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ST.

MARTIN DE PORRES SPECIAL SCHOOL


722 – Tres de Abril St., Labangon Cebu City

PROGRESS EVALUATION

NAME: Jan Lester Cedeño AGE/SEX: 29/M


MEDICAL DIAGNOSIS: Spastic Cerebral Palsy

I. OBSERVATIONS

Posture

Jan is able to keep his head in an upright position 80% of the time during therapy sessions.
During 20% of time, verbal prompts are required for him to become aware that his neck is not in
proper alignment. He is also able to assume a proper sitting position 100% of the time in therapy
sessions. Although the 100% is not reflective of his actual posture, the student clinician rated his
posture with the said rating because in times when he shifts to an inappropriate posture, he
immediately adjusts himself from the deviation.

Clinical Impression: The improvement in posture is deemed to have positive effects in areas such
as speech and feeding. However, this area would be better addressed by Physical Therapists.

Oral Peripheral Mechanism (OPM)

Jan shows an improvement in labial control. This improvement is exhibited by an increase in


drooling management. When in rest position, Jan is able to manage his drooling 100% of the
time. However, when he is presented with gross motor tasks (i.e. hand reaching, neck exercises),
drooling is observed.

Clinical Impression: Jan’s improvement in labial control is important for feeding and speech,
specifically for the production of bilabials and for bolus management.

Speech

Jan is able to consistently produce bilabials such as /b/ and /m/. He is also able to produce /p/,
although not consistently. He has a tendency to retract his lower lip during the production of /p/
allowing his lower lip to articulate with his upper incisors simulating the position of labiodentals.
Whenever he exhibits this misarticulation, he is able to correct himself whenever presented with
visual cues (i.e. mirror). He is also stimulable to tactile cues, making him aware where the
articulation is currently happening compared to where it should be.

Clinical Impression: These speech sounds (/p/, /m/) are functional for Jan in calling the attention
of his mom and dad through utterances such as /mama/ and /papa/. This improvement in speech
would also lead to an improvement in his behavior, specifically, his tantrums. Tantrums are often
observed when Jan is unable to express himself verbally effectively.

Language

Jan is able to answer yes-no questions regarding preference, visual information and general
information. Because Jan is limited by his spasticity, the student clinicians resorted to the use of
other conventional means of expression (/o/ = yes; head shake = no). It was also observed that
Jan’s receptive language was functional however his expressive language cannot be thoroughly
observed because of the limitations in his speech.

Clinical Impression: Improvement in his language would lead to more opportunities for
socialization. It may seem that answering yes-no questions are simple, however this is a starting
point for socialization. It may be a simple yes-no question but it is social interaction in itself.

II. OVERALL CLINICAL IMPRESSION

Improvement in Jan’s posture is a gateway to progress in areas such as feeding and speech. Good
posture is required for speech that requires less effort. In terms of feeding, proper posture is
required to prevent aspiration and facilitate easier swallowing. These areas are also complimented
by the improvement in his OPM structures. Improvement in his speech leads to the optimization
of Jan’s language skills seeing that his receptive language is functional. The motor limitations in
his speech presents as a major barrier in his expressive language. However, because there are
improvements in these said areas, it also greatly affects his behavior. Being able to express
himself effectively to others would decrease his frustration and tantrums. Lastly, Jan shows signs
of good prognosis because of the excitement he presents during therapy sessions. In Jan’s case,
motivation is the key and the greatest facilitator.

III. RECOMMENDATIONS

- Continue line of SLP management


- Physical therapy services to improve his overall mobility and decrease spasticity
- AAC evaluation; The use of an AAC system would help Jan better express himself and
facilitate his speech

Prepared by:

FIDEL ANDREI M. LIAO


Student Number: 212-19543
Cebu Doctors’ University
Department of Speech-Language Pathology

Noted by:

GENEVIVE M. ROBLE-QUINTO, CSP-PASP


Speech – Language Pathology Clinical Supervisor
Cebu Doctors’ University
ST. MARTIN DE PORRES SPECIAL SCHOOL
722 – Tres de Abril St., Labangon Cebu City

AAC EVALUATION

NAME: Jan Lester Cedeño AGE/SEX: 29/M


MEDICAL DIAGNOSIS: Spastic Cerebral Palsy

COGNITION:

Attention
Jan was observed to have adequate attention span during structured tabletop activities. Attention
was always present whenever the student clinician presents Jan with activities.

Arousal
Jan was observed to be responsive with most of the tasks presented to him. He was never
observed to be lethargic or unresponsive.

Information Processing
Jan is able to appropriately respond to commands and executes them within 3 seconds of the
student clinician’s instruction.

Motivation
Jan is always motivated during therapy sessions. This is exhibited by consistent smiling an
eagerness to participate in whatever activity presented.

Behaviour:
Jan is always calm during therapy sessions. He is always attentive to the activity presented but
at times moves his head to the direction of a moving stimulus (i.e. passerby)

LANGUAGE:

Receptive Language
Jan was observed and reported to have good vocabulary. He has spatial, quantitative, qualitative
and temporal objects. Jan also understands the concept of pronouns and has adequate
knowledge on most common nouns (i.e. body parts, animals, fruits, common food, ADL
objects). He is able to respond to yes-no questions regarding preference, visual information and
general information. He is also able to follow commands that do not have major motor
demands.

Expressive Language
Jan communicates through head shaking and unintelligible approximations. Due to his
spasticity, it is difficult to thoroughly evaluate his expressive language.
MOTOR:

Oro-Motor
Informal oro-motor observation was done. His teeth, tongue, and lips were observed to be of
symmetry, typical color, and etc. However, spasticity was observed in his tongue and lips. He is
able to purse, retract and protrude his lips. The mobility of his tongue is greatly affected with the
spasticity, he is unable to protrude, elevate and lateralize his tongue. However, the mobility of his
jaw is functional and not visibly limited by his spasticity.

Fine Motor Skills


Jan’s fine motor skills were not observed. He had no gripping skills because of the amount of
spasticity in his hands.

Gross Motor Skills


Jan was non-ambulatory and is wheelchair-bound. He is able to sit upright whenever verbally
prompted but has a difficulty mobilizing and properly positioning his legs. Limited ROM of the
upper extremities was observed.

MSIPT
Movement
Forward and backward, side-to-side movement of the left arm was observed. He had difficulty
extending his left arm, which puts his right arm at some point of flexion at all times, even when
he moves his arm forward and backward.

Control Site
Pad of the middle finger of his left hand

Input Method
A bondpaper cut to the size of an iPad mini was used during the evaluation. A 2 x 2 grid with 2.5
x 3.5-inch animated pictures was presented. A 2 x 3 grid with 2.5 x 2.5 inch animated pictures
was also presented. However, his accuracy was better on the 2 x 2 grid.

Position of Input Method


The bondpaper was placed approximately half a foot below eye level and 2 feet away from Jan.

Targeting
Pointing (direct selection) was performed.

SENSORY:

Hearing
Jan was responsive to both environmental and speech sound of varying intensities from varying
distances. Based on observations, Jan has functional hearing
Visual (Oculomotor)
Jan was observed to visually fixate on the different animated pictures presented. He
visually tracked presented icons and performed lateral and up-down movements of both eyes.
Such behaviors were also observed when he looked at himself on the mirror. In terms of visual
localization and scanning, he was able to locate icons from different quadrants.

PRESENT COMMUNICATION ABILITIES:

Jan communicates through approximations and grunting. It is up to the communicative partner to


decipher his utterances and validate them through yes-no questions.

FUTURE COMMUNICATION NEEDS:

It is expected for Jan to be able to communicate to his peers in school and other communicative
partners at home. He should also be able to independently communicate his needs to other
members of the community.

CONCERNS AND CONSIDERATIONS:

Jan’s current tonicity and limited ROM may limit his access to the AAC system. Because of these
limitations, it should be expected that there are frequent errors in the initial stages in his AAC
use.

LINGUISTIC COMPETENCE:

Jan is able to recognize animated pictures.

OPERATIONAL COMPETENCE:

Jan is able to point to pictures.

SOCIAL COMPETENCE:

Jan exhibited consistent eye contact with communicative partners.

STRATEGIC COMPETENCE:

Jan was observed to self-correct whenever he pointed to the wrong pictures.


AAC PARTNER:

FACILITATORS BARRIERS
Jan has good familial support and peer support
in school. He has a yaya who assists him in No barriers were identified.
everything he does.

AAC ENVIRONMENT:

FACILITATORS BARRIERS
Because the use of an AAC system is new
Jan is exposed to multiple contexts where he
to the Cebu setting, there may be
may utilize his AAC Device.
judgmental eyes.

AAC SYSTEM:

MOTOR ACCESS FEATURES: OUTPUT:


 Direct selection via hands and fingers  Spoken
 Written
 Text to speech output (digitized/human
voice)

SYMBOLS/DISPLAYS: VOCABULARY/ORGANIZATION:
 2D; colored 2.5x3.5inch animated  Core vocabulary
pictures  Icons/Symbols
 2 x 2 grid display
 Dynamic displays
 Syntactic LANGUAGE
REPRESENTATION/ORGANIZATION:
PORTABILITY:  Single meaning pictures
 Use of iPad
DURABILITY AND REPAIR:
FLEXIBILITY:  (+) Ipad with durable cover
 (+) Vocabulary
 (+) Display (Dynamic/static)
 (+) Output (Digitized/male voice)
AUDIO/VISUAL FEATURES
MESSAGE FORMULATION:  Sound (adjustable)
 Pictures  Contrasting colors
RECOMMENDATIONS:

The following are respectfully recommended:


I. Recommendations
1. Discussing to and educating the family regarding the AAC evaluation results and
course of therapy
2. Downloading free AAC applications, (1) Alexicom and (2) SoundBoard, for trial
3. Continuation of Speech Therapy in order to further speech and language learning
4. Occupational therapy to improve digital manipulation.
5. Physical therapy to improve upper extremity ROM.

Prepared by:

FIDEL ANDREI M. LIAO


Student Number: 212-19543
Cebu Doctors’ University
Department of Speech-Language Pathology

Noted by:

GENEVIVE M. ROBLE-QUINTO, CSP-PASP


Speech – Language Pathology Clinical Supervisor
Cebu Doctors’ University
ST. MARTIN DE PORRES SPECIAL SCHOOL
722 – Tres de Abril St., Labangon Cebu City

INDIVIDUALIZED THERAPY PLAN

NAME: Jan Lester Cedeño AGE/SEX: 29/M


MEDICAL DIAGNOSIS: Spastic Cerebral Palsy

End goal: To use the AAC device for communication in all contexts

RATIONALE
GOALS
NEEDS READINESS
LTG1: To navigate to
specific icons in 100% of
the instances provided
without cues.
STG1: To navigate to
different ADL objects in
100% of the instances
provided without cues.
STG2: To navigate to Jan needs to be able to Jan has knowledge on these
navigate to the different pages
different ADL actions in concepts and is able to use
of his AAC device to use the
100% of the instances device for communication his middle finger to
provided without cues. effectively and efficiently. navigate the AAC device
STG3: To navigate to
different food items in
100% of the instances
provided without cues.
STG4: To navigate to
different internal states in
100% of the instances
provided without cues.
LTG2: To use strategic
measures in using the AAC
device in 100% of the
instances provided without
Jan needs to have strategies
cues.
whenever a problem occurs
STG5: To use the BACK Jan is able to identify the
and he is unable to use his
button whenever an error is icon BACK and is able to
AAC. He also needs to
committed in 100% of the use his middle finger to
learn how to correct his
instances provided without navigate the AAC device.
errors.
cues.
STG6: To vocalize /ah/ to Jan is able to vocalize /ah/.
ask for help whenever his
AAC device is switched off
in 100% of the instances
provided without cues.
LTG3: To use his AAC to
communicate to different
communicative partners
100% of the opportunities
provided without cues.
STG7: To say “Hi” using
his AAC device to 5
different communicative
Jan needs to use the AAC Jan has intact
partners without cues.
device for communication communicative intent and is
STG8: To call different
in real life contexts, not just comfortable in interacting
communicative partners
for therapy sessions. with other people.
using his AAC device in
100% of the instances
provided.
STG9: To use his AAC
device whenever asked with
a question 100% of the time
with different
communicative partners.