Case Study 1 - Speech and Language
@CPETeamLCHS @LCHSLearning
Case Study 1 - Speech and Language Therapy
Case History
- 75 y/o male named John
- Left sided ischaemic CVA in May last year
- PMH: hypertension, angina, T2 diabetes, stents, knee replacements, cataracts
Handover from hospital admission:
- Swallowing recommendations: Dysphagia Trained Nurse managed; Level 4 pureed diet and Level 3 moderately think fluids
- Communication: right sided facial weakness, moderate phonatory dysarthria, mild aphasia, evidence of apraxia of speech
- Patient discharged home with Assisted Discharge Stroke Service
ADSS therapy plan:
- To improve speech intelligibility at conversational level
- To achieve diaphragmatic breathing technique
- To use clear speech strategies
Initial assessment in Outpatient Patient clinic
Swallowing:
OroMotorExam: mild right-sided facial weakness, good range of lingual movement, good strength observed.
Oral stage: reduced lip seal with rim of cup resulting in anterior loss of fluids with thin fluids. Good rotary chew, mildly slow manipulation of bolus
Pharyngeal stage: hyolaryngeal elevation and excursion observed on palpation with all trials. Multiple swallows required for all diet. Delayed overt signs of aspiration with thin fluids, likely due to pooling of fluids within the valleculae/pyriform. No overt signs of aspiration and clear voice post-swallow on diet trials and level 1 fluid.
Patient presenting with mild oropharyngeal stage dysphagia characterised by reduced lip strength and overt signs of aspiration on thin fluids.
Therapist recommendations: Slips of level 1 – slightly thick fluids, level 7 regular diet. Patient commented that level 1 fluids felt easier to swallow and that he felt he could tolerate this consistency. He expressed some concern about using thickener if he ever went out for a meal and that this would likely discourage him from socialising.
Communication:
Patient (Pt.) reports speech has deteriorated since leaving hospital due to reduced opportunities to speak, he spends most of the day alone at home. Pt. lives with son however, son is at work for most of the day. Patient has recently bought a parrot to increase his conversation opportunities at home.
Pt. reports anxiety when speaking to unfamiliar listeners and speaking on the phone, due to concerns that they will not understand him/might ridicule him.
Pt. presented with moderate dysarthria characterised by imprecise articulation, reduced intelligibility of speech and poor breath support.
No evidence of aphasia during clinic session.
Block of 5 dysarthria therapy sessions offered to pt.
Info from further sessions:
- Pt. actively using clear speech strategies during therapy activities and conversation
- Pt. speaking more regularly with friends on the phone who have commented on his speech sounding clearer
- Pt. happy with therapy progress and is less anxious at the thought of speaking with unfamiliar listeners
- Speech intelligibility has greatly increased during therapy activities
- Pt. remains feeling breathless regularly, breath support increased when speaking however pt. remains breathless during any physical activity. (Referral to respiratory)
- Pt. looking into stroke groups and furthering his communicative opportunities
TOMs Scales can be found in J Drive:
J:\2019-2020\LCHS\AHP Services\TOMs\ADAPTED SCALES