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
