10/2/23, 2:26 PM Transcript

Olivia La Plume

[email protected]

Assessment Results
Client Name: Julie- Assessment (SLP)

Examination Date: August 19th, 2023

Mode: learning

Case History 100/100

Collaborators 100/100

Hypothesis ✓

Assessments 100/100

Skills Check 100/100

Diagnosis 100/100

Recommendations 100/100

Completion Time 98 Minutes

Your Competency Score 100%

Overall Competency Rating

Mastering Competency

Skills Check
Adult AAC Needs Assessment 100/100
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Accent 1400 with NuEye 100/100

Accent 1400 with NuPoint Head Tracking 100/100

Tobii Dynavox I-12 with Eye Control 100/100

Brief Screen of Orientation, Memory, Language, & Recall 100/100

Oral Peripheral Exam 100/100

Completed 6 of 5

Clipboard Contents

Case History
Reflective (+): 28

Acceptable (0): 7

Rejected (-): 0

Education and Work

9 seconds
Tell me about your educational and vocational history.

Well, I have a high school education. But I worked in the banking

industry for twenty-one years. Then that kind of got stuck; it was
stalled. I decided to make a change, and I started working for a
pharmacy. And I studied for a year and got my pharmacy tech
license. I did that for seven years, and that place wasn't doing good
after that. I had an opportunity to go into construction field, it was
something I had never done, it was my brother-in- law, was out in
Illinois. I went over there for a year-and-a-half just to make some
extra money, not knowing any of this was going to happen but to
pay off bills and do other things. And it ended up to be kind of a
lifesaver for us 'cause with the extra money when I came, I started
having issues there. When I came back, I was not able to work, and

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that's when I started going down. So the money I made helped get
us through that year-and-a-half before I was diagnosed.

Social / Behavioral

12 seconds
Describe a typical day for you.

My activities during the day pretty much is watching TV. And you
know occasionally, I'll, I have a Kindle, I'll try to play a few games.
But you know again, it's with one finger. That's pretty much my
whole day.

14 seconds
Describe how you use and access a computer.

Accessing the computer before I had this was not a problem, just
like everybody else, turn it on and type. Now it's again, typing with
one finger but, usually it's my right hand. This is the weaker hand,
but I have to, I do use my left hand a lot. But typing is easier with
my right hand.

15 seconds
What is most difficult for you each day?

Every activity is hard for me to do. I have no strength in my arms

and my hands so just lifting up a bottle of water is hard.

16 seconds
Do you participate in a support group?

No, I'll have to remember that.

Language / Literacy

20 seconds

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Explain any issues with communication.

I think my communication is pretty good. I mean people can tell I

get winded, but they don't have a problem understanding me.

21 seconds
What strategies do you use to improve your communication?

Well, on the days that I feel like I can't talk a lot, I text. And again,
it's with one finger, but it works. And that's pretty much it, if I can't
talk to someone, I just tell them to text me.

29 seconds
Do you have difficulty reading?

No, I don't have a problem reading.

36 seconds
Do you have difficulty writing?

Now, my writing, yeah it's messy. It's difficult to do any of it now. I

mean I can, and you can read it, but it's nowhere near what it was.

2 minutes 50 seconds
Do you have any difficulties with communication?

No, I don't have any difficulties other than if I talk too long, I get
short of breath, or if I'm really tired, I get short of breath. But I
mean I speak okay in short periods of time.

3 minutes 2 seconds
Do people ask you to repeat yourself?

No, no one's ever asked me so far to repeat myself.

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3 minutes 10 seconds
Do you ever have to modify or shorten your conversation?

Yes, sometimes I have to shorten my sentences and take breaks if

it's going to be a longer conversation.

Speech, Fluency, and Voice

1 minutes 18 seconds
How do you describe your voice?

My voice seems to sound pretty good on most days if I haven't had

a lot of conversation or you know a lot of phone calls. It's pretty
much good during the day.

1 minutes 23 seconds
Has your voice quality changed?

My voice has changed some. I find that I can't talk as loud, I can't
scream, which might be good. I can't say words, just at a higher
pitch. There's no air to come out.

1 minutes 24 seconds
Does your voice give out at times?

Yes, my voice does give out a lot.

1 minutes 25 seconds
Are you able to get louder?

Sometimes I can get louder, sometimes I can't. It just depends on

how I'm feeling in that day.

1 minutes 27 seconds
Does anything improve your voice?
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I find that if I drink water, I sound better. It keeps all of everything

clear, so I do drink a lot of water during the day.

1 minutes 29 seconds
Describe your voice banking process.

It was good, I mean I did pretty good with it. I don't remember how
many visits it took. But you know, one to two hours each time. We
first started by calibrating my voice, saying like ten different
phrases. And then I would have to repeat them so it would
recognize me and download all that and make sure it came back
okay, that the audio was picked up good. They understood my
voice and then we started, you know, each time you had to say
those same ten phrases before you would start recording. It was
like 1,600 phrases.

1 minutes 31 seconds
Did you record each time at the clinic in a sound booth or did you
record at your home?

Yeah, I wanted a better quality sound. A lot of people do it at

home, but I wanted to do it to where it was good.

1 minutes 35 seconds
Were you able to complete the entire voice banking list?

Yeah. After, you get tired, yeah.

Feeding / Swallowing

1 minutes 37 seconds
Do you have any difficulties swallowing your saliva? If yes, please
describe.

I haven't had any issues with swallowing yet. I mean occasionally

you get the little bit of stuff that feels like it's stuck in your throat.

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Mainly dairy products is what does it for me. But other than that,
no, I haven't really had any swallowing issues.

1 minutes 38 seconds
Have you noticed an increase in drooling since your diagnosis?

It's not bad now. I mean at night, maybe I drool a little bit. During
the day it doesn't seem to be a problem yet.

1 minutes 42 seconds
Do you have any difficulties eating and drinking?

I have a feeding tube, but I eat on my own. I don't use the tube
other than just to flush it every day, but I eat pretty much anything
I want. I haven't had any problems. I mean occasionally, I'll, I don't
call it choking because just like normally some people choke on
their spit or something, that's all I get. I don't have food or anything
that I choke on when I go to eat. Now it's hard for me to breathe
after I eat a little bit, it's like I have no room. And It won't be much
food, and I have to put my air on and get my lungs going but, or if I
talk too long I get really winded. If I'm tired, I get really winded.

Medical

2 minutes 4 seconds
Do you have any medical issues aside from the ALS?

I really don't have, I've never really had any major problems
medically. This was just, you know, your basic things everybody
has issues. Nothing, no major stuff, until this.

2 minutes 9 seconds
Are you currently taking any medications, and if so, what do you
take?

I'm not really on a lot of medication. I do take a few things. I take a

blood pressure pill. I'm not really sure why because I don't have
problems, but they won't take me off of it. And I take a thyroid pill.
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Then I have, the only medication they really have out for ALS, it's
not for a treatment, it's not a cure-type thing. It's Riluzole. And I've
been on it since I was originally diagnosed. And it's supposed to
give you two to three months. And they say it slows progression. I
don't know if it's working, but I'm not willing to get off of it to try.

Hearing / Vision

2 minutes 14 seconds
Do you have any difficulties with your hearing?

I don't have any hearing issues.

2 minutes 15 seconds
Describe any vision problems.

My eyes are not great. I should have regular prescription glasses,

but as of right now, I just use reading glasses.

Identifying / Family Information

2 minutes 17 seconds
Tell me about your family. Who do you communicate with?

Oh, well, I'm married. We have two kids, a daughter and a son. One
is 33 and the other one is 29. We've been married 36 years in May.
I tend to forget, I forget how old I am. And two grandchildren.

2 minutes 18 seconds
Is there a family history of voice, speech, or language problems? If
yes, please describe.

I really don't know a lot about my family history.

Areas of Concern

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2 minutes 25 seconds
Why are you here today?

The reason I came today for the communication device is because

my arms and my hands have gotten so weak that I'm not able to
communicate well through a phone or a computer or anything. I
can't type any more. When I text, I use one finger, so. And knowing
that my voice, you know my body's getting weaker, wanted to get a
head start on it.

2 minutes 25 seconds
Tell me about your diagnosis.

I was diagnosed with ALS in August of 2012. I went to several

neurologists, did lots of bloodwork, MRIs, muscle biopsies, spinal
taps, many, like five or six, nerve and muscle conduction tests, and
they finally decided it was ALS.

2 minutes 27 seconds
Describe the progression of your symptoms.

It started with foot drop in my right foot, went up my leg to about

my knee. Then it went to the left leg. Now it's up to well, I'd say my
waist down, I can't pretty much move. But now it's gone up into the
upper part, it's affected my, all my midsection. My arms and my
hands are getting really weak. And my breathing is down to like
nineteen percent because of my muscles not working. So it's
progressed, but I'm still going.

2 minutes 28 seconds
How are you feeling today?

Well, today I am really tired.

2 minutes 30 seconds
Have you had any previous speech, occupational, or physical
therapy?
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No therapy, no.

2 minutes 32 seconds
Which specialists made your final diagnosis?

So I ended up going to a neurologist that specialized in

neuromuscular diseases. And that's where after about a year-and-
a-half of having problems, they diagnosed me. I was actually
diagnosed in Augusta, Georgia, because between Baton Rouge and
New Orleans they couldn't figure out what it was.

Collaborators
Reflective (+): 12

Acceptable (0): 7

Rejected (-): 0

Medical

10 seconds
You contact the Primary Care Physician

This is Dr. Justin Phillips. I'm Julie's primary care physician.

13 seconds
Describe her current mobility skills.

Julie ambulates via her motorized wheelchair, which she controls

with her left hand. Her fine motor abilities are declining, and she
will require adaptations for control access in the near future.

14 seconds
Describe her current ability to eat and drink.

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At her last appointment, Julie reported that she has not had issues
with eating and drinking thus far. She is aware that eating and
drinking will become more difficult for her in the future. She
indicated that she is uninterested in swallow study at this time.

15 seconds
Describe her current ability to communicate with others.

At this time, Julie is able to communicate verbally. However, I'd

expect this ability to decline. I feel she is in medical need of a
communication device as her disease continues to progress.

16 seconds
Describe her current speech skills and respiratory status.

Over the past six months, her shortness of breath has increased.
At this time, she is still breathing on her own and does not require
ventilator support. She has a pulmonologist who has been
following her case and will advise when ventilator support is
needed. She is beginning to have a harder time talking due to her
shortness of breath. I was pleased to hear your evaluation is
occurring at this time.

21 seconds
Does Julie take any medications?

Julie is taking Riluzole, Bumex, and Levoxyl. The neurologist can

provide you with her most recent list and dosage.

3 minutes 49 seconds
You contact the Primary Care Physician

This is Dr. Justin Phillips. I'm Julie's primary care physician.

3 minutes 52 seconds
When was Julie diagnosed?
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Julie was diagnosed with ALS five years ago.

3 minutes 54 seconds
Does Julie take any medications?

Julie is taking Riluzole, Bumex, and Levoxyl. The neurologist can

provide you with her most recent list and dosage.

3 minutes 57 seconds
Describe her current speech skills and respiratory status.

Over the past six months, her shortness of breath has increased.
At this time, she is still breathing on her own and does not require
ventilator support. She has a pulmonologist who has been
following her case and will advise when ventilator support is
needed. She is beginning to have a harder time talking due to her
shortness of breath. I was pleased to hear your evaluation is
occurring at this time.

3 minutes 58 seconds
Describe her current ability to communicate with others.

At this time, Julie is able to communicate verbally. However, I'd

expect this ability to decline. I feel she is in medical need of a
communication device as her disease continues to progress.

3 minutes 59 seconds
Describe her current ability to eat and drink.

At her last appointment, Julie reported that she has not had issues
with eating and drinking thus far. She is aware that eating and
drinking will become more difficult for her in the future. She
indicated that she is uninterested in swallow study at this time.

4 minutes 0 seconds
Describe her current mobility skills.
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Julie ambulates via her motorized wheelchair, which she controls

with her left hand. Her fine motor abilities are declining, and she
will require adaptations for control access in the near future.

4 minutes 3 seconds
You contact the Neurologist

Hello, I'm Catherine Ross, Julie's neurologist. I sent her report to

your clipboard.

Family

3 minutes 6 seconds
You contact the Husband

Hi, I'm Julie's husband.

3 minutes 7 seconds
What are your concerns?

Julie having ALS was a total shock to our family. We went from one
doctor to another, and we were scared and confused. All I wanted
to do was understand what was happening, and then, when we
were told she had ALS, all I wanted to do was make it go away. I
don't know if I'll ever come to terms with the awful hand she's
been dealt, but I've decided to put my anger aside and just help
Julie live the best life she can from here on out. It's obvious that
the ALS is progressing. She can barely use her hands now, and we
know it's only going to get worse. I hate the idea of her having to
use a machine to communicate, but we both know it's the right
thing to do and it'll help as she gets worse. Another thing is, Julie
uses her computer every day, and she's hopeful that her device
will help her continue to do so.

3 minutes 9 seconds
What were Julie's symptoms at the time of her diagnosis?

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Julie was tripping all the time. She would drop things for no reason.
She complained of her legs hurting and they were tired a lot. It
took a long time for us and the doctors to figure out what was
going on.

3 minutes 11 seconds
Explain what a typical day is like for Julie.

Julie needs help to do almost everything. If I'm not around, she

watches a lot of TV or reads. When I'm home, I try to get her
outside as much as I can, but it's hard.

3 minutes 12 seconds
Do you feel Julie is able to communicate well with you?

I can understand her, but I think she's talking less and taking more
breaks than she used to.

3 minutes 13 seconds
Tell me about any previous therapy Julie has had.

Julie hasn't had any therapy before.

3 minutes 16 seconds
Does her ability to communicate change during the day? If yes,
when does she have the greatest problems?

She gets tired quickly and doesn't talk in the evenings as much as
she used to.

Allied Professions

3 minutes 34 seconds
You contact the SLP for Voice Banking

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Hello, I'm Ann Staffino. I'm the speech-language pathologist who

completed voice banking with Julie a few years ago.

3 minutes 40 seconds
What program did you use for voice banking?

I used Model Talker with Julie.

3 minutes 43 seconds
What device do you recommend?

I haven't seen Julie for the past few years, but I would hope she can
find a device that will allow her to use her synthetic voice.

3 minutes 45 seconds
Have you seen Julie for speech therapy?

I only saw Julie for voice banking. She has not had any speech
therapy at our clinic.

Hypothesis
Hypothesis #1

5 minutes 40 seconds
Daily communication

ASL

Assessments
Augmentative and Alternative Communication

30 seconds

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Adult AAC Needs Assessment

3 minutes 26 seconds
Accent 1400 with NuEye

7 minutes 40 seconds
Accent 1400 with NuPoint Head Tracking

11 minutes 11 seconds
Tobii Dynavox I-12 with Eye Control

32 minutes 58 seconds
Education Regarding Device Access and Options

Psychosocial

33 minutes 12 seconds
ALS Specific Quality of Life-Revised (ALSSQOL-R)

Results: Julie answered 50 questions pertaining to her experiences

in the last week. Considering all parts of her life, including physical,
emotional, social, spiritual, and financial, over the past week, her
overall quality of life has been a 4 on a scale of 0-10. (Very bad = 0
to Excellent = 10). Her total score for the ALSSQOL-R was 300 with
an average score of 6.5. Using the scale of 0 = No Problem to 10 =
Tremendous Problem, Julie indicated that fatigue is a 6, speaking is
a 2, and strength and ability to move is a 9. Julie also indicated that
she has been interested in other people and things and her desire
for social contact has been strong.

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Cognition and Achievement

33 minutes 25 seconds
Brief Screen of Orientation, Memory, Language, & Recall

Hearing

36 minutes 10 seconds
Hearing Screening

Results: Julie passed a pure tone hearing screening.

Oral Peripheral

36 minutes 20 seconds
Oral Peripheral Exam

Diagnosis
AAC/ Augmentative Communication

44 minutes 36 seconds
Needs AAC System

Neurological

44 minutes 59 seconds
Amyotrophic Lateral Sclerosis

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Recommendations
Recommendations

45 minutes 24 seconds
Due to the degenerative nature of ALS impacting Julie's breath
support, articulatory movements, and fine motor skills,
recommend she use a speech-generating device with eye gaze.
Based on the AAC trials and input from the client, recommend the
Tobii Dynavox I-12+ with eye gaze for functional communication.
Also recommend individual therapy to become familiar with the
features of the software, customize the device for Julie's personal
needs, and provide education to client and family.

Skills Check
Adult AAC Needs Assessment
Which statement best describes the needs of the client you are evaluating?

A. Julie needs an AAC device because she is nonverbal.

B. Julie does not need an AAC device.

C. Julie needs an AAC device due to a degenerative disease. Correct

D. Julie needs an AAC device because of cognitive impairments.

Based on the information presented in the case, which statement applies to this
client?

A. Julie understands the need and/or value of using an AAC system. Correct

B. Julie is uninterested in an AAC device.

Based on the case history interview, what are your impressions of Julie's expressive
and receptive language abilities?
Currently, they are WFL. However due to the prognosis of her degenerative
disease, this will likely decline.
Where will Julie need to access an AAC system primarily?

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A. While walking

B. While driving

C. While sitting in a wheelchair Correct

D. While at school

E. While at work
When will Julie likely use an AAC system? Select all that apply.

A. When she improves

B. When her skills decline Correct

C. When she is tired Correct

D. When she returns to work

What access methods can Julie currently operate given her present-day abilities? Select
all that apply.

A. A switch controlled by her legs

B. Typing with her pointer finger Correct

C. Head control Correct

D. Eye gaze Correct

Due to the degenerative nature of her disease, which access method will Julie likely
need to use long term?

A. A switch controlled by her legs

B. Typing with her pointer finger

C. Head control

D. Eye gaze Correct

Who are Julie's likely communicative partners? Select all that apply.

A. Spouse Correct

B. Children Correct

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C. Grandchildren Correct

D. Doctors and therapists Correct

E. Students
Enter additional notes regarding communicative partners and Julie's ability to
communicate (i.e. visual impairment, hearing impairment, familiarity with AAC).
ALS
In what environment will Julie primarily need access to an AAC system?

A. Hospital

B. Home Correct

C. School

D. Work
Which device features would be beneficial for Julie? Select all that apply.

A. Single-message communicator

B. Computer access and ability to connect to the internet Correct

C. Ability to operate toys

D. Speech-generating device with voice output for use of personal recorded voice
Correct

E. Ability to control items in environment (TV, lights) Correct

F. Use of PECS icons

Accent 1400 with NuEye

Which statement is more accurate?

A. Calibration exceeds a score of 1 and is unsuccessful.

B. Calibration is lower than 1 and is successful. Correct

Which statement is more accurate?

A. The client verbalizes difficulty with accessing the lower quadrants of the device.
Correct

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B. The client is able to access the device and spell her name accurately.
Enter notes regarding Julie's performance with this device.
She has trouble accessing the lower quadrant, she is getting a slightly higher score
than what we want so a different device might be more suitable
What do you recommend doing next?

A. Give up.

B. Try a different access method or a different device. Correct

C. Recalibrate the device.

Accent 1400 with NuPoint Head Tracking

Describe how head pointing is used with this device.
The small reflective dot on her forehead use the natural movement of her head to
point on the screen. Activation is made by dwelling over the desired area.
Which statement is more accurate?

A. The client is successful with head pointing access.

B. The client verbalizes difficulty with head pointing and expresses concern
regarding her degenerative illness impacting her ability to move her head long
term. Correct

Tobii Dynavox I-12 with Eye Control

Which statement is most accurate?

A. Calibration is unsuccessful.

B. After lowering the device on the mount, calibration is successful. Correct

C. Calibration is successful with no intervention needed.

Which statement is more accurate?

A. Client is able to access the device and spell her name with minimal cues. Correct

B. Client is unable to access the device.

Describe the process for how a client pauses and then unpauses this device.

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You can pause and resume by looking below the screen to bring up the menu that
lets you choose to pause or resume.
Summarize the options available for this device.
Julie is able to communicate using social media, a talk option, as well as she has
access to social media, a camera, calculator, alarm, music, pictures, and contacts.
She also has options to web browse.
Enter a summary of the Tobii Dynavox I-12+ device trial with Julie.
Julie seemed most responsive to this device and is able to communicate well on
the device. This device also seemed most appropriate for the functions she
wanted.

Brief Screen of Orientation, Memory, Language, & Recall

Score

A. 0

B. 1 Correct

What year is it?

A. A. 2015

B. B. 2016

C. C. 2017 Correct

D. D. 2011
Score

A. 0

B. 1 Correct

What month is it?

A. A. April Correct

B. B. December

C. C. January

D. D. March
Score
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A. 0

B. 1 Correct

What day of the week is today?

A. A. Monday

B. B. Tuesday

C. C. Wednesday Correct

D. D. Thursday
Score

A. 0

B. 1 Correct

What season is it?

A. A. Winter

B. B. Spring Correct

C. C. Summer

D. D. Fall
Score

A. 0

B. 1 Correct

Where are you right now?

A. A. School

B. B. Hospital

C. C. Library

D. D. Clinic Correct

Score

A. 0

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B. 1 Correct

Identify the words.

A. A. Dog, leaf, nose Correct

B. B. Ball, paper, bat

C. C. Car, bike, stick

D. D. Glasses, keys, cup

Score

A. 0

B. 1 Correct

Score

A. 0

B. 1 Correct

Score

A. 0

B. 1 Correct

Score

A. 0

B. 1 Correct

Identify the series of numbers.

A. A. 1, 3, 5, 7

B. B. 2, 4, 6, 8

C. C. 5, 10, 15, 20 Correct

D. D. 10, 20, 30, 40

Score

A. 0

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B. 1 Correct

Identify the series of numbers.

A. A. 9, 7, 5, 3 Correct

B. B. 8, 6, 4, 2

C. C. 20, 15, 10, 5

D. D. 40, 30, 20, 10

Score

A. 0

B. 1 Correct

Identify the series of words from earlier.

A. A. Ball, paper, bat

B. B. Dog, leaf, nose Correct

C. C. Car, bike, stick

D. D. Glasses, keys, cup

Score

A. 0

B. 1 Correct

Score (client must complete three steps to earn credit)

A. 0

B. 1 Correct

What is my title?

A. A. Physician

B. B. Physical therapist

C. C. Speech-language pathologist Correct

D. D. Teacher

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Score

A. 0

B. 1 Correct

Calculate and enter the total score. Total points possible = 15.
15
Is further testing recommended?

A. Yes

B. No Correct

Oral Peripheral Exam

Define the term fasciculation.
Movement or tremors at the surface of the tongue.
What does the observation of fasciculations provide you and how does that impact
your clinical findings?
This is one of the first signs of ALS.
Enter notes regarding Julie's alignment, occlusion, and palate.
WFL
Calculate and enter the average rate for each diadochokinetic task.
/p/: 10, /k/: 8.6, /t/: 10, /ptk/:26
Which statement is most accurate?

A. Julie's average rate for diadochokinetic tasks is average.

B. Julie's average rate for diadochokinetic tasks is above average.

C. Julie's average rate for diadochokinetic tasks is below average. Correct

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