3/2/25, 8:45 PM Transcript

Skye Baker

[email protected]

Assessment Results
Client Name: Amy- Assessment (SLP)

Examination Date: March 2nd, 2025

Mode: learning

Case History 97/100

Collaborators 100/100

Hypothesis ✓

Assessments 100/100

Diagnosis 100/100

Recommendations 100/100

Completion Time 100 Minutes

Your Competency Score 99%

Overall Competency Rating

Mastering Competency

Clipboard Contents

Case History
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 1/27
3/2/25, 8:45 PM Transcript

Reflective (+): 36

Acceptable (0): 22

Rejected (-): 1

Identifying / Family Information

3 minutes 7 seconds
Do you speak any languages other than English?

No.

3 minutes 13 seconds
Is there a family history of voice, speech, or language problems?

Not that I am aware of.

3 minutes 26 seconds
Tell me about your family.

I reside back with my mom and dad. Well, I do have two teenage
daughters, so you know, they are both active in sports.

Areas of Concern

4 minutes 20 seconds
Why are you here today?

All started just over a couple of years ago. And there's been
moments in the last couple years where it's gotten better, and
then moments where it's worse. And actually, like these last couple
of weeks have been worse than normal, worse than normal. But
like this is probably the worst it's gotten. I mean it's gotten this bad
before. But as far as level of like communication, as far as other
people being able to understand, and me being able to project,
this is probably like the worst I guess, I meant for lack of better

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 2/27
3/2/25, 8:45 PM Transcript

words. You know, communication is tough. Just simply making

phone calls is a huge, huge struggle.

5 minutes 7 seconds
How do you describe your voice?

Very soft. There is times that I can't understand, like when I say
something, so I guess, hard to understand.

6 minutes 4 seconds
How do you perceive your voice at this time: mild, moderate, or
severe?

I would say severe.

6 minutes 24 seconds
Describe how you use your voice during a typical day.

Well, I do have two teenage daughters. So you know, they are both
active in sports. We have a lot of stuff going on at their school. And
you know, as far as at home right now, in the last couple of weeks,
really I've just been trying to organize stuff. At my home prior to
that, it is was primarily school stuff, you know homework. Really,
that's it.

6 minutes 56 seconds
How long has your voice been an issue?

It was just over, I wanna say it's, wasn't, September last year. Let's
see, June is when it started and actually I was being treated for a
neck injury and which I still, you know, battle with, have neck pain.
A couple of my discs are kind of pressed together. However,
whether they are related or not, I have no clue. It did start with a
cold, and you know, I wasn't having any vocal issues. I used to work
as a loss mitigation negotiator, and so one of my primary
functions--actually I was a marketing manager at the time--one of
my primary functions involved being on the phone with attorneys
and agents nationwide. So I was on the phone all day. When I first
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 3/27
3/2/25, 8:45 PM Transcript

got this cold, I could talk fine. Again, I just talked or I spoke like I
was sinusy or clogged up. And it just didn't go away. I started
getting concerned like a month into it. People were like, this is
going around, this is going around and everyone was kind of off
sick. Like another month went by. I'm like something's not right. Do
I have mono? What's going on? Then it went away, runny nose,
feeling so stopped up. But then I began to lose my voice. So that's
really all I can tell you as far as remembering when it started.

7 minutes 30 seconds
Has your voice improved or declined since initial onset?

It's just I been like the whisper like as my regular voice has been
going on a lot lately. So to me, like when you said whisper,
although if I were, I could still project it, if I really needed to or
wanted to.

8 minutes 4 seconds
Is your voice ever normal? If yes, when and for how long; for
example, moments, sentences, hours, days?

Occasionally, when it's I would say just back to like to give you a
good time frame to compare it to. I mean, probably four sentences
would be the longest that it would come out.

8 minutes 20 seconds
Did you ever have a period of complete voice loss?

I guess not, like, even where nothing would come out.

9 minutes 3 seconds
Do you engage in any vocal behaviors like yelling, screaming,
throat clearing, coughing, or weight lifting?

Clearing the throat, I notice myself doing that a lot. And sniffling.
Like I always feel like my, I have a runny nose. And one of ENTs--I
don't believe you have this report--he noticed a lot of drainage,
excessive drainage. To be honest, I don't know if other ENTs noted
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 4/27
3/2/25, 8:45 PM Transcript

that or not. And yelling or screaming, again, I mean I can't scream.

Prior to losing my voice, you know what if complete honesty, I
wouldn't call it screaming. I have yelled loudly at my daughters at
times. Did it happen often, no.

10 minutes 21 seconds
What previous evaluations or therapy have you had?

I did take speech therapy when this first started. So I mean, she
gave me breathing exercises, deep breathing for at home. We did
try different tones. It was more vocal in our session. She gave me a
couple of breathing exercises. And I probably should have done it
more, but I just felt like they weren't doing anything.

11 minutes 10 seconds
What types of exercises did you work on in therapy?

I just remember it being just where I am solely focusing on

breathing from my diaphragm, and it was just [breath].

11 minutes 24 seconds
Were you ever given a diagnosis?

One of the things that she did is, she would hold a tissue in front of
my nose and my mouth when I would speak. And she was amazed
that--I forget the exercise she did. Whatever it was, like, the tissue
was not moving. I sound very breathy but there was not nearly as
much breath coming out when I was speaking. She found that, like
I forget what she related it to. Then I brought that up to my
primary doctor. For the longest time, he thought I had an issue
with my palate so that was his for months and months. And the
speech, like, they totally disagreed, the speech therapist and my
primary doctor. That went on for a six-month period. I finally just
said, whether it is what you think it is or not, we need to move this
along. I need to see other specialists. So I just ended up taking it
upon myself to get in to see you.

41 minutes 5 seconds
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 5/27
3/2/25, 8:45 PM Transcript

Does anything improve your voice?

Well, and let's go back for a second. I will say if I don't speak for
hours, in fact, like if I know I have to make an important phone call,
I'll just, I won't talk for hours. What I call "saving my voice." So I can
actually make an important phone call. I can usually get through a
phone call or two by doing that. So yes, if I am completely quiet for
hours, then it is better momentarily. The other time when I was
talking to my aunt about this, I laugh, but like drinking wine or
alcohol, I think it's because it relaxes that entire area.

Education and Work

12 minutes 59 seconds
How has your voice impacted your vocation?

Well, job, I was in finance for sixteen years, and you know that's
huge. Even to get a phone interview, I just find myself always
having to find another way when it comes to applying for jobs.
Then it's discouraging. So I am still jobless. I am in school, and I do,
it's not so bad at school because I think it's a smaller campus, they
are real good there, they are familiar with my condition. I shouldn't
say familiar with my condition, but they are aware of vocal issues.
But I remember a couple of situations where you know, we as a
group were asked to speak aloud. And especially the first time, it
was really embarrassing. I put my hands in the air and I said, and I
looked at my professor, and he just kind of went [makes gesture].
And they passed over me, but it was still... There were about 50
people. So that kind of opened my eyes to, wow, there's a lot more
you're going to be struggling with in the social environment or
setting, whether it's work, school, or with my children. I think it's
just hard to accept. So you know, I take it day by day and stay
hopeful.

13 minutes 30 seconds
Tell me about your educational history.

I am in school at Gateway Technical College in biomedical

engineering.

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 6/27
3/2/25, 8:45 PM Transcript

13 minutes 46 seconds
Do you have to speak in groups at school often?

Not a lot, so I am lucky with that. Because I will tell you, you know
I'm in student government. I'm actually the treasurer for our
biomedical club. But what I noticed with myself is, I did miss the
last couple of meetings, and it was just because no matter what, I
always have to speak. I do just mind there's usually about ten
people who will show up to our meetings. And they are all just
wonderful people, I have never, well I shouldn't say never--I've had
one situation with a student that was kind of disheartening, but we
won't ever talk about that. But for the most part, everyone of any
student group I've been in, they're wonderful, they treat me as if I
am just like them. So I'm saying this because I have no reason to
fear going to group settings, but I do avoid them. I think it's just
because I feel I'm putting myself out there, and I feel like I may not
want to deal with it that day.

Social / Behavioral

15 minutes 31 seconds
How does your voice disorder impact you on a day-to-day basis?

What I do notice like at home you know, normally if you would ask
like um when I was working and before this, you know my daily
routine has totally changed. There is, I might watch the news for
five minutes, but then it's complete silence in my home. I don't you
know if I could keep the news on or have music playing--that was
always relaxing in the morning as I was getting ready for the day. I
notice now, like whether it's in my car or at home, a lot of times
even for me just to think about stuff or plan out my day, it just, it
seems like it takes a lot more thinking because of my vocal issue.
So silence is key for me to kind of get through my day more
successful, or that's probably not the right word. To get more stuff
done. I can tell you another hard thing for me to cope with on a
social level like, as I like stated earlier, sometimes like my voice will
come out just fine, but then again most sentences sounds like this,
half the time it sounds like this, sometimes it comes out good. So
even like people who know me, to explain it to family and friends,
they're like, they think it's a confidence issue more so, or they just
don't quite understand what I have going on. I don't even

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 7/27
3/2/25, 8:45 PM Transcript

understand it, so I understand it, how they feel. But to be in my

place and try to explain it, it just really brings out a lot of emotion.

16 minutes 14 seconds
Describe your home and how you use your voice at home.

It is a big house. Yeah, communication in that house is rough at

times because it's larger house, and I do, I get frustrated whether
it's my mother or children because that's usually who it is. Where
they're yelling from upstairs and expecting a response when I'm,
you know, thirty, forty feet downstairs. And that happens daily.

16 minutes 32 seconds
Do you avoid speaking when there is background noise?

Not that I avoid, but I talk less.

17 minutes 15 seconds
What are your greatest frustrations?

Like I said, the biggest struggle that I find myself struggling with is
just like the phone calls or even professional conversations. The
other thing is, you know, I have two teenage daughters, so even
interacting at like their school functions. I just I find myself limiting
what I say at certain times, which is good in some ways, but in
most ways, it is not.

Speech, Fluency, and Voice

18 minutes 0 seconds
Do you feel any increase in effort for conversation, increased
loudness, or with singing?

Yes, what amazes me is like, people with vocal issues that are
actually able to sing. So I have wondered about that. I cannot sing.

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 8/27
3/2/25, 8:45 PM Transcript

18 minutes 51 seconds
Does your voice change during different times of the year?

No, I haven't kept very good track. I can go off what other people
have stated. You know this time of the year, my mother mentioned
to my aunt that it has been worse recently. Just so you know, I
reside back with my mom and dad, so she would know. Obviously,
we speak on a daily basis. Do remember in March, but she said it
was a lot better. A lot of people--around the time of March,
February, and maybe April--did make mention that it was getting
better. But if you ask me why I am getting angry, I do remember
times feeling, well it's way better, I'll tell you that. Right now, I do
feel it's at its worst. Whether that has to do with weather or
season, it's hard to say.

19 minutes 44 seconds
Does your voice get worse with use?

Absolutely.

22 minutes 1 seconds
Are you able to get louder?

I could probably yell a little, a little bit louder. It does, it takes a lot
of effort, and I obviously get winded a lot quicker. That--you know,
obviously I try not to yell as much as possible, but when I get
frustrated and you know people don't hear what I'm saying, a lot of
times, especially with my children and family, it comes off as what
are you mad about, why are you angry? You know, so that's
frustrating as well.

43 minutes 45 seconds
Is your voice quality variable from day to day, morning to
afternoon, week to week?

I'll say this, too, as soon as I speak, with my eyes watering here,
even though it's not bad right now. A lot of times when I cry or if I
am passionate about what I'm speaking about. Like upset.

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 9/27
3/2/25, 8:45 PM Transcript

Sometimes when I am speaking about politics. But if I am

passionate or having emotions, it will project louder naturally.

Feeding / Swallowing

22 minutes 18 seconds
Do you have any difficulties swallowing?

Sometimes when I'm swallowing medication or vitamins, like if

there with, it's primarily just with pills. And I have to try like
sometimes three times to actually swallow it.

42 minutes 10 seconds
Have you ever had to thicken the consistency of the liquids you
drink?

No.

42 minutes 10 seconds
Redirect #1

This question is insensitive, uses medical jargon, or is not

developmentally appropriate for your client.

Medical

22 minutes 58 seconds
Do you have any medical issues?

I do have alopecia, severe hair loss. Now it has grown back. But I
mean, I personally I think it's from stress, stress related. And a little
bit hereditary. Because my father has half of his hair. I know it is a
little bit hereditary. I had spots and this last year, and basically I'm
trying to think of what I take. This is something else I take daily,
Biotin. That's more like a supplement that I've just been taking for
like the last three months. But my hair is growing back. I'm happy

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 10/27
3/2/25, 8:45 PM Transcript

about that. Other than that, as far as health issues, I think that's
about it.

23 minutes 5 seconds
Have you had any previous surgeries? If yes, what type of surgery?

I had shoulder surgery, my right. Well I have a plate. Well, two

plates, a plate here and a plate here. It shattered like a snow cone.
That was from a different accident in 2001.

23 minutes 15 seconds
Are you currently taking any medications?

Yes. I take alprazolam and I also take Adderrall. That's for anxiety. I
mean as far as medications I take, I mean I do take pain medicine
occasionally for my neck, which primarily consists of Ibuprofen and
just over-the-counter headache or pain medicine. For sinus,
Claritin. And I do notice when I take Claritin, it does help. It seems
as if it doesn't one hundred percent. Like I can't say when I take
Claritin, I can talk at this level consistently, and I haven't taken it
since I've been here for the last week, and it's been worse. So I
think that might be imperative. But it is easier for me to speak and
talk and maybe just breathe. So other than that.

24 minutes 25 seconds
Have you seen a physical therapist?

The physical therapist for my neck, I mean, obviously we would do

some, he did a lot of stretching. He did a lot of core, he did a lot of
leg. He kind of did full-body therapy from that as well. He gave me
a lot of exercises for home, which did help. One was going up to
the corner of the wall just so you could open up that area. The
other was actually just like personal stretches. And that does help,
still to this day, I'll do that.

24 minutes 35 seconds
Do you cough at night?

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 11/27
3/2/25, 8:45 PM Transcript

Not that I am aware of.

24 minutes 58 seconds
Do you clear your throat often?

Yes.

25 minutes 7 seconds
Do you have any abnormal respiratory patterns or shortness of
breath?

Not that I am aware of.

25 minutes 27 seconds
Do you have any laryngeal pain or sensations in your throat such
as pain, tightness, muscular aching, soreness, burning, globus,
dryness, tickle, or increased mucus?

No.

25 minutes 42 seconds
Have you ever been scoped?

I've gotten scoped so many times. The first one, that's a whole
other story, but they won't release. I'm working on it.

25 minutes 51 seconds
Have you ever been intubated or had a tracheostomy?

No.

26 minutes 8 seconds
Do you have any history or current symptoms of reflux?

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 12/27
3/2/25, 8:45 PM Transcript

No.

26 minutes 48 seconds
Do you or anyone else in your family have a history of ulcers?

Not that I am aware of.

27 minutes 41 seconds
What else would you like to tell me?

Before I forget too because I wanted to tell you this, because I

think it's imperative. Breathing for me is--I think I don't breathe
right. That's, I'm just gonna say that because a lot of times when
my voice is stronger, it's coming from my diaphragm and it's on the
exhale. I don't know if that means much to you, but that's all I
wanted to tell you.

28 minutes 17 seconds
Do you have any issues with your jaw or TMJ?

I have never ever had issue with my jaw locking or anything related
to TMJ.

28 minutes 52 seconds
Do you have any dental problems?

No.

29 minutes 5 seconds
Do you have any issues with cramping or muscle dystonia?

Like spasm? I mean very seldom, no. I mean, I'll tell you sometimes
it does feel like I have a spasm in my neck. No and yeah, if you had

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 13/27
3/2/25, 8:45 PM Transcript

to say consistently, I wouldn't say that consistent, it just has

happened.

29 minutes 47 seconds
What were your specific cervical, shoulder, and spine injuries?

I had, it's mainly in my neck--whether I know it's my disc this is

solely just off what doctors have advised me of. I mean, I have
gotten sets of injections before my vocal loss. With my last set of
injections, I do, I don't know if this is significant or not, when he
gave me those that last time he did injections, it did feel different,
like a pinching sensation. And I did discuss that with him, but I
think it was normal.

29 minutes 58 seconds
What type of injections did you get?

Steroid. It did give short-term pain relief, but then it would come
right back.

30 minutes 21 seconds
Did you have MRI or CT scans following the car accident?

I did get an MRI done, but at not at that time, there was nothing.
The CT scans were, I think, were just primarily of my neck area.

30 minutes 54 seconds
What type of medical care did you seek after the accident?

No, I did not go to the emergency room. Like I said, it was just that
Monday. And actually, my--I called my primary doctor, and they
could not get me in that day. So I ended up, they told me just to go
to walk-in, but I actually ended up just going directly to my
chiropractor. They could get me in right away.

31 minutes 29 seconds

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 14/27
3/2/25, 8:45 PM Transcript

Tell me more about your car accident and any other symptoms
you experienced at the time of your accident.

I just, I do remember just kinda being shooken up. You know, I

mean, I remember it taking me a minute to get out of my car.
Because it was a pretty good impact. But then after, it just kind of it
was like to gather my thoughts. What just happened, you know?
Other than that, I just remember talking to him making sure he
was okay; he was making sure I was okay. Basically, it was just
whiplash; I was hit from behind. I remember I was actually fine that
day and all weekend. And I remember waking up the following
Monday, and I was in such pain. I had no, there was no way I could
even turn my head left or right, it was that strong of pain for a, a
good week, and actually probably two weeks. I mean it got better
as, after the first week, but it was still what I considered severe. I
didn't have full motion, I couldn't turn like either way. And then it
got better. Actually, I mean I got therapy, went to the chiropractor.
I was getting treatment for several months. It got better for about
six, well probably about five months where I had no treatment.
And then, when I started having therapy again, was after I got my
job. And I feel, I mean logic tells me, I had an hour commute and I
was sitting, you know, eight to nine hours a day, so I think just
from sitting constantly, it brought back that neck and discomfort.
But now that I've been off work again, it has not gotten better. So,
but it's different than what it initially was, I mean have motion, no
problem. It's just constant discomfort. And just like right now, I feel
like it needs to be moved around, and it like, when it cracks, it gives
me instant relief.

31 minutes 49 seconds
Have you ever seen a neurologist?

Yes. They sent me back to an ENT.

32 minutes 15 seconds
Do you or anyone else in your family have a history of dyspnea?

Not that I am aware of.

32 minutes 41 seconds
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 15/27
3/2/25, 8:45 PM Transcript

Do you or anyone else in your family have a history of tremor?

No.

32 minutes 58 seconds
Has anyone talked with you about surgical options?

No, there's not been any surgery for my neck. Vocally, noted they
could do Botox through the front. But he doesn't feel it's gonna
help. And after I Googled what that procedure consists of, I really
do not want to do that. They also said they could do an actual
surgery, but there's only a fifty percent chance it would work.

Hearing / Vision

33 minutes 28 seconds
Do you have any hearing difficulties?

No.

33 minutes 37 seconds
Do you have any vision problems?

No.

Language / Literacy

34 minutes 48 seconds
Do you have any difficulty understanding when people are talking
to you?

No.

35 minutes 1 seconds
Describe any difficulties you have with your speech or ability to
think of words.
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 16/27
3/2/25, 8:45 PM Transcript

Ironically, I have not until about maybe two months ago, and that
was the first like time I noticed and it was like consistent for a
couple of weeks where I would be thinking of a word, I know what I
wanted to say, but I just couldn't get the word out. But now that
does not seem to happen since, like. It just happened a couple
times, in that couple-week period. I'm hoping it was just like a one
time hormonal thing.

Collaborators
Reflective (+): 12

Acceptable (0): 8

Rejected (-): 0

Medical

44 minutes 17 seconds
You contact the Primary Care Physician

Hello, I am Joe Larkin. Amy has been a patient of mine for the past
five years. As you are aware, her voice has been an issue for some
time now, and she is seeking a second opinion. I will send you the
reports I have on file to assist with your evaluation.

44 minutes 25 seconds
What is Amy's diagnosis?

Two-and-a-half years ago, Amy was involved in a motor vehicle

accident. She has had continued neck pain and headaches. She
has had dysphonia for the past two years. She has a history of
anxiety and depression, which is well managed. Amy also suffers
from alopecia.

44 minutes 58 seconds
What do you recommend?

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 17/27
3/2/25, 8:45 PM Transcript

I referred Amy to the ENT specialist for his recommendations.

45 minutes 11 seconds
What is Amy's prognosis?

Her prognosis for full recovery from her neck injury is guarded.
Her former otolaryngologist recommended medical management
for her dysphonia, which Amy was not interested in. I am hopeful
that your evaluation may lead to additional insight into her
prognosis.

45 minutes 36 seconds
What do you think is the cause?

Amy describes the onset of her voice loss paired with an upper
respiratory infection. Her URI improved; however, her voice did
not. I initially believed her vocal changes were a result of a palatal
insufficiency; however, the SLP and otolaryngologist that she
initially saw did not believe that was the case.

45 minutes 58 seconds
What medications does Amy take?

She takes alprazolam for anxiety, Adderall, Biotin, ibuprofen as

needed, and Claritin as needed.

46 minutes 6 seconds
What other therapists has Amy seen?

I sent you the reports I have on file to your clipboard. I do not

believe the SLP she was working with is practicing any longer. I
hope you find the information you are looking for.

46 minutes 18 seconds
Describe any recent neurological testing.

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 18/27
3/2/25, 8:45 PM Transcript

Amy had an MRI of her head a year ago. There was nothing
significant with the MRI findings. There were no lesions or shifts
observed. She also had a CT scan of her head and neck. Her head
CT was normal. With regards to her neck, she was noted to have a
disc injury with the outer wall of the disc torn.

46 minutes 25 seconds
What type of injections did Amy receive?

Amy received steroid injections in an attempt to alleviate some

pain and discomfort from her neck injury. I will send you a report I
have on file from the anesthesiologist who completed the
injections.

46 minutes 38 seconds
You contact the ENT

Hello, I am Steven Gessler. I am an otolaryngologist. I have

evaluated Amy and will send you the information I have on file.

46 minutes 50 seconds
Have you treated Amy?

I conducted a videostroboscopy and will send you the results. After

a trial of speech therapy, Amy was referred back to our office for
consideration of medical management.

46 minutes 57 seconds
What did you recommend?

Following the videostroboscopy, I recommended a voice evaluation

and follow-up therapy. After the trial therapy for four weeks, she
was referred back to me, and we discussed treatment options such
as nerve blocker injections and surgery. Amy declined both
options.

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 19/27
3/2/25, 8:45 PM Transcript

47 minutes 3 seconds
What surgery did you recommend?

Surgery to adjust the nerve input and muscle tension by physically

altering the muscles or nerves going to the larynx.

47 minutes 20 seconds
Do you recommend any oral medications?

I did not recommend oral medications for Amy as I do not feel they
would be of benefit to her.

47 minutes 29 seconds
What are your impressions from the videolaryngoscope?

The information you are looking for is in the report I sent to your
clipboard.

47 minutes 37 seconds
You contact the Neurologist

Hello, Dr. Shepard's office. I am sorry, Dr. Shepard is out of the

office. The primary care physician for your client should have all of
the documentation that you need. Have a good day.

Family

47 minutes 48 seconds
You contact the Daughter

Hi, I'm Amy's daughter. My mom's voice just won't get better. My
sister and I try to help her, but we don't know what to do.

47 minutes 57 seconds
How do you help your mom?
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 20/27
3/2/25, 8:45 PM Transcript

Sometimes, I try to explain the problem to people we don't know. I

also try not to yell from my room upstairs because her voice is not
loud enough to yell back.

48 minutes 7 seconds
Has your mom's voice improved?

My mom's voice has never really improved. Some days are a bit
better than others, but for the most part, her voice has sounded
really weak for almost two years now. If she doesn't talk for a long
time, her voice sounds a little better, but that only lasts for a few
minutes, and then it is really weak and breathy again.

48 minutes 24 seconds
Are you able to have conversations with your mom?

I can talk to my mom and understand what she is saying if we are

in the same room. Her voice is not loud enough for me to talk to
her if we are out in a noisy place.

Hypothesis
Hypothesis #1

49 minutes 12 seconds
VF paralysis

Precerviced: breathy voice, occasional glottal fry,

decreasedloudness, strain

Assessments
Voice and Resonance

50 minutes 39 seconds
Sentence Reading
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 21/27
3/2/25, 8:45 PM Transcript

52 minutes 18 seconds
Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

Results: Amy's voice was noted to be moderate-severely breathy

and strained, particularly when she tried to project. Occasional
periods of normal voicing was observed, generally in short bursts
following a noisy onset to production. This was especially evident
in the sustained /i/ productions.

52 minutes 57 seconds
Spectrogram

53 minutes 34 seconds
Rigid Video Stroboscopy Analysis

Results: Videostroboscopy was performed using a 70-degree rigid

oral endoscope during phonation, pitch glides, laryngeal
diadochokinesis, and breathing. Anterior portion of the folds could
not be visualized.

53 minutes 55 seconds
Flexible Endoscopy Analysis

Notes: Under flexible endoscopy, the following parameters were

observed. Vocal fold abduction was noted to be within normal
limits during inspiration & expiration during quiet breathing. The
vocal folds were noted to approximate at mid-line during attempts
at sustained phonation on /i/. With the flexible endoscope in place,
Amy was asked to read the abductor and adductor spasmodic
dysphonia sentences. The vocal folds were noted to spasm closed
on some of the vowel initial words. Abductory spasms could not be
ruled out but were inconsistent with given tasks. Posterior and
lateral pharyngeal wall compression were noted at higher

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 22/27
3/2/25, 8:45 PM Transcript

frequencies, indicative of extrinsic laryngeal/pharyngeal muscle

tension.

54 minutes 59 seconds
Analysis of Dysphonia in Speech and Voice (ADSV) Analysis

57 minutes 16 seconds
Aerodynamic Resistance

Results: 57.42 cm H2O (l/s). Normative Data: Laryngeal Airway

Resistance (Norm 31 to 45 cm H2O l/s).

57 minutes 45 seconds
Mean Expiratory Airflow

Results: .46 L/s Normative Data: (Norm <.20 L/s)

58 minutes 3 seconds
Mean Peak Air Pressure

Results: 8.77 cm H2O. Normative Data: Mean Peak air pressure

(Norm 4 to 8 cm H2O).

58 minutes 13 seconds
Vital Capacity

Results: 2.7 liters (Norm 2 to 4 Liters)

58 minutes 36 seconds
Voicing Efficiency

Results: Results below expected values. Notes: Normative Data:

MeanPeak air pressure (Norm 4 to 8 cm H2O) and Laryngeal
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 23/27
3/2/25, 8:45 PM Transcript

Airway Resistance (Norm 31 to 45 cm H2O).

59 minutes 35 seconds
Average Fundamental Frequency for CAPE-V Sentences

59 minutes 58 seconds
Average Fundamental Frequency for Reading

1 hours 18 seconds
Average Fundamental Frequency for Spontaneous Speech

1 hours 1 minutes 16 seconds

Average Fundamental Frequency Sustained /a/

1 hours 1 minutes 44 seconds

Average Fundamental Frequency Sustained /i/

1 hours 2 minutes 16 seconds

Highest Fundamental Frequency

1 hours 2 minutes 38 seconds

Lowest Fundamental Frequency

1 hours 3 minutes 16 seconds

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 24/27
3/2/25, 8:45 PM Transcript

Counting 1-10

1 hours 3 minutes 46 seconds

Counting 1-100

1 hours 3 minutes 59 seconds

Counting 60-90

1 hours 4 minutes 21 seconds

Low-tech Assessment

Results: Maximum phonation time, conversational intensity, and

maximum intensity are all below expectations for Amy's age and
gender. Her s/z ratio was significantly elevated. During the
counting task, she noted significant effort was required and
became more breathy as she counted higher.

Motor Speech / Intelligibility

1 hours 5 minutes 19 seconds

Diadokokinetic Speech Patterns

1 hours 5 minutes 42 seconds

Connected Speech Sample

Oral Peripheral

1 hours 6 minutes 7 seconds

Oral Peripheral Exam
https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 25/27
3/2/25, 8:45 PM Transcript

Results: Completed an oral mechanism exam with Amy to assess

the strength, speed, coordination, and range of motion of all
articulators. Findings were generally within normal limits. Facial
function was normal with the exception of a slight asymmetry of
the nose, with the tip deviating to the right. Amy noted occasional
tingling in the area of her mandible. Lips were symmetrical and
had full ROM, strength, and coordination. Tongue and jaw function
were within normal limits. Palatal function was symmetrical, but
noted limited palatal elevation with repeated /a/ productions. This
corresponds to a perceptual quality of nasal air emission on
occasion; however, testing for nasal air emission using a paper
paddle was negative. Alternating motion rates and sequential
motion rates were within normal limits. Laryngeal palpation
indicated significant tension in the musculature surrounding the
larynx, particularly on the left side. Amy indicated discomfort in the
region of the cricoid cartilage. Palpation of the hyoid bone was
particularly difficult on the right side. The entire laryngeal complex
appeared to deviate slightly to the right.

Hearing

1 hours 6 minutes 59 seconds

Hearing Screening

Results: Amy passed a pure tone hearing screening.

Psychosocial

1 hours 7 minutes 18 seconds

Voice Handicap Index (VHI)

Results: Total Score: 85. Subscale scores: Functional 30; Physical

29; Emotional 26. Amy completed the Voice Handicap Index
questionnaire, which required her to respond to statements
typically used to describe the voice and the effects of vocal issues
in everyday life. Mean values of these self-perceived ratings were
totaled and compared to normative data. The statements,
representing functional, emotional, and physical effects, were
rated on a 0 to 4 scale (0= never, 4= always). Amy's scores indicate

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 26/27
3/2/25, 8:45 PM Transcript

her voice problem is having a severe effect on her physical,

emotional, and functional well-being.

Diagnosis
Voice/ Resonance/ Airway

1 hours 15 minutes 56 seconds

Mixed Abductor/Adductor Spasmodic Dysphonia

1 hours 16 minutes 6 seconds

Vocal Hyperfunction

Recommendations
Recommendations

1 hours 18 minutes 36 seconds

Amy qualifies for outpatient services. Recommend educating Amy
regarding techniques to reduce hyperfunctional behaviors and
laryngeal tension. Recommend a consultation with ENT for
consideration of botulinum toxin injections.

https://www.simucase.com/simucase/simulation/download_assessment/2e68d7f0-0660-4369-b2f5-49c316de8d63 27/27