SLP CSE and Communication Ax Neurodegenerative

Client was referred by Dr. Thomas Kelly on 2024-08-15 to NeuroHealth SLP services for speech and communication assessment. Client seen today for initial evaluation with consent. Purpose of visit was to assess communication abilities and provide recommendations. Attendees present: spouse and caregiver. GENERAL INFORMATION: - Live: Lives with spouse in a single-story home - Work: Retired engineer - Neurologist Dr. Sarah Lee involved - Completed intake paperwork - Service request for occupational therapy submitted RELEVANT MEDICAL HISTORY: - Parkinson's disease diagnosis 2018 - Onset: 2017 with tremors and speech difficulties - Previous SLP involvement: - Initial assessment in 2018 - Follow-up in 2019 - Telehealth sessions in 2020 - Pertinent medications: - Levodopa - Carbidopa - Amantadine Respiratory: - Mild shortness of breath - Pulmonary function test normal - Oxygen levels stable - Pending sleep study GERD: - Occasional heartburn - Managed with dietary changes Weight: - Recent weight loss of 5 lbs - Long-term weight stable - Current weight status: within normal range Secretion Management: - Sialorrhea: mild drooling - Xerostomia: not present - Uses sugar-free gum for management - Education on secretion management provided PHYSICAL STATUS: - Mobility status: uses a cane - Physical activity level: walks daily VISION/HEARING: - Vision status: wears glasses - Hearing status: mild hearing loss, uses hearing aids COMMUNICATION STATUS Verbal Expression: Level of support: Moderate support required Yes / No: Accurate 80% of the time Auditory Comprehension: Mild difficulty with complex instructions Symbol and Reading Comprehension: Intact Written Expression: Uses large print and simple sentences AAC TRIALS Experience with technology: Moderate Devices and Apps demonstrated: - iPad with speech apps - Dynavox - Proloquo2Go - Text-to-speech app CLINICAL SWALLOW EVALUATION: Reported dysphagia symptoms: - Difficulty swallowing liquids - Coughing during meals - Sensation of food sticking - Prolonged meal times EAT-10 score: 12 FOIS score: 5 Reported compensatory strategies: - Chin tuck - Small sips of water Current Diet: Soft solids and thickened liquids Typical Meals: - Breakfast: Oatmeal and fruit - Lunch: Soup and sandwich - Dinner: Mashed potatoes and steamed vegetables Oral Care: - Brushes teeth twice daily Observations: - Dentition: Good - Oral Motor Exam: - Tongue: Reduced lateral movement - Cheeks: Normal - Lips: Reduced closure - Diadochokinetics: Slow but rhythmic - Articulation/Intelligibility: Mildly impaired - Breath Support: Adequate - Sustained Phonation: 10 seconds - CN 5 trigeminal: Normal - CN 7 facial: Mild weakness - CN 9 glossopharyngeal: Normal - CN 10 vagus: Normal - CN 12 Hypoglossal: Mild weakness Food trials: Successful with thickened liquids Meal observation: Coughing noted with thin liquids SUMMARY OF FINDINGS Client presents with mild dysarthria and moderate dysphagia, likely secondary to Parkinson's disease. Recommendations for further assessment include a modified barium swallow study. Risk factors for adverse events (i.e. aspiration pneumonia) as a result of the host condition include: reduced cough reflex and impaired swallow function. Prognostic Statement: Swallow function expected to decline gradually over time. Discussion: Swallow: - Swallow management education provided - Dysphagia progression education provided - Preventative measures discussed - Expected changes to swallow function discussed - Risks and benefits of oral vs modified diet vs tube feeding discussed and client preferences - Swallow and cough maintenance options discussed and client preferences - Referrals made for swallow management Communication: Communication strategies and devices discussed. Written information provided included: - Dysphagia management - Communication strategies - Use of AAC devices - Oral care routines - Dietary recommendations - Swallow safety tips - Exercise handouts Swallowing Recommendations: - Diet: Continue with soft solids and thickened liquids - Oral care: Continue current regimen - Positioning: Upright during meals - Strategies: Use chin tuck and small sips - Treatment: Swallow therapy sessions - Treatment goals: Improve swallow safety and efficiency - Referrals: Modified barium swallow study Communication Recommendations: - Equipment through insurance: Dynavox - Speech exercises/strategies: Daily articulation exercises - Low-tech communication aids: Picture cards - Referrals and follow-ups: Follow-up with neurologist and SLP Client agrees with recommendations. PLAN - SLP follow-up plan: Weekly sessions for 3 months - Planned assessments and timeline: Modified barium swallow study in 2 weeks - Planned collaboration with other healthcare professionals: Neurologist and dietitian - Planned referrals: Occupational therapy - Planned delegation to support personnel: Caregiver training - Planned treatment sessions: Focus on swallow safety and communication strategies