Wab Screener

MEDICAL DX: TREATMENT DX:

ADULT ONSET FLUENCY DISORDER FLUENCY DISORDER

DATE OF ONSET: DATE OF EVAL: PRECERT DATE: TREATMENT DATE: PROCEDURE:

XX XX XX XX 60 MIN FLUENCY TREATMENT

SUBJECTIVE: Patient arrived 5 minutes late to the session since he was coming from another appointment; remained cooperative and engaged throughout the session. PATIENT REPORT: “My stuttering is usually a lot worse than it is right now. You guys make me feel relaxed so it’s not as bad as it typically is.” PAIN: 0/10

VERBAL

OBJECTIVE: In order to increase the fluency of patient’s speech, the following short-term goals were addressed with associated tasks completed: #1. Patient will verbalize understanding of fluency strategies (cancellation, pull out, easy onset, etc.) mod cues. STATUS: ONGOING > Graduate clinician educated patient on the following fluency strategies: - Cancellation - Pull out - Easy onset > Patient verbalized understanding of the above strategies; “I actually do most of those already. I just didn’t know there were names for those things.” #2. Patient will maintain a reduced rate of speech within informal conversation 80% of opportunities min cues. STATUS: ONGOING > SLP and graduate clinician engaged patient in conversational discourse; patient utilizing an appropriate rate of speech throughout the conversational exchange.

> Patient reports that he now uses a much slower rate of speech than he did prior to the onset of his fluency disorder to prevent the onset of dysfluencies. > Patient endorses a decrease in dysfluencies when utilizing a slower rate of speech. #3. Patient will identify 2-3 triggers that exacerbate speech dysfluencies. STATUS: ONGOING >Given mod. verbal cues from graduate clinician, patient able to identify the following triggers that exacerbate his speech dysfluencies: - Stress - Frustration/anger - Fatigue > During conversational discourse, the following types of disfluencies were observed with associated frequencies: - Blocks: 4x - Whole-word repetitions: 8x - Part-word repetitions: 6x #4. Patient will participate in standardized language eval. > The Western Aphasia Battery (WAB) Bedside Screener was used to assess the patient’s current language performance with the following results: - Spontaneous Speech 17/20 (85%) - Auditory Verbal Comprehension 10/10 (100%) - Sequential Commands 9/10 (90%) - Repetition 9.5/10 (95%) - Object Naming 10/10 (100%) - Reading 7/10 (70%) - Writing 8/10 (80%) - Apraxia 10/10 (100%) - Bedside Aphasia Score: 92.5 - Bedside Language Score: 88 - Classification: Anomic ASSESSMENT: Patient demonstrating excellent compliance for utilizing fluency strategies inside and outside of the ST environment. Patient’s disfluencies characterized by blocks, whole-word repetitions, and part-word repetitions. Patient benefits from utilizing a slow rate of speech and avoiding stressful situations to prevent the onset of dysfluencies. No concerns re: patient’s language as determined by his performance on the WAB bedside screener.

Patient’s reading score likely impacted by speech dysfluencies rather than a language deficit. Patient to continue with ST focusing on utilization of fluency strategies. EDUCATION: -

Fluency strategies SLP plan of care Telehealth Recommendations

PLAN: - Continue POC - RTC placed GOALS: PATIENT GOAL: "To improve my speech" LONG-TERM GOAL: #1. Patient will improve verbal fluency at conversation level with use of stuttering modification/fluency shaping strategies. SHORT-TERM GOALS: [ADDRESSED IN OBJECTIVES SECTION]