SPPA 4030 Case Study: an Introduction

SPPA 4030 Case Study: An Introduction

Case History Patient SD is a 49 year old female clothing store clerk who awoke early one morning with bilateral weakness and slurred speech. Her husband called 911 and she was taken to the hospital via ambulance. In the ER she presented with bilateral weakness of the upper and lower extremities and a difficulty being understood. She was oriented to person, place and time. A CT scan taken at that time indicated a large brainstem lesion that extended bilaterally from the rostral medulla and the pons. Findings were consistent with an occlusive stroke. When SD was admitted to the acute neuro rehabilitation unit she presented with severe quadriplegia, severe spastic dysarthria* and severe dysphagia. A nasogastric feeding tube was inserted and she initially received no food by mouth. Over the next several months, SD underwent intensive rehabilitation. She underwent two videofluoroscopic swallowing studies at 3 weeks post-onset. At that time she exhibited significant laryngeal penetration and occasional aspiration when swallowing thin liquids and difficulty orally manipulating semi-solid and solid boluses. A repeat swallow study performed at 5 weeks post-onset showed marked improvement and oral feeding was introduced, initially in the form of thickened liquids and a pureed diet and graduating to a normal diet over approximately three weeks. Initially SD exhibited no intelligible speech. This gradually improved over time such that at approximately 16 weeks post-onset she was approximately 60 % intelligible at the word and sentence level as tested by the Computerized Assessment of Intelligibility of Dysarthric Speech (CAIDS). Improvement continued over the next few months and reassessment at 38 weeks post-onset revealed that intelligibility had improved to over 90 percent at the word and sentence level. Recordings of a standard reading passage were taken at that time. These files are located in the zip file you will download for the completion of your lab assignments. SD eventually returned home with the use of a cane and while some residual speech disturbances remain, she is a functional oral communicator.

Folder Location of Files: Case Study Rbwpretx.wav – reading of the rainbow passage at 16 weeks post onset. Rbwpostx.wav – reading of the rainbow passage at 38 weeks post onset.

General Activity Description It is often helpful to use our understanding of normal speech physiology and acoustics to compare how a client performs a task at different phases of the treatment process. This can achieve a number of goals. For example, we can support our perceptual impressions with measurement approaches that are less prone to clinician bias. Additionally, using instrumented approaches can also help provide information about those factors that may underlie the speech disorder itself or its perceptual consequences. This activity, which will span the whole semester, will require you apply your knowledge of speech science to an actual clinical case. Specific assignments will be provided that correspond to the content being covered in the class.

The Learning Objectives for this activity are to (1) improve facility with computer-based analysis of speech acoustics; (2) gain skill in acoustically analyzing clinical speech samples and (3) apply of concepts covered in course to a clinical case. To achieve these objectives, it is important that, like all the out-of-class assignments, you complete these activities individually. While you may consult with your colleagues on general issues, you must do your own work and submit your own assignment. *Spastic Dysarthria is a term used to describe a dysarthria (a motor speech disorder) typically associated with bilateral damage to the upper motor neuron system that supplies the speech musculature (i.e. corticospinal tract to respiratory musculature and corticobulbar tracts to phonatory and articulatory musculature). According to the Mayo Clinic classification system, spastic dysarthria can be perceptually characterized by the following speech subsystem features: Phonation: Harsh, strained strangled vocal quality with low pitch and frequent pitch breaks. Resonance: Hypernasality typically occurs. Nasal air emission is not common. Prosody: Monopitch, monoloudness, short phrases and reduced rate of speech Articulation: Imprecise consonants including consonant voicing errors (voicing voiceless plosives), incomplete articulatory contact and reduced consonants clusters