Clinical Observation Project – Fall 2013

1. Clinical ObservationProject – Fall 2013 Holly Sottiaux Jessica McFadden Trinity Letteri Whitney Grim Stan Glass

2. Client’s Information Name: Stan Glass Age: 67 Disorder: Isolated nominal aphasia

3. Case History • Stan suffered a CVA in the left temporoparietal lobe on October 25, 2013 • Typical speech & language prior to this event • Neurologist assumes isolated nominal aphasia • No other areas appear to be damaged by CVA • Wife reports profound difficulty with naming and word finding, and the presence of nonsensical speech

4. Case History, cont. • Stan is a retired postal service worker • Two daughters • Bachelor’s degree in journalism • Worked in this field in the past • Enjoys traveling, crossword puzzles, and reading

5. Overall Outcome The client will improve expressive language skills by increasing word retrieval and naming ability so that he can appropriately communicate with family and friends.

6. Short Term Goal #1 • The client will initiate a conversation upon entering therapy with the clinician on 4 out of 5 occasions. • Reasoning: • For those with right hemisphere brain damage, communication through verbal means is often a problem. Therefore, pragmatic skills are affected and patients had difficulties with conversational discourse, such as initiating conversation. This study showed that in order to improve conversational discourse, they had the client initiate a conversation. • Blake, M., Frymark, T., &Venedictov, R. (2013).An evidence-based systematic review on communication treatments for individuals with right hemisphere brain damage. American Journal of Speech- Language Pathology, 22, 146-160. doi: 10.1044/1058- 0360(2012/12-0021)

7. Short Term Goal #1, cont. • Materials: • Data collection sheet • Procedures: • Upon entering therapy, wait to see if client initiates conversation • If no initiation, prompt client and wait for response: • Example: “Hi Stan, how are you?” • Record data

8. Short Term Goal #2 • Given a tangible item, the client will name objects correctly 80% of the time. • Reasoning: • This study stated that treatment for individuals with aphasia may lead to only small gains over a long course of time, and that using atypical items over typical items did not always improve the generalization of the individual. Because of these findings, I chose to use typical vegetable items in this naming objective for Stan. • Stanczak, L., Waters, G., & Caplan, D. (2006). Typicality‐based learning and generalisation in aphasia: Two case studies of anomia treatment. Aphasiology, 20(2-4), 374-383. doi:10.1080/02687030600587631

9. Short Term Goal #2, cont. • Materials: • Data collection sheet • Plastic fruit • Procedures: • Introduce naming activity • Communicate expectations to client • Show fruit and provide a carrier phrase • If no response or incorrect response, begin cueing: • “This is a/an ____” and make the first sound of the word • Finish phrase and have client repeat word • Use positive verbal reinforcement with each correct response • Record data

10. Short Term Goal #3 • Stan will request three items from the clinician by independently pointing to items on a picture board in 100% of trials. • Reasoning: • When recovering from nominal aphasia, patients need to be aware of compensatory strategies to use when word finding may be difficult. Being able to correctly use a picture board will help Stan to efficiently communicate in various settings. Once Stan is familiar with this strategy, it can be very helpful. Multiple picture boards can be made for different situations in order to better organize wants and needs. • Jacobs, B., Drew, R., Ogletree, B. T., & Pierce, K. (2004). Augmentative and alternative communication (aac) for adults with severe aphasia: Where we stand and how we can go further. Disability & Rehabilitation, 26(21/22), 231-240. doi:10.1080/0963828041233128024

11. Short Term Goal #3, cont. • Materials: • Data collection Sheet • Picture board • Procedures: • Introduce activity & explain when the clinician points to 1 of 6 tangible objects on the table, client must use picture board to communicate “I want…” and then clinician’s chosen object • Give client an example of this type of communication • Communicate expectations • Point to object. If no response/incorrect, begin cueing: • Ask client, “What do you want?” • Use hand-over-hand to chose correct item on the picture board • Use positive verbal reinforcement with each correct response • Record data

12. Short Term Goal #4 • Given a phrase verbally, the client will match phrases with a picture representation correctly in 90% of attempts. • Reasoning: • I picked this goal because Stan has trouble naming everyday items. Having him use visual scenes in therapy will help him generalize to outside of therapy in his own environment. I started this goal with visual and/or verbal cues because at this point Stan cannot do this on his own. Later on in therapy he will hopefully no longer need verbal and/or visual cues. • Sarno, M. T., Silverman, M., & Sands, E. (n.d.). Speech therapy and language recovery in severe aphasia -- Sarno et al. 13 (3): 607 -- Journal of Speech and Hearing Research. Speech Therapy and Language Recovery in Severe Aphasia -- Sarno et al. 13 (3): 607 -- Journal of Speech and Hearing Research. Retrieved October 25, 2013, from http://jslhr.asha.org/cgi/content/abstract/13/3/607

13. Short Term Goal #4, cont. • Materials: • Data collection sheet • Visual scene of a laundry room • Visual scene of a bathroom

14. Short Term Goal #4, cont. • Procedure: • Introduce naming activity and explain client is to point to the object on a visual scene that correctly corresponds to the object the clinician says • Communicate expectations of therapy goal to the client • Give client a visual scene of a laundry room • Ask question related to object and wait for response. If no response/incorrect, begin cueing: • Name the object from the question and wait for client’s response • Reference object again and prompt the client to point to the object • Use hand-over-hand to choose the correct object in the visual scene • Have client repeat this process with a total of five chosen objects from the laundry room visual scene • Repeat this procedure using a visual scene of a bathroom (5 objects) • Use positive verbal reinforcement with each correct response • Record data