Harry Dauge

DOB: 3/5/48
Sex: M
Post-onset: 1 month post CVA
Referral: neurologist
 
 

Pertinent Medical History (PMH):	HTN  COPD
Social history:	Tobacco: 50 pack year, smokes 1 ppd now  Alcohol: none  Owns & operates retail outlet mall
Family history:	father died of heart attack at age 50  mother has no significant medical history
Surgical history:	knee surgery in college
Current complaints:	poor speech

Interview: (Questions quoted from Duffy (1995) Motor Speech Disorders)
 

ONSET & COURSE
1. Do you have any difficulty with your speech? If not, has anyone else commented on a change or problem with your speech?	Damn it...bad
2. When did the speech problem begin?  Did it begin suddenly or gradually?  Who noticed it first, you or someone else?	x (no response or response unintelligible)
3. Did you develop any other difficulties when your speech problem began?  Were other problems present before your speech problem began?  Did other problems develop after the speech problem began?	Lotty
4. Has the speech problem changed?  Better, worse, stable, better-than-stable, fluctuating?	gotta talk...shit...bad
5. Has your speech ever returned to normal?  If so, when and for how long?	no
ASSOCIATED DEFICITS
1. Have you had any difficulty with chewing? drooling?	no
2. Is it difficult to move food around in your mouth? Why?	no
3. Does food get stuck in your cheeks or in the roof of your mouth?  Do you have to remove it with your finger or a fork?	Lotty
4. Do you have trouble moving food back in your mouth to get a swallow started?	no
5. Do you have trouble with swallowing?  Food or liquid?  Do you have trouble getting a swallow started?  Do you lose food or liquid out of your mouth?  Does food or liquid ever get into or out of your nose when you swallow?  Does food or liquid go down before you swallow and cause coughing or choking?  Do you gag or choke when swallowing?  Do you cough or choke when completing a swallow?  Have you had to modify your diet because of these problems?  Have you lost weight?	no
6. Have you had any change in your emotional expression?  Do you cry or laugh more easily or less easily than in the past?	no
7. Are you taking any medications that seem to affect your speech?	Lotty
PATIENTS PERCEPTION OF THE PROBLEM:
1. What did your speech sound like when the problem began?  Did anything feel different when you spoke?	shit
2. Describe your current speech difficulty. How does it sound to you?  How does it feel to speak?  Is it faster or slower?  Louder or slower?  Less precise?  Is speaking effortful?	x
3. Have you noticed any change in the appearance or feeling in your face or mouth?	x
CONSEQUENCES OF THE DISORDER:
1. Do people ever have trouble understanding you?  When? What do you do if that happens?	aw shit
2. Do you ever have to write to make yourself understood?  Has your speech problem affected your work?  Does it prevent you from doing anything?	(picks up pen, purposeful but ineffective writing)
MANAGEMENT
1. What have you done to compensate for your speech difficulty?  Have you had any help for your speech?  When?  For how long?  What was done?  Did it help?	Lotty
2. Do you think you need help with your speech now?	Lotty
AWARENESS OF DIAGNOSIS AND PROGNOSIS:
1. What have you been told is the cause of this problem?	x
2. In view of this diagnosis, what is going to happen?	x

Report of Handicap
(Adapted from Verdolini (1994) "Voice Disorders" in Tomblin et al. (Eds) Diagnosis in Speech-language Pathology
 

Area	No Impact	Very little impact	Some impact	Significant Impact	Profound (can't perform in this area)
Professional					x
Social					x
Communicative					x
Physical			x
Emotional					x

Name: Harry Dauge	Age:	Date: 10/1/96
Examiner:	Onset: 9/8/96	Etiology: CVA

Subtest I:
 

Syllable Combinations	Seconds	Trial 1	Trial 2	Trial 3	Best Trial
/puh tuh/	3	4	3	3
/tuh kuh/	3	5	2	4
/puh tuh kuh/	3	1	2	2

Subtest II:
 

One syllable	Score	Two syllable	Score	Three syllable	Score
Thick Zip Jab Please Love Hard Jig Strength Hope soft	2 1 2 1 2 2 1 1 2 1	Thicken Zipper Jabber Pleasing Loving Harden Jiggle Strengthen Hopeful soften	2 1 2 0 2 2 1 1 2 1	Thickening Zippering Jabbering Pleasingly Lovingly Hardening Jiggling Strengthening Hopefully softening	1 0 2 0 2 2 1 0 2 1

Subtest III:

Limb Apraxia

Stimuli	Searching Behaviors	Score
Make a fist  Wave goodbye  Snap your fingers  Make an OK sign  Indicate someone is crazy  Make a hitch-hiking sign  Make a pointing sign  Salute  Play the piano  Scratch	X  X    X	2  5  1  4  2  2  5  5  1  4

Oral Apraxia
 

Stimuli	Searching Behaviors	Score
Stick out your tongue  Whistle  Puff out your cheeks  Kiss a baby  Clear your throat  Bite your lower lip  Show me your teeth  Take a deep breath and hold it  Lick your lips  Open your mouth	X  X  X    X	1                                                                                   0                                                                                     0                                                                                     2                                                                                    2                                                                                     1                                                                                     4                                                                                  2                                                                                    3                                                                                    5

Subtest IV
 

Plate I  II  III  IV  V  VI  VII  VIII  IX  X

Ashtray  Living room  Newspaper  Banana  Cigarette  Potatoes  Butterfly  Coffeepot  Typewriter  refrigerator

Latency Time 2  4  0  1  0  0  1  4  4  5

Utterance Time 2  3  5  2  3  4  6  1  8  7

Subtest V
 

Plate Ashtray  Living room  Newspaper  Banana  Cigarette  Potatoes  Butterfly  Coffeepot  Typewriter  refrigerator

Trial 1 1  3  3  1  3  1  2  3  4  3

Trial 2 1  1  3  1  2  1  2  1  2  3

Trial 3 2  2  4  0  3  2  3  1  1  4

Subtest VI:
 
 

exhibits anticipatory errors  exhibits phonemic perseverative errors exhibits phonemic transposition errors exhibits phonemic voicing errors exhibits phonemic vowel errors exhibits visible/audible searching numerous and varied off-target attempts at the word  errors are highly inconsistent errors increase as phonemic sequence increase exhibits fewer errors in automatic speech than in volitional speech  exhibits marked difficulty initiating speech intrudes a schwa sound between syllables or inconsistent clusters  exhibits abnormal prosodic features exhibits awareness of errors and inability to correct them  exhibits a receptive-expressive gap

No Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes