1. Case Presentation Case #4, Esther Jessica Cassellius April LaCoursiere Meghan Neu

2. Current Communication Esther’s abilities are limited and dependent on family members due to her severe apraxia Esther’s abilities are limited and dependent on family members due to her severe apraxia Her husband interprets and initiates most conversations Her husband interprets and initiates most conversations She is frustrated because she is not able to talk She is frustrated because she is not able to talk She uses some speech and gestures, but writing is her main communication mode She uses some speech and gestures, but writing is her main communication mode She mostly writes in 1-3 word phrases She mostly writes in 1-3 word phrases

3. Comprehension Previously assessed Previously assessed Was able to answer multiple choice, true/false, yes/no questions with 85% accuracy when reading 20 pages Was able to answer multiple choice, true/false, yes/no questions with 85% accuracy when reading 20 pages Was able to identify a picture when given 4 word choices Was able to identify a picture when given 4 word choices Esther’s listening comprehension appears to be intact Esther’s listening comprehension appears to be intact

4. Language Expression Expressive language is limited Expressive language is limited Occasionally initiates conversation, often takes on the role of the responder Occasionally initiates conversation, often takes on the role of the responder

5. Pragmatics and Communication Intent Esther has lots of information to share about her family Esther has lots of information to share about her family She is eager to communicate when given the opportunity to write and the topic has be established She is eager to communicate when given the opportunity to write and the topic has be established Her pragmatic skills appeared appropriate and passive Her pragmatic skills appeared appropriate and passive

6. Communication Needs Communication to carry out social interactions Communication to carry out social interactions Needs to communicate with many different family members Needs to communicate with many different family members Likes to participate in activities, such as Likes to participate in activities, such as Playing cards Playing cards Going out to eat Going out to eat Church activities Church activities Talking on the telephone Talking on the telephone

7. Communication Needs Communication related to medical care and decision making Communication related to medical care and decision making Attends physical therapy as well as speech therapy Attends physical therapy as well as speech therapy Needs to be able: Needs to be able: Report complaints Report complaints Talk about current status Talk about current status Ask questions Ask questions Give opinion Give opinion

8. Communication Needs Communication related to basic needs and wants Communication related to basic needs and wants Important that Esther be able to: Important that Esther be able to: Express feelings Express feelings Make choices Make choices Give opinion Give opinion

9. Hearing No formal assessment No formal assessment Responded to conversational level speech throughout the assessment Responded to conversational level speech throughout the assessment

10. Vision No formal assessment No formal assessment Was able to find small targets on laptop computer and Lightwriter Was able to find small targets on laptop computer and Lightwriter Was able to read both small and medium texts with ease Was able to read both small and medium texts with ease

11. Cognition No severe cognitive impairments as a result of the stroke No severe cognitive impairments as a result of the stroke Was able to follow complex information and directions Was able to follow complex information and directions Grasped functional concepts of the devices rather quickly Grasped functional concepts of the devices rather quickly We felt she posses the cognitive and linguistic abilities to use a supplemental speech device We felt she posses the cognitive and linguistic abilities to use a supplemental speech device

12. Augmentative Considerations These supplemental systems were used during the assessment: These supplemental systems were used during the assessment: Gestures Gestures Writing Writing Lightwriter Lightwriter Main goal is to increase communication independence, which may be done by using one of the above supplemental systems Main goal is to increase communication independence, which may be done by using one of the above supplemental systems

13. Summary We feel Esther is a good candidate for a speech generating device We feel Esther is a good candidate for a speech generating device

14. Recommendations 1. Supplement speech with the use of signs and gestures 2. Begin trial therapy with the Lightwriter to familiarize operation and begin generalization to group activities, such as Socialize! 3. Trial therapy with DynaVox This device does not require Esther to type in full sentences and may aid in initiation of conversation This device does not require Esther to type in full sentences and may aid in initiation of conversation

15. Recommendations 4. Trial therapy with the Pathfinder Makes vocabulary more accessible Makes vocabulary more accessible Does not require communication in full sentences Does not require communication in full sentences 5. Dyad treatment with another augmentative device user Help to meet communication goals, such as Help to meet communication goals, such as increasing comfort level increasing comfort level Increasing generalization with different listeners Increasing generalization with different listeners Increasing conversation skills Increasing conversation skills Increasing participation in activities Increasing participation in activities