Case Study 1, Sample Patient 5

Sample Patient Five (audio: sample 4)

DOB: 7/4/35
Sex: M
Post-onset: 3 months
Referral: neurologist

Pertinent Medical History (PMH): DJD
ALS diagnosed 7/98

Social history: Tobacco: none
Alcohol: 3 beers/day
Married, accountant

Family history: father died age 54, respiratory failure
mother died age 88 CVA

Surgical history: none

Current complaints: voice is slurred

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? My words get a little slurred together sometimes. My wife says I sound nasal

2. When did the speech problem begin?
Did it begin suddenly or gradually?
Who noticed it first, you or someone else? I really just noticed it the past month or so. It’d sound bad when I got home from work. It’s gotten worse since then.

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? My left leg became weak just a few weeks before that. My other leg was weak about the same time as my speech got bad.

4. Has the speech problem changed?
Better, worse, stable, better-than-stable, fluctuating? It’s definitely getting worse.

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? 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? Now that you mention it, I get a little choked up more often now, but only when I’m not paying attention.

6. Have you had any cahnge in your emotional expression?
Do you cry or laugh more easily or less easily than in the past? Well, I was pretty upset when I heard what I had and how I’ll probably die from it. I guess I get kind of down now and then.

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? Like it was slurred

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? It’s slurred. I think I talk a little slower too to make it sound better. It’s worse when I’m tired.

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, especially when it’s bad. 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? I don’t have to write. I’m still working but I will probably retire pretty soon because it’s getting harder to get to work with my legs.

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? I slow down, repeat myself

2. Do you think you need help with your speech now? I’d like to get back to normal

AWARENESS OF DIAGNOSIS AND PROGNOSIS:

1. What have you been told is the cause of this problem? I have Lou Gherig’s disease.

2. In view of this diagnosis, what is going to happen? Well, the doctor said it’s probably going to get worse and worse, probably won’t be able to walk after awhile.

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):	DJD ALS diagnosed 7/98
Social history:	Tobacco: none Alcohol: 3 beers/day Married, accountant
Family history:	father died age 54, respiratory failure mother died age 88 CVA
Surgical history:	none
Current complaints:	voice is slurred

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?	My words get a little slurred together sometimes. My wife says I sound nasal
2. When did the speech problem begin? Did it begin suddenly or gradually? Who noticed it first, you or someone else?	I really just noticed it the past month or so. It’d sound bad when I got home from work. It’s gotten worse since then.
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?	My left leg became weak just a few weeks before that. My other leg was weak about the same time as my speech got bad.
4. Has the speech problem changed? Better, worse, stable, better-than-stable, fluctuating?	It’s definitely getting worse.
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?	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?	Now that you mention it, I get a little choked up more often now, but only when I’m not paying attention.
6. Have you had any cahnge in your emotional expression? Do you cry or laugh more easily or less easily than in the past?	Well, I was pretty upset when I heard what I had and how I’ll probably die from it. I guess I get kind of down now and then.
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?	Like it was slurred
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?	It’s slurred. I think I talk a little slower too to make it sound better. It’s worse when I’m tired.
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, especially when it’s bad. 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?	I don’t have to write. I’m still working but I will probably retire pretty soon because it’s getting harder to get to work with my legs.
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?	I slow down, repeat myself
2. Do you think you need help with your speech now?	I’d like to get back to normal
AWARENESS OF DIAGNOSIS AND PROGNOSIS:
1. What have you been told is the cause of this problem?	I have Lou Gherig’s disease.
2. In view of this diagnosis, what is going to happen?	Well, the doctor said it’s probably going to get worse and worse, probably won’t be able to walk after awhile.

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