Dysarthria Evaluation Report

ST Plan of Care Name: XX Date of Birth: XX Age: XX Medical Record Number: XX Date of Service: XX Referring Physician: XX Diagnosis: XX 1. 2.

Dysarthria following cerebral infarction Cerebrovascular accident (CVA), unspecified mechanism (HCC)

ICD-9-CM ICD-10CM 438.13 I69.322 434.91 I63.9

This patient requires skilled therapy in conjunction with instruction in a home program to achieve maximal functional improvement. Therapy will address the below stated problem list and goals. Assessment: Prognosis: Fair Problem List: Dysarthria Reason for Skilled Therapy: Level of difficulty of the program, New instruction General Assessment: Patient presents with flaccid dysarthria characterized by imprecise consonants, distorted vowels, and short phrases. Voice qualities include rough, harsh, and hypernasal. Patient is recommended to receive voice therapy to improve overall speech intelligibility. Prognosis is fair due to patient's motivation to attend therapy, lifestyle, and stroke history. Oral/Motor Oral/Motor Overall Oral/Motor Status Oral/Motor Comments

5/16/2018 Impaired An oral mechanism exam was performed to assess the structures and functions of the oral cavity. Lip seal/strength adequate. Patient has no upper teeth, but has lower dentition. Patient demonstrated left sided tongue weakness against resistance. ROM intact but characterized by slowed movements. Patient also demonstrated reduced velar movement during phonation. Patient was asked to produce alternating motion rates (AMRs) (ex. "puhpuhpuh" "tuhtuhtuh" and "kuhkuhkuh") and sequential motion rates (SMRs) (ex. "puhtuhkuh") quickly and for as long as possible. Productions across all tasks were slow with reduced number of productions (3-5). Reduced breath support with shallow respiration was also observed.

Voice - Other Voice Other Respiration

5/16/2018 shallow

Vocal Quality Harsh Rough Vocal Loudness

harsh;rough moderate severe decreased

Motor Speech Motor 5/16/2018 Speech Dysarthria Acoustic Measures A sample of the patient’s speech during maximum phonation, a reading task, and a conversations task were recorded and analyzed. Maximum Phonation of vowel /a/: 1.7 seconds Below Normal Mean F0: 136.27 Hz Normal Standard Deviation: 11. 6 Hz Above Expected Mean Intensity: 68.4 dB Normal SD: 3.8 Harmonic-to-noise ratio: 1.6 Below Expected Reading Mean F0: 122.4 Normal SD: 42.7 Above Expected Mean Intensity: 56.4 dB Below Expected SD: 10.5 dB Above Expected Conversation Mean F0: 116.5 Hz Normal SD: 21.2 Hz Below Expected Mean Intensity: 57.6 dB Below Expected SD: 11.29 dB Above Expected Measurements reveal significantly reduced maximum phonation time which is indicative of reduced respiratory support. Reduced harmonic-to-noise ratio and increased standard deviation for max. phonation and reading, reveal increased noise levels in speech, reflective of the patients harsh and rough voice. However, reduced standard deviation in conversation speech indicates monopitch. Additional Measures The patient was asked to read the The Grandfather Passage and his response was recorded. The following measurements were made: WPM (words/minute): 37.68 (norm: 150 words/minute) Below Expectation SPM (syllables/minute): 48.99 (norm: 282 syllables/minute) Below Expectation Syllables per breath group: 4.48 (norm: 11.6 syllables) Below Expectation Vowel Space Measurements The vowels /i, a, u, ae/ were used to assess the patients vowel space at word and sentences levels. Patients sentence vowel space was 62.5 K and word vowel space was -13K, which both fall below the expected norm of 219K, indicating significant vowel distortions. AIDS Results The Assessment of Intelligibility of Dysarthric Speech (AIDS) was performed to evaluate the patient's speech intelligibility at the word and sentence level. The patient was asked to read aloud the indicated word selected by the examiner and his responses were judged by two trained listeners unaware of the chosen words. Out of the 50 words provided, the judges determined the patient to be approximately 60% intelligible. During the sentence level portion of the assessment, the patient was asked to read aloud the sentences selected by the clinician, with the sentences increasing in length from 5 words to 15 words. Based on the 30 sentences

selected, the judges determined the patient's average intelligibility to be approximately 64%. Articulation impaired Goals: Goals Speech Therapy Long Term LTG Dysarthria (to be achieved within 12 weeks or 08/08/2018): * Patient will increase speech intelligibility from 60% to 80% utilizing improved breath control, increased intensity and over-articulation. Speech Therapy Short Term STG Dysarthria (to be achieved within 4 weeks or 06/13/2018): * Patient will utilize learned speech strategies at the word level and short structured/cued speech tasks with 70% accuracy to improve speech intelligibility. 1. Exaggerated articulation 2. Increasing loudness 3. Improved breath control

Plan: Duration: 2x month for 3 months Follow Up Treatments: Articulation therapy, Respiratory retraining, Vocal intensity training History of Present Condition: Patient is a 54 y/o male who was referred by his PCP due to speech concerns. Patient presents with dysarthria and left hemiparesis secondary to a CVA that occurred in October 2015. Patient has a history of tobacco abuse and other risk factors for stroke. He reports that his speech has worsened over the past several months and complains that people do not understand him, especially when speaking over the phone. He would like to receive speech therapy to improve his intelligibility for communicating with his mother and girlfriend. He lives at home with his mother and is on disability leave from work. He reports that he no longer has swallowing difficulty, but indicates that he often coughs when he eats and drinks, especially with liquids. Patient had an MBS in July 2016 and received exercises for a home exercise program and diet recommendations of soft consistencies with single, small sips of thin liquid using a chin tuck. Chief Complaint: Speech Intelligibility Pain Rating: Pain Assessment: No/denies Speech G-Codes: Functional Limitations: Motor speech Motor Speech Current Status (G8999): CK Motor Speech Goal Status (G9186): CJ