Speech Pathology Therapy

Therapy Session Attended To

• 68yo M (Arthur Pendelton, DOB: 12/05/1956, URN: 492-810-33) attended OP SP clinic at 10:30 AWST on 14/05/2024 for ongoing dysphagia and mild expressive aphasia rehab, 6 wks post L MCA ischaemic CVA. Pt reports occasional coughing on thin fluids when fatigued, but tolerating soft diet well. Frustrated with word-finding difficulties during phone calls.
• L MCA infarct (02/04/2024), HTN, AF, hyperlipidaemia. Hx of L TKR (2019).
• apixaban (Eliquis®) 5 mg PO BID, perindopril (Coversyl®) 5 mg PO daily, atorvastatin (Lipitor®) 40 mg PO nocte, Ginkgo biloba 120 mg PO daily.
• Lives with wife in single-level home (Subiaco, WA). Retired accountant. Ex-smoker (quit 2010), nil EtOH currently.
• Penicillin (rash).

Objective

• Oromotor exam: Mild R CN VII weakness (reduced R labial seal), lingual ROM WNL, slightly reduced speed on alternating motion rates (AMRs). Swallow trial: Tolerated IDDSI Level 6 (Soft & Bite-Sized) solids and IDDSI Level 0 (Thin) fluids via single sips using chin tuck without overt signs of aspiration; wet voice noted on consecutive cup sips of thin fluids, cleared with spontaneous throat clear.
• VFSS (15/04/2024): Mild pharyngeal residue (valleculae), trace silent aspiration on large bolus thin fluids, resolved with chin tuck strategy.

Reports

• Inpatient SP discharge summary (22/04/2024): Discharged on IDDSI Level 6 diet and Level 1 (Slightly Thick) fluids; upgraded to thin fluids with strategies at initial OP r/v on 01/05/2024.

Therapy

• Completed 20 mins of Semantic Feature Analysis (SFA) targeting high-frequency household and financial nouns, followed by 15 mins of Effortful Swallow and Mendelsohn manoeuvre exercises.
• Reduced SFA cueing hierarchy from phonemic cues to independent circumlocution prompts due to high accuracy on baseline targets.

Outcome

• Achieved 85% accuracy naming 20 target items with minimal verbal cueing. Demonstrated 100% safe swallow across 10 trials of thin fluids when strictly pacing and utilising single sips + chin tuck.

Plan

• Continue daily home exercise program (HEP): SFA worksheets (15 mins BD) and swallow exercises (3 sets of 10 reps TDS). Maintain IDDSI Level 6 diet and thin fluids with strict pacing/chin tuck precautions.
• R/v in SP clinic in 2 wks (28/05/2024 at 10:30 AWST) to assess readiness for IDDSI Level 7 (Regular) diet trial. Referred to community aphasia communication group.