Kent State University

Speech and Hearing Clinic

Final Report

Name: Paul (Simucase) Date of Assessment: 5/4/17

Age: 63
DOB:

A. Case History
Paul, a 63 year old man, was admitted to the hospital two years ago following what CT results
confirmed as an ischemic stroke occurring in the left middle cerebral artery, initially resulting in
global aphasia, severe oral and verbal apraxia, and moderate oral dysphagia. Upon discharge,
Paul presented with Broca’s aphasia, severe oral and verbal apraxia, and moderate oral
dysphagia. At this time, Paul eats and drinks a normal diet with no reported concerns. Significant
medical history shows the cause of Paul’s stroke being a congenital heart defect which has since
been surgically repaired. Paul also has mild hearing loss in his right ear. Prior to his CVA, Paul
was living at home with his wife, Sue, and has since returned home. He is a retired musician who
enjoys singing and playing the guitar, as well as emailing his friends. He received inpatient
therapy in the Day Hospital Program, but has not received any outpatient therapy since his
discharge. He was referred by Dr. Rudy after expressing interest in additional speech therapy
during an annual checkup.

B. Assessment
Boston Diagnostic Aphasia Examination – Third Edition:
 Given to evaluate the level of impairment in all language modalities such as reading
comprehension, auditory comprehension, verbal expression, and written expression.
 Overall Severity Rating: 2 out of 5
Areas of Strength: auditory comprehension, simple reading tasks, simple writing to
diction
Areas of Weakness: verbal fluency, confrontation naming, complex auditory
comprehension, spontaneous writing.
Cognitive Linguistic Quick Test:
 Given to assess overall cognitive functioning such as memory, attention, language, and
executive functioning.
 Severity Rating: Mild 3.4
 Indicated a mild impairment in cognitive linguistic function, however, performance was
confounded by expressive language and motor speech demands of the test.
Pure Tone Assessment:
 Given to determine the presence of and severity of hearing loss.
 Unilateral hearing loss in the right ear at 30dB and below
Normal hearing in the left ear
Apraxia Battery for Adults 2nd Edition:
 Given in order to detect the presence or determine the severity of apraxia.
  Diadochokinetic Rate: 6 (Moderate), Increasing Word Length: 7 (Moderate), Oral
Apraxia: 36 (Mild), Utterance Time for Polysyllabic Words: 80 (Moderate), Repeated
Trials 5 (Moderate), Inventory of Articulation Characteristics of Apraxia: 9
Stroke Specific Quality of Life Scale:
 given to assess Paul’s quality of life post stroke.
 Positive ratings in aspects of social roles and family life
Negative ratings in language and work/productivity
Reading a Factual Story out loud:
 Given to informally assess Paul’s verbal expression and fluency
 Indicated weaknesses in verbal fluency and expression
Reading Comprehension:
 Given to informally assess reading comprehension by reading a short story and
answering 10 questions about the reading.
 9 out of 10 correct
Picture Description:
 Given to informally assess spontaneous verbal expression.
 Demonstrated difficulties in verbal expression and word finding abilities during this
activity.
Procedural Discourse – How to make a peanut butter sandwich:
 Given to assess verbal expression and sequencing when presented with a familiar action.
 Paul was able to comprehend the task but demonstrated difficulties in verbal expression
and fluency.
Boston Naming Test:
 Given to assess confrontational naming and word retrieval.
 Initially demonstrated difficulties in word finding abilities but showed improvements
with the use of phonemic cues.
Writing Sample: Spontaneous Written Output:
 Given to assess written expression when asked to describe the Cookie Theft Picture
 Demonstrated weaknesses in areas of word finding, written expression, and semantic
paraphasias
Writing Sample: Writing to Diction:
 Given to informally assess reproducing a word through written abilities
 Wrote 9 out of 10 words correctly

C. Interpretation
During assessment Paul demonstrated relative strength in the area of auditory comprehension as
indicated by the Boston Diagnostic Aphasia Examination (BDAE), with minor deficits in more
complex comprehension tasks, shown by a score of 7 out of 10 in the area of embedded
sentences. Paul also demonstrated relative strength in reading comprehension as indicated by a
score of 9 out of 10 correct on a reading comprehension task. Deficits in verbal expression were
indicated by results of the Boston Diagnostic Aphasia Examination, which assessed phrase
length, melodic line, and grammatical form, as well as tasks such as reading a factual story out
loud, providing a description of a picture, and describing how to make a peanut butter sandwich.
During these tasks Paul demonstrated limited phrase lengths, telegraphic speech, and impaired
prosody. Paul also demonstrated difficulties in confrontational naming on the BDAE and the
Boston Naming Test, but improved with the use of phonemic cueing. Spontaneous written
expression was also impaired as indicated by a writing sample describing the Cookie Theft
picture, but Paul demonstrated strength when writing to diction. Paul was also administered the
Cognitive Linguistic Quick Test, which determined a mild deficit in cognitive linguistic function.
However, it is important to note these results were confounded by the expressive language and
motor speech demands that the subtests included. When administered a Stroke Specific Quality
of Life rating scale, Paul reported high levels of satisfaction with his energy, family roles, mood,
personality, self-care, thinking, vison, and upper extremity function. However, he rated lower
levels of satisfaction in the areas of language, social roles, and work/productivity. Paul also
presents with a mild hearing loss in his right ear, but shows no interest in a hearing aid and is
functioning at a normal level without one. Given the information obtained from the assessments,
Paul presents with non fluent Broca’s aphasia with specific deficits in the areas of verbal
expression, written expression, and complex reading tasks; demonstrating strength in areas of
auditory comprehension and reading comprehension.

Goal 1: During conversation, Paul will comment and answer wh- questions with 3 to 5 word
utterances in 8 out of 10 turns when given a phonemic cue or gesture.

Using Promoting Aphasics Communicative Effectiveness (PACE) to help accomplish this goal
by promoting natural conversational skills in areas of both interest and functionality such as
famous musicians and important locations/activities (restaurants, stores, friend’s homes, etc.).
Sample Materials: File folder, picture cards (two sets, one for daily activities and one for
musicians).
Scoring: Record with a tally each time the client verbally expresses information about the
card in at least a 3 word utterance or higher out of 5 turns.

Communication Partner Training will be used to help provide Paul and his wife with strategies to
promote successful verbal communication. Paul’s wife will first learn about Communication
Partner strategies and receive resources to assist in communication. Then, during therapy, Paul
and his wife will watch a short adult interest video together. Paul’s wife will then ask Paul a
series of increasingly complex questions and practice using the proper cueing techniques and
supports during their interaction.
Sample Material: Predetermined video links, a list of questions pertaining to the video, a
reference of appropriate cues for communication.
Scoring: Paul and his wife will use the Conversation Partner Rating Scale provided in the
Communication Partner Training materials, and will work together to rate their initial
interaction and then every three interactions after that to track progress.

Goal 2: Paul will accurately type an email containing a minimum of three sentences about a
familiar topic 80% of the time when using compensatory strategies and modifications.

Semantic Feature Analysis will be used in order to elicit Paul to write the features of selected
vocabulary words. Using the components of the semantic feature analysis chart, Paul will
identify and write the designated features of the word. After being allowed an appropriate
amount of wait time, gestures and phonemic cues will be provided.
Sample Materials: Semantic feature analysis verb and noun chart, large white board,
picture/word cards to place in the middle of board, sections of board will be taped off for
each category, dry erase markers and eraser.
Scoring: Paul will receive a plus for every vocabulary word with 4 out of 5 features
accurately identified.

Paul will type three complete sentences pertaining to a description of a picture onto the
computer. During this practice, Paul will use WordQ (or a similar program that he determines) to
assist in accuracy.
Computer access, (laptop or in facility), WordQ or similar program, Realistic pictures
such as Norman Rockwell or a magazine.
Each word in the sentence will count as 1 point, grammatical accuracy will count as 1
point. Percentages will be calculated for each three sentence description by taking the
number of points possible and number of points achieved.