Name __________________________________ Score ______/100
 

Case One
 

Mrs. Jones is 54 years old and is 5 days s/p a left hemisphere stroke. She has just been admitted to an inpatient rehabilitation facility where you are the SLP on the stroke team. The discharge summary from the acute care hospital indicates that the patient initially had "garbled speech" and that a swallowing evaluation had revealed the need for thickened liquids. This is the only information provided related to communication/swallowing.
 

1. Based on this information, indicate how you will plan to assess the patient (put a check in the appropriate boxes)
 

Area	Assess carefully	Screen	Will not assess
Oral Motor
Cognition/Executive function
Receptive language
Expressive language
Speech production
Swallowing

 

2. For each of the areas above you will be screening, give examples of ways you will elicit behaviors to judge whether additional assessment is needed.
 

3. For each of the areas in question one you will be assessing carefully, give examples of formal instruments you might use, and samples of subtests that are included in those instruments.
 

4. Mrs. Jones exhibits mild impairments in auditory comprehension. Her spontaneous speech is fluent but characterized by sound substitutions, which are more prevalent during repetition. These behaviors are most consistent with what diagnosis?
 

5. The oral motor exam was unremarkable. In light of the previous diagnosis of dysphagia, what would you expect to be the nature of her swallowing problems, if she still has them?
 

6. Mrs. Jones does not exhibit dysarthria. If she did, what type would she most likely exhibit?
 

Case Two
 

Mr. Ward suffered a CVA following hip surgery. He was initially disoriented and unable to follow commands, but at the time of the current assessment was able to participate in most assessment activities.
 

1. Considering the history of Mr. Ward's illness, did he most likely suffer a hemorrhagic or ichemic stroke?
 

2. Mr. Ward exhibited inconsistent ability to follow commands, generally reliable responses to yes/no questions, impaired naming, fluent speech, and good repetition. These behaviors are most consistent with what diagnosis?
 

3.Based on the assessment findings, develop four treatment goals for Mr. Ward. These should be objective and measurable, but may be targeted at the impairment, disability, or handicap level.
 

4.Develop a 30 minute lesson plan to address these goals.
 

Target	Time	Procedures

Case Three

Mr. Horn was admitted to the hospital with complaints of difficulty swallowing . He also exhibits speech production deficits characterized by severely reduced rate, harsh voice, imprecise articulation, and hypernasality. He has no complaints of comprehension or formulation problems.
 

1. Based on this history (there is no current medical diagnosis), you should be able to plan for an assessment that will address most carefully (check all that apply):

_____ speech _____ language _____ cognition _____ swallowing
 

2. You should be further able to plan an initial assessment session lasting

a) 15 minutes or less

b) 15-30 minutes

c) 30-60 minutes

d) more than 60 minutes
 

3. List the 5 most important interview questions you will want to include in your assessment.
 

4. The oral motor exam reveals overall weakness of lips, tongue, and velum, with fasciculations noted on the tongue. Reduced range of motion of the lips and increased resistance to passive movements are also noted. Based on these findings and the speech characteristics described above, what is the most likely therapy diagnosis?
 

5. Given this diagnosis, or considering the oral motor and speech characteristics described, what swallowing deficits would you expect to see?
 

6. Develop 4 treatment goals for Mr. Horn.
 

7. Assume you are going to see Mr. Horn twice per week as an outpatient. Develop a lesson plan for a 60 minute session.
 

Target	Time	Procedures