Case Study 1, Sample Patient 2

Sample Patient Two (audio: sample 3)

DOB: 7/10/30
Sex: F
Post-onset: 10 days
Referral: neurologist

Pertinent Medical History (PMH): Hypertension diagnosed 1981
Type II diabetes (AODM) diagnosed 1990
CVA (current admission)
bilateral corticospinal tract damage

Social history: Tobacco: none
Alcohol: none
Married, retired school teacher

Family history: father deceased: stroke, age 58
mother: hypertension, arthritis

Surgical history: hysterectomy 1972

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? Just listen to me

2. When did the speech problem begin?
Did it begin suddenly or gradually?
Who noticed it first, you or someone else? I had a stroke a week ago.

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 sppech problem began? I fell out of my chair and I couldn’t get up

4. Has the speech problem changed?
Better, worse, stable, better-than-stable, fluctuating? Better now, I could barely talk when I came to the hospital

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? Not really

2. Is it difficult to move food around in your mouth? Why? I don’t have my dentures

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? no

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 yournose 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 wheen completing a swallow?
Have you had to modify your diet because of these problems?
Have you lost weight? no

6. Have you had any cahnge in your emotional expression?
Do you cry or laugh more easily or less easily than in the past? Yes, yes. I don’t know what’s wrong. I guess I’m upset about the stroke. But then I laugh a lot too, so I don’t know.

7. Are you taking any medications that seem to affect your speech? no

PATIENTS PERCEPTION OF THE PROBLEM:

1. What did your speech sound like when the problem began?
Did anything feel different when you spoke? All garbled, people couldn’t understand me

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? A little slurred, not very clear. I have to go slower.

3. Have you noticed any change in the appearance or feeling in your face or mouth? not really

CONSEQUENCES OF THE DISORDER:

1. Do people ever have trouble understanding you?
When? What do you do if that happens? Yes, most of the time. I just repeat myself, more slowly.

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? no. no. I’m retired.

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? Go slower. No

2. Do you think you need help with your speech now? Yes, I want to sound better

AWARENESS OF DIAGNOSIS AND PROGNOSIS:

1. What have you been told is the cause of this problem? I had a stroke that affected my brain and nerves

2. In view of this diagnosis, what is going to happen? I have to have therapy.

Report of Handicap
(Adapted from Verdonlini (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

Pertinent Medical History (PMH):	Hypertension diagnosed 1981 Type II diabetes (AODM) diagnosed 1990 CVA (current admission) bilateral corticospinal tract damage
Social history:	Tobacco: none Alcohol: none Married, retired school teacher
Family history:	father deceased: stroke, age 58 mother: hypertension, arthritis
Surgical history:	hysterectomy 1972
Current complaints:	poor speech

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?	Just listen to me
2. When did the speech problem begin? Did it begin suddenly or gradually? Who noticed it first, you or someone else?	I had a stroke a week ago.
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 sppech problem began?	I fell out of my chair and I couldn’t get up
4. Has the speech problem changed? Better, worse, stable, better-than-stable, fluctuating?	Better now, I could barely talk when I came to the hospital
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?	Not really
2. Is it difficult to move food around in your mouth? Why?	I don’t have my dentures
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?	no
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 yournose 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 wheen completing a swallow? Have you had to modify your diet because of these problems? Have you lost weight?	no
6. Have you had any cahnge in your emotional expression? Do you cry or laugh more easily or less easily than in the past?	Yes, yes. I don’t know what’s wrong. I guess I’m upset about the stroke. But then I laugh a lot too, so I don’t know.
7. Are you taking any medications that seem to affect your speech?	no
PATIENTS PERCEPTION OF THE PROBLEM:
1. What did your speech sound like when the problem began? Did anything feel different when you spoke?	All garbled, people couldn’t understand me
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?	A little slurred, not very clear. I have to go slower.
3. Have you noticed any change in the appearance or feeling in your face or mouth?	not really
CONSEQUENCES OF THE DISORDER:
1. Do people ever have trouble understanding you? When? What do you do if that happens?	Yes, most of the time. I just repeat myself, more slowly.
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?	no. no. I’m retired.
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?	Go slower. No
2. Do you think you need help with your speech now?	Yes, I want to sound better
AWARENESS OF DIAGNOSIS AND PROGNOSIS:
1. What have you been told is the cause of this problem?	I had a stroke that affected my brain and nerves
2. In view of this diagnosis, what is going to happen?	I have to have therapy.

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