Initial Speech Pathology Assessment

Reason for Referral: Referred from St. Jude's State Hospital ward for outpatient speech pathology following a recent cerebrovascular accident (CVA) on 15 October 2024. The primary concern is post-stroke communication difficulties, specifically expressive aphasia, and suspected dysphagia, which was noted during initial feeding attempts. Background Information: Patient is Mr. John Smith, 72 years old. Relevant medical history includes hypertension and type 2 diabetes. No previous speech therapy. Patient resides at home with his wife, who provides significant caregiver support. Primary language is English, with some conversational ability in basic German from his youth. Presenting Concerns: Mr. Smith's wife reports significant difficulty with Mr. Smith expressing his needs and engaging in conversations. She is also very concerned about his swallowing, as he has coughed frequently during meals since returning home from the hospital, leading to fear of choking. Communication: Expressive language is significantly impaired, characterised by anomia and agrammatism. He uses single words and short phrases, often with significant effort and word-finding difficulties. Receptive language appears mildly impaired for complex commands but is generally functional for simple instructions and conversation. Speech intelligibility is fair, but reduced due to word approximations. No notable fluency issues. Social use of language is impacted by expressive difficulties, leading to frustration. Reading and writing abilities have not yet been formally assessed but appear similarly affected. Cognition / Communication Support Needs: Attention appears intact for short periods. Memory for recent events is fair, but he struggles with sequencing multi-step tasks. Problem-solving is mildly impaired. No current use of formal AAC tools, but his wife uses visual cues and simplified language to aid comprehension. Voice: Vocal quality is clear, with appropriate volume and pitch. No hoarseness or breathiness noted. Functional voice use is limited by expressive language difficulties rather than vocal cord pathology. Swallowing: Patient reports feeling food 'sticking' in his throat. Wife reports frequent coughing during and immediately after meals, particularly with thin liquids and dry solids. Modified diet currently includes thickened fluids and soft, minced solids. Risk of aspiration is high, and safety at mealtimes is a significant concern for the family. Observed oral-motor function during assessment showed mild weakness in tongue lateralisation. Assessment Tools Administered: Bedside Swallow Assessment, informal observation of expressive and receptive language during conversation, and the Aphasia Screening Test (AST) was partially administered. Client Goals: Mr. Smith expressed a desire to be able to tell his wife what he wants to eat without frustration. His wife's primary goal is for Mr. Smith to return to safe oral feeding and reduce aspiration risk. Clinical Summary: Mr. Smith presents with significant expressive aphasia and dysphagia following a recent CVA. Communication strengths include generally functional receptive language for simple commands. Areas of concern are profound expressive language difficulties impacting daily communication and a high risk of aspiration due to swallowing difficulties, leading to significant anxiety for both Mr. Smith and his wife. These challenges profoundly impact his ability to participate in daily activities and maintain social connections. Recommendations / Next Steps: Proposed therapy will focus on dysphagia rehabilitation, including compensatory strategies (e.g., chin tuck, smaller bites) and exercises to improve oral-motor strength. Receptive and expressive language therapy will focus on functional communication strategies, word-finding techniques, and visual supports. Parent/caregiver education provided regarding safe feeding practices and communication strategies. Referrals to an ENT for a videofluoroscopic swallow study (VFSS) and a dietitian for nutritional support have been made. Home support strategies include providing a calm mealtime environment and using a communication book with pictures for basic needs. "This set of notes has been produced with the assistance of an AI-scribing service. I confirm that verbal consent has been obtained from the patient. I have reviewed the content of notes and confirm that these are a full and accurate record of my clinical assessment."