Case Study 1, Sample Patient 3

Sample Patient Three (audio: sample 5)

DOB: 1/9/33
Sex: M
Post-onset: 18 months
Referral: neurologist

Pertinent Medical History (PMH): CVA 1987
Type II diabetes (AODM) diagnosed 1991
arthritis
BPH
Parkinson’s disease diagnosed 1995

Social history: Tobacco: 20 pack year history, quit 1975
Alcohol: 1 glass of wine every night
Widowed, retired university professor

Family history: both parents killed in MVA 1968

Surgical history: TURP 1992
Total knee replacement (right) 1987

Current complaints: people can’t understand me

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? People don’t understand me

2. When did the speech problem begin?
Did it begin suddenly or gradually?
Who noticed it first, you or someone else? About a year ago. Came on gradually. My golf group kept telling me I was mumbling.

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 get tired easily, now I know I have Parkinsons

4. Has the speech problem changed?
Better, worse, stable, better-than-stable, fluctuating? I don’t really know. Seems like I’m better some days than others, but I can’t really tell, ya’ know?

5. Has your speech ever returned to normal?
If so, when and for how long? hard to say

ASSOCIATED DEFICITS

1. Have you had any difficulty with chewing? drooling? Seems like I’ll drool sometimes, especially when I’m tired

2. Is it difficult to move food around in your mouth? Why? It takes a little longer to chew

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, just takes me a little longer

6. Have you had any cahnge in your emotional expression?
Do you cry or laugh more easily or less easily than in the past? no, not really

7. Are you taking any medications that seem to affect your speech? they’re still fixing my medicines, some work better than others

PATIENTS PERCEPTION OF THE PROBLEM:

1. What did your speech sound like when the problem began?
Did anything feel different when you spoke? I guess I mumble

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? Doesn’t feel much different to me, I go the same speed, sometimes I get tired, and my voice gets soft.

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, some of the time. I just repeat myself

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. I’m retired. I don’t do as much but not because of my speech but because I tend to fall down.

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. My niece is a therapist, she told me to do exercises, but I haven't gotten around to them.

2. Do you think you need help with your speech now? I guess

AWARENESS OF DIAGNOSIS AND PROGNOSIS:

1. What have you been told is the cause of this problem? I have Parkinson’s Disease

2. In view of this diagnosis, what is going to happen? I have to take medicine and go to 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):	CVA 1987 Type II diabetes (AODM) diagnosed 1991 arthritis BPH Parkinson’s disease diagnosed 1995
Social history:	Tobacco: 20 pack year history, quit 1975 Alcohol: 1 glass of wine every night Widowed, retired university professor
Family history:	both parents killed in MVA 1968
Surgical history:	TURP 1992 Total knee replacement (right) 1987
Current complaints:	people can’t understand me

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?	People don’t understand me
2. When did the speech problem begin? Did it begin suddenly or gradually? Who noticed it first, you or someone else?	About a year ago. Came on gradually. My golf group kept telling me I was mumbling.
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 get tired easily, now I know I have Parkinsons
4. Has the speech problem changed? Better, worse, stable, better-than-stable, fluctuating?	I don’t really know. Seems like I’m better some days than others, but I can’t really tell, ya’ know?
5. Has your speech ever returned to normal? If so, when and for how long?	hard to say
ASSOCIATED DEFICITS
1. Have you had any difficulty with chewing? drooling?	Seems like I’ll drool sometimes, especially when I’m tired
2. Is it difficult to move food around in your mouth? Why?	It takes a little longer to chew
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, just takes me a little longer
6. Have you had any cahnge in your emotional expression? Do you cry or laugh more easily or less easily than in the past?	no, not really
7. Are you taking any medications that seem to affect your speech?	they’re still fixing my medicines, some work better than others
PATIENTS PERCEPTION OF THE PROBLEM:
1. What did your speech sound like when the problem began? Did anything feel different when you spoke?	I guess I mumble
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?	Doesn’t feel much different to me, I go the same speed, sometimes I get tired, and my voice gets soft.
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, some of the time. I just repeat myself
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. I’m retired. I don’t do as much but not because of my speech but because I tend to fall down.
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. My niece is a therapist, she told me to do exercises, but I haven't gotten around to them.
2. Do you think you need help with your speech now?	I guess
AWARENESS OF DIAGNOSIS AND PROGNOSIS:
1. What have you been told is the cause of this problem?	I have Parkinson’s Disease
2. In view of this diagnosis, what is going to happen?	I have to take medicine and go to 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