SPPA2008_5007 Acquired Language and Cognitive Communication Disorders Case Study PDF

Semester 2, 2024 SPPA2008_5007 Acquired Language and Cognitive Communication Disorders Case study 1- Information Lauren, a 56-year-old Caucasian woman born in Perth, Australia, experienced a...

Semester 2, 2024 SPPA2008_5007 Acquired Language and Cognitive Communication Disorders Case study 1- Information Lauren, a 56-year-old Caucasian woman born in Perth, Australia, experienced a right-sided stroke involving the right middle cerebral artery (MCA). She is currently 6 months post-stroke, right-handed and has normal hearing. Prior to her stroke, Lauren was a social drinker but had no other notable medical history. She worked full-time as an office manager for a local small business. Lauren is married to her husband Ted, and they have 4 adult children who all work full time. Ted has played an essential role in her journey towards recovery, providing her with support and motivation. Her adult children visit when they can and have also provided a great deal of emotional support. In the initial phase of her recovery, Lauren underwent comprehensive stroke rehabilitation for 8 weeks, which included physiotherapy, occupational therapy, and speech-language therapy. Speech Pathology rehabilitation at the time focused on the presence of an accompanying mild dysarthria, dysphagia, and lower left facial weakness which has since resolved. At the time of discharge, Lauren had not been formally assessed for a cognitive-communication disorder; however, it was recommended that she should seek a referral to a private speech pathologist if she experienced any ongoing communication problems. Before the stroke, Lauren was known for her sociable and engaging personality. She would readily participate in group discussions, share stories, and actively contribute to conversations. She had a strong circle of friends. Since her discharge from services, and returning home, it has become apparent that Lauren's stroke had an impact, not only on her health but also on the dynamics of her communication and social interactions. Ted, her husband, reports that Lauren is sometimes confused during conversations and is easily distracted with difficulty concentrating, including when reading. She is more literal than before, sometimes misinterpreting humour and jokes. She is easily confused and distracted and sometimes talks a great deal without conveying much information or getting to the point. Her friendships are being affected, and people are visiting less often. Lauren has now been referred to you, a private speech pathologist. Lauren has not seen a speech pathologist since her discharge from the hospital. Her GP has made the referral. In your first assessment session, you ask Ted, Lauren's husband, to complete the Montreal Protocol for the Evaluation of Communication (MEC) screening questionnaire – informant version.  Semester 2, 2024 SPPA2008_5007 Acquired Language and Cognitive Communication Disorders Montreal Protocol for the Evaluation of Communication MEC Y. Joanette, B. Ska, H. Côté, P. Ferré, L. LaPointe, P. Coppens & S. Small Communication screening questionnaire – interview version (Interviewing an informant who knows the person well – Ted- Lauren’ s husband and his responses are in the final column of the table below and in italics) Have you noticed any changes in the way that your wife communicates since her stroke- YES If yes, can you explain your observations? " Her rehabilitation time was quite limited. The speech pathology primarily handled her eating and drinking, not so much on her talking. Since she was speaking okay, I figured nothing more was really needed. But I have noticed some changes to be honest." Scoring: Answers in bold suggest an acquired communication disorder. Note: The clinician should provide sufficient detail and clarification to ensure that the proxy understands the question; and is comparing their person’s communication profile to before the stroke, TBI, etc. In comparison with before the (stroke, TBI…), do you think that she: 1. Clearly understands what you say yes NO n/o Notes transcribed from (for example follows discussion with Ted- conversations) Lauren’s husband Yes- "Typically, Lauren will keep up with conversations, but occasionally she will get sidetracked and needs things repeated. She especially struggles with complex discussions, more so when tired or if things are hurried."  Semester 2, 2024 SPPA2008_5007 Acquired Language and Cognitive Communication Disorders 2. Understands indirect statements yes NO n/o No-“Not consistently. (i.e., when s/he is asked something There have been indirectly) instances where Lauren misunderstands what is asked of her unless it is very explicit and straightforward." 3. Expresses ideas clearly (e.g. when yes NO n/o Yes-“Usually, Lauren giving explanations, finds the right communicates her words…) message effectively. But, when she tries to convey something complex, it becomes challenging to decipher her intent. This often leads to arguments; she perceives it is our fault if we don't understand her.” 4. Speaks too much, interrupts you YES no n/o Yes 5. Repeats the same ideas YES no n/o Yes “Yes, it's quite frustrating, and she doesn't seem to realize that she's doing it." 6. Participates in group conversations (for yes NO n/o Yes example with family, during meals….) " It's hard to pinpoint exactly, but at times she seems to miss the essence of the conversation. This is a new thing; she never used to be like this." 7. Does not initiate conversation, YES no n/o No waits for questions to be asked "Lauren initiates conversations, but often the subject matter seems to come from nowhere, unexpectedly." 8. Changes topic, loses track of the YES no n/o Yes conversation  Semester 2, 2024 SPPA2008_5007 Acquired Language and Cognitive Communication Disorders 9. Makes inappropriate, unexpected YES no n/o Yes comments 10.Expresses feelings (for example, in facial yes NO n/o No expressions and tone of voice) “She was once quite empathetic, but now we find ourselves having to explain things in a more straightforward, concrete manner." 11.Has a monotonous voice YES no n/o Yes “Sometimes… again, it appears to have changed a bit” 12.Maintains adequate visual contact when yes NO n/o No “Not always.” conversing 13.Adapts when there is a change in the yes NO n/o No conversation topic "It appears to be quite challenging for her to keep up with more intricate and detailed discussions., especially with the kids" 14.Smiles or understand jokes yes NO n/o No “She definitely doesn't." Other observations: "It's disheartening to see how she has changed since the stroke… She was always intuitive, expressive, and humorous. I believe she's frustrated about being of working age and it is really hard on all of us." ASSBI Resources: www.assbi.com  Semester 2, 2024 SPPA2008 _5007 Acquired Language and Cognitive Communication Disorders Case 2: information Nola is a 61-year-old Indigenous woman who was diagnosed with Alzheimer’s disease one year ago after experiencing increasing difficulties with memory and finding words. She has been living with her son, Lloyd, her six (6) grandchildren and other members of her extended family in a regional town but has recently moved into a residential facility in the city where she can be closer to other members of her family. Lloyd had found it increasingly difficult over the past year, as Nola tended to wander away from home during the day and he was becoming increasingly concerned for her safety. Nola is finding both the diagnosis and the change in living circumstances challenging and feeling increasingly isolated. She had been trying to hide her difficulties from her family for some time. She remembers the memory problems her own mother had experienced and the impact this had on her own life. She feels a burden on her family. Nola was an artist throughout her adult life. Painting was her main form of creative expression, but she also enjoyed weaving and working with clay, with all her art deeply connected to her Indigenous heritage. She often travelled around the country to share and promote her artwork and culture. She was a valued member of the community and a strong advocate for Aboriginal girls and women being educated, something that she had not been able to do. Over the past six months, Nola’s family noticed she had been speaking less, though she still enjoyed conversations. She often picked the wrong words and struggled to stay on topic. Nola even mentioned to staff that she was losing her train of thought mid-sentence. She used to love participating in yarning circles, but staff have noticed she’s not engaging as much, and when asked about what was discussed, her responses were less detailed and organized. The organization running the residential facility is eager to find ways to better support Nola and other Aboriginal residents who have recently joined.