Case Presentation - University of Minnesota Duluth

Case Presentation - University of Minnesota Duluth

Case Presentation Judith Iwasko Case History Age: 63 years old Left cerebrovascular accident March 2002 Right sided hemiplegia Speech services @ Mercy Hospital and Health Center, dismissed due to plateau Currently receiving services at RFP Prior to CVA

Worked in human relations department at Fond du Lac College. Married Five grown children and five grown grandchildren. Participates in adult day-program at Moose Lake skilled nursing facility. Evaluations

September 2003, Minnesota Test for Differential Diagnosis Results: Auditory Comprehension: moderate impairment, Follow 1-2 part simple level directions, Answer simple concrete Yes/No questions, Inconsistantly able to understand paragraph information Reading Comprehension: moderate to severe

Matched forms and letters to pictures Matched words to pictures Matched printed words to spoken words Unable to complete paragraph comprehension Expressive Language Severe impairment: Unable to answer simple questions Unable to describe pictures Unable to produce sentences or give biographical information beyond her first name. Able to repeat monosyllables (given semantic, gestural

and phonemic cues). Able to perform rote tasks (counting, days of week) when given semantic and gestural cueing. Name pictures when maximum cueing provided. Eval continued Written Language: severe impairment Unable to write sentences or paragraphs Able to write numbers, using non-dominant hand Able to write letters to dictation with minimum cueing.

Numerical Concepts: moderate/minimal impairment Able to understand monetary concepts Able to make change accurately Occasional errors with time concepts Evaluation September 2003, Motor Speech Exam Structural Functional abnormalities during voluntary movement:

Acoustic Motor Speech Exam: Moderate groping behaviors Reduced tongue strength on right side Reduced range of motion of tongue Slow and misarticulated puh Unable to produce tah and kah or combine syllables. Nonverbal Oral Apraxia:

Produced 2/20 independently, needed prompts for remaining 18. Searching/groping movements Reduced speed Diagnosis Severe Apraxia Moderate to Severe Aphasia Moderate impairment of auditory comprehension and numerical concepts Severe impairment of reading comprehension,

expressive language, and written language. Past Therapy Total communication approach: Communication book Symbols Basic sign language

Writing Number lines Alphabet cards Dynavox Speech production Melodic Intonation AAC Candidacy Due to her limited expressive language abilities (verbal and written) to communicate at a functional daily living level, Judith would benefit from an alternative mode of communication.

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