FND Wolfson screening proforma

(make use of information in context and transcript) (If transcript not available use information from context) Wolfson assessment clinic appointment between Dr. Sarah Jones, Speech and Language Therapist and Mrs. Emily Carter on 01/11/2024 at 10:00 for 60 minutes. Aim of this assessment is to determine if Mrs. Carter would still like rehabilitation and whether the Wolfson would provide the most suitable intervention. Mrs. Carter was referred by Dr. David Smith on 15/10/2024. The referral letter is on file and will not be duplicated here. **Name:** Emily Carter **Tel. No:** 07700 900123 **Email:** emily.carter@email.com **DOB:** 12/03/1985 **MRN:** 1234567 **NOK name:** John Carter **NOK Tel. No:** 07700 900456 **NOK email:** john.carter@email.com **Onset of symptoms** Mrs. Carter reports that her symptoms began approximately 6 months ago, following a viral illness. She initially experienced difficulties with speech and swallowing, which gradually worsened. She also reports experiencing fatigue and cognitive difficulties. **1. Current list of symptoms** * **Speech:** Mrs. Carter reports significant speech difficulties, including slurring, stuttering, and difficulty finding words. She describes her speech as being worse when she is tired or stressed. She currently uses communication strategies such as writing things down and using gestures. These strategies are moderately effective. * **Swallowing:** Mrs. Carter reports difficulty swallowing, particularly with solids. She has modified her diet to include softer foods and liquids. She reports occasional coughing when eating. She is currently using thickened fluids. These strategies are moderately effective. * **Fatigue:** Mrs. Carter reports significant fatigue, which impacts her ability to participate in daily activities. She rests frequently throughout the day. * **Cognitive difficulties:** Mrs. Carter reports difficulties with memory, attention, and executive function. She uses a diary and reminders to help manage her cognitive difficulties. Mrs. Carter describes a typical day as involving waking up, having breakfast (modified diet), resting, completing some light housework, resting again, and then preparing dinner. She requires assistance from her husband with some tasks. **2. Patient's understanding of FND** Mrs. Carter states, "I understand that FND is a condition where my brain isn't communicating properly with my body, causing my speech and swallowing problems." **3. Agreement with diagnosis of FND** YES: [x] Mrs. Carter states, "I agree with the diagnosis because it explains the symptoms I'm experiencing, and I haven't found any other explanation for my symptoms." **4. Seeking a second opinion** NO: [x] Mrs. Carter states, "I am happy with the diagnosis and the care I am receiving." **5. Current list of diagnoses** * Functional Neurological Disorder (FND) - diagnosed 2 months ago **6. Previous treatments or interventions** Mrs. Carter has received speech therapy and dietary advice from a speech and language therapist. She has also seen a neurologist and a gastroenterologist. **7. Rehab Goals** * Improve speech intelligibility. * Improve swallowing safety and efficiency. * Increase independence with daily activities. **8. Happy with online assessment as a precursor to taking part in rehab? **YES: [x] Mrs. Carter is happy to participate in online sessions. **9. Suitable quiet space for online sessions** YES: [x] **10. Current capacity to engage in therapy sessions** Mrs. Carter is willing to engage in therapy sessions for 60 minutes, 3 times a week. **11. How would patient access assistance during an appointment if needed?** Mrs. Carter stated that her husband will be present during the sessions and can assist her if needed. There are no safeguarding issues. **12. Presence of someone in the home if necessary?** Mrs. Carter's husband will be present during the sessions. **13. Falls** Mrs. Carter has not experienced any falls. **14. Standing** Mrs. Carter is able to stand independently for short periods of time. **15. Functional seizures** Mrs. Carter has not experienced any functional seizures. **16. Dystonia** Mrs. Carter has not experienced any dystonia. **17. Mood and risk** Mrs. Carter reports feeling anxious and frustrated due to her symptoms. She denies any thoughts of self-harm. Protective factors include support from her husband and family. **18. History of trauma** Mrs. Carter denies any history of trauma. **19. Use of alcohol and recreational drugs** Mrs. Carter does not consume alcohol or recreational drugs. **20. Preferred mode of intervention** Mrs. Carter prefers online speech therapy sessions. **21. NOK details and consent for them to be contacted in an emergency** John Carter, husband, 07700 900456. Consent given to contact in an emergency. **22. Current life stressors** Mrs. Carter is experiencing stress related to her symptoms and the impact they have on her daily life. **23. Current medications** * Sertraline 50mg daily **Outcome** Mrs. Carter is suitable for the Wolfson rehabilitation program. The next step is to schedule her for an initial speech therapy assessment and develop a treatment plan.