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Case Study 2: ‘Mona’. Background Information. Client gender/age Female; 86 years old Diagnosis Left MCA infarct– resulting in dense right hemi and expressive/receptive dysphasia. After a fall in rehab: Right temporal intracranial haemorrhage. . Learning Objective:.

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Background Information

Client gender/age

  • Female; 86 years old

    Diagnosis

  • Left MCA infarct– resulting in dense right hemi and expressive/receptive dysphasia.

  • After a fall in rehab: Right temporal intracranial haemorrhage.


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Learning Objective:

  • Which areas are supplied by the MCA and what deficits may result from damage to this artery?


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Patient History:

Medical history:

  • Type II diabetes mellitus

  • Hypertension

    Social history:

  • Partner deceased

  • Lived alone premorbidly

  • Supportive daughter and granddaughter


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O/E:

  • Glasses

  • Normal hearing

  • Ambulation by wheelchair

  • Co-operative for assessment

    Functional Communication:

  • Non-fluent verbal output

  • Some automatic speech present – ‘No’, ‘Oh yes’

  • Comprehension intact for simple conversation/instructions

  • Responsive at times, minimally responsive at others – fell asleep during some assessment


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Learning Objective:

  • How will you assess this patient?

  • Which areas would you like to assess?

  • Which assessment tools would you use?


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Assessment tools used

Subtests of the Boston Diagnostic Aphasic Examination (BDAE):

  • Word comprehension

  • Repetition of sentences

  • Responsive naming

  • Oral reading

  • Commands

  • Apraxia Assessment



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Learning Objective:

  • How would you summarise these test results?

  • Given the information, what diagnosis could you make?

     Click to find out…


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Diagnosis:

  • Broca’s Aphasia - characterised by: - Intact comprehension at a simple conversational/instructional level;

    - Repetition intact

    - Non-fluent verbal output

  • Oral Apraxia – characterised by inability to carry out oral volitional movements.


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Learning Objective:

  • Identify some long and short-term goals for this patient…


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GOALS:

LTG:

  • Functional communication that allows patient to convey basic needs and wants using verbal output and gestural cues.

    STG:

  • Reliable yes/no

  • Increase verbal output – with the aid of semantic and phonemic cueing

  • Use picture book to communicate effectively


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Learning Objective:

  • Think of some therapy ideas you could employ in order to achieve these long and short term goals…


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Therapy

  • Spoken-word/picture matching

  • Yes/no responses

  • Picture naming with cues


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Learning Objective

  • A speech and swallowing report must be written to place in Mona’s file. This report could be read by all types of health professionals in the hospital, as well as the patient’s family…

  • What headings would you use in this report?

  • Think about all of the relevant information you will need to include…



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