1. Case Presentation Judith Iwasko

2. Case History Age: 63 years old Age: 63 years old Left cerebrovascular accident March 2002 Left cerebrovascular accident March 2002 Right sided hemiplegia Right sided hemiplegia Speech services @ Mercy Hospital and Health Center, dismissed due to plateau Speech services @ Mercy Hospital and Health Center, dismissed due to plateau Currently receiving services at RFP Currently receiving services at RFP

3. Prior to CVA… Worked in human relations department at Fond du Lac College. Worked in human relations department at Fond du Lac College. Married Married Five grown children and five grown grandchildren. Five grown children and five grown grandchildren. Participates in adult day-program at Moose Lake skilled nursing facility. Participates in adult day-program at Moose Lake skilled nursing facility.

4. Evaluations September 2003, Minnesota Test for Differential Diagnosis September 2003, Minnesota Test for Differential Diagnosis Results: Results: Auditory Comprehension: moderate impairment, Auditory Comprehension: moderate impairment, Follow 1-2 part simple level directions, Follow 1-2 part simple level directions, Answer simple concrete Yes/No questions, Answer simple concrete Yes/No questions, Inconsistantly able to understand paragraph information Inconsistantly able to understand paragraph information Reading Comprehension: moderate to severe Reading Comprehension: moderate to severe Matched forms and letters to pictures Matched forms and letters to pictures Matched words to pictures Matched words to pictures Matched printed words to spoken words Matched printed words to spoken words Unable to complete paragraph comprehension Unable to complete paragraph comprehension

5. Expressive Language Severe impairment: Unable to answer simple questions Unable to answer simple questions Unable to describe pictures Unable to describe pictures Unable to produce sentences or give biographical information beyond her first name. Unable to produce sentences or give biographical information beyond her first name. Able to repeat monosyllables (given semantic, gestural and phonemic cues). Able to repeat monosyllables (given semantic, gestural and phonemic cues). Able to perform rote tasks (counting, days of week) when given semantic and gestural cueing. Able to perform rote tasks (counting, days of week) when given semantic and gestural cueing. Name pictures when maximum cueing provided. Name pictures when maximum cueing provided.

6. Eval continued Written Language: severe impairment Written Language: severe impairment Unable to write sentences or paragraphs Unable to write sentences or paragraphs Able to write numbers, using non-dominant hand Able to write numbers, using non-dominant hand Able to write letters to dictation with minimum cueing. Able to write letters to dictation with minimum cueing. Numerical Concepts: moderate/minimal impairment Numerical Concepts: moderate/minimal impairment Able to understand monetary concepts Able to understand monetary concepts Able to make change accurately Able to make change accurately Occasional errors with time concepts Occasional errors with time concepts

7. Evaluation September 2003, Motor Speech Exam September 2003, Motor Speech Exam Structural Functional abnormalities during voluntary movement: Structural Functional abnormalities during voluntary movement: Moderate groping behaviors Moderate groping behaviors Reduced tongue strength on right side Reduced tongue strength on right side Reduced range of motion of tongue Reduced range of motion of tongue Acoustic Motor Speech Exam: Acoustic Motor Speech Exam: Slow and misarticulated “puh” Slow and misarticulated “puh” Unable to produce “tah” and “kah” or combine syllables. Unable to produce “tah” and “kah” or combine syllables. Nonverbal Oral Apraxia: Nonverbal Oral Apraxia: Produced 2/20 independently, needed prompts for remaining 18. Produced 2/20 independently, needed prompts for remaining 18. Searching/groping movements Searching/groping movements Reduced speed Reduced speed

8. Diagnosis Severe Apraxia Severe Apraxia Moderate to Severe Aphasia Moderate to Severe Aphasia Moderate impairment of auditory comprehension and numerical concepts Moderate impairment of auditory comprehension and numerical concepts Severe impairment of reading comprehension, expressive language, and written language. Severe impairment of reading comprehension, expressive language, and written language.

9. Past Therapy Total communication approach: Total communication approach: Communication book Communication book Symbols Symbols Basic sign language Basic sign language Writing Writing Number lines Number lines Alphabet cards Alphabet cards Dynavox Dynavox Speech production Speech production Melodic Intonation Melodic Intonation

10. AAC Candidacy Due to her limited expressive language abilities (verbal and written) to communicate at a functional daily living level, Judith would benefit from an alternative mode of communication. Due to her limited expressive language abilities (verbal and written) to communicate at a functional daily living level, Judith would benefit from an alternative mode of communication.