1999 Received speech therapy at Polinsky from August to December 1999 Began RFP Spring Semester 2000 Began RFP Spring Semester 2000 –Receives Group and Individual tx –Participates in Socialize!

Assessment April 2004, given the Apraxia Battery for Adults-2 (ABA-2) April 2004, given the Apraxia Battery for Adults-2 (ABA-2) Tasks Tasks –DDK: Unable to sequence syllables Severely impaired Severely impaired –Increasing word length: number of syllables correct with imprecise articulation

Assessment Cont –Limb Apraxia and Oral Apraxia No evidence of limb Apraxia No evidence of limb Apraxia Mild oral Apraxia Mild oral Apraxia –Utterance time for polysyllabic words Mild impairment Mild impairment Misarticulation of words Misarticulation of words –Repeated trial (amount of deterioration in productions of words over three consecutive trials) Severe articulation errors Severe articulation errors First production more correct than last First production more correct than last

Assessment Cont Inventory of Articulation Characteristics of Apraxia Inventory of Articulation Characteristics of Apraxia –Abnormal prosodic features –Awareness of errors & inability to correct –Errors highly inconsistent –Visible/audible searching

Current Diagnosis Current Diagnosis Severe Apraxia of Speech Severe Apraxia of Speech Mild Aphasia Mild Aphasia Mild Dysarthria Mild Dysarthria

Treatment Utilizing MIT Utilizing MIT –Produces 2+ word phrases following a delay and intervening question with 72% accuracy Increasing participation, interactions, and ways of communicating Increasing participation, interactions, and ways of communicating –Contributes to group conversation by verbalizing, writing, gestures, or a letter board

Treatment Increasing reading comprehension Increasing reading comprehension –Answered multiple choice, true/false, yes/no questions with 85% accuracy when reading 20 pages Writing phrases Writing phrases –Writes with no more than 2 grammatical or spelling errors 89% of the time

Recommendations Improve expressive speech utilizing MIT at the 2-4 word/phrase level Improve expressive speech utilizing MIT at the 2-4 word/phrase level Improve writing and spelling Improve writing and spelling Improve reading comprehension Improve reading comprehension Increase participation using a variety of communication modes Increase participation using a variety of communication modes

AAC Assessment Communication Needs Communication Needs Seating and Positioning Seating and Positioning Visual Status Visual Status Motor Control Motor Control Switch Assessment Switch Assessment Cognitive and Language Assessment Cognitive and Language Assessment

Communication Needs Interview (include family members) Interview (include family members) –Communication partners –Communication mode Strategies & word retrieval ability Strategies & word retrieval ability –Interest in activities (computer use) –Feelings on current communication system

Seating and Positioning We feel there are no factors to interfere with an AAC system We feel there are no factors to interfere with an AAC system

Visual Status Baseline vision screening Baseline vision screening –Reading task

Motor Control Words per minute on computer Words per minute on computer Direct selection and written language will be assessed: Direct selection and written language will be assessed: –name –Copying sentences –“prime” words (ie: cat) to dictation

Switch Assessment Not an area of concern for Esther Not an area of concern for Esther

Cognition and Language Assessment Informal naming tasks Informal naming tasks Cueing- visual and semantic Cueing- visual and semantic Reading comprehension Reading comprehension Comprehension of symbols Comprehension of symbols

AAC Options Lightwriter Lightwriter Pathfinder Pathfinder

Discussion Additions, thoughts, Ideas! Additions, thoughts, Ideas!