CWR965 _ Nursing _ Advance _ Navjot

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School

University of New South Wales *

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Course

485

Subject

Communications

Date

Nov 24, 2024

Type

docx

Pages

6

Uploaded by ChancellorElectron10813

Differential Diagnosis: Apraxia of Speech (AOS) Apraxia of Speech (AOS) is a motor speech disorder characterized by difficulty with the planning and programming of speech movements. In the case of Mr T, the following information supports a potential diagnosis of AOS: 1. Nature and Level of Breakdown: Mr T exhibits effortful speech and production errors, indicating difficulty in planning and executing the precise movements required for speech production. He reported that his thoughts were clear and he was able to form sentences in his mind, suggesting that the breakdown is in the motor planning and programming stage rather than in language comprehension or formulation. 2. Spared and Impaired Sensorimotor Speech Processes: a. Spared: - Resonance: Mr T's resonance was unremarkable, suggesting that the velopharyngeal function is intact. - Single-word comprehension and object knowledge: Mr T demonstrated no difficulties in these areas, indicating that his language comprehension and semantic memory are functioning well. b. Impaired: - Speech affected by the number of syllables: Mr T struggles with multisyllabic words, indicating difficulty in sequencing the necessary motor movements for longer words. - Inconsistent speech: Mr T's speech is slow, unintelligible at times, and dysrhythmic. This inconsistency in speech production is a characteristic feature of AOS. - Oral diadochokinetic (DDK) movements: Mr T's DDK movements were found to be mild but slow and dysrhythmic, further supporting the presence of AOS. In summary, Mr T's symptoms are consistent with a diagnosis of Apraxia of Speech (AOS), a motor speech disorder characterized by difficulties in motor planning and programming of speech movements. The nature of the breakdown suggests impairments in the sensorimotor speech processes involved in speech production, specifically in the planning and execution of precise movements for speech. References: - Duffy, J. (2013). Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. Elsevier Health Sciences.
- American Speech-Language-Hearing Association (ASHA). (n.d.). Apraxia of Speech (Adult). Retrieved from https://www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/#collapse_6 Assessment (453 words) In order to effectively manage the client, Mr T, who is suspected to have apraxia of speech, it is important to gather additional information through various assessments. These assessments will help determine the underlying cause of Mr T's speech difficulties and inform the treatment plan. 1. Detailed Case History: A detailed case history will provide important information about Mr T's background, medical history, current symptoms, and impact on daily activities. It will help identify any potential contributing factors such as previous strokes, head injuries, or other neurological conditions that may be relevant to the speech disorder. 2. Oral Peripheral Examination (OPE): An OPE will assess the range of movement and strength of the articulators involved in speech production. By examining the lips, tongue, jaw, and velopharyngeal function, the clinician can determine if there is any inconsistency in the range of movement, which is characteristic of apraxia of speech. In the case of apraxia of speech, the OPE findings will be within normal limits, indicating that the speech difficulties are not due to muscle weakness or paralysis. 3. Speech Tasks: Speech tasks such as conversation, describing the cookie theft picture, or reading a passage (e.g., Grandfather's Passage) can provide valuable information about Mr T's speech production abilities. These tasks allow the clinician to observe the consistency and accuracy of speech production, as well as the presence of errors or distortions. In the case of apraxia of speech, speech will be characterized by inconsistent errors, difficulty with longer and multisyllabic words, and impaired prosody. Dysarthria, on the other hand, typically shows consistent errors and may present with weakness or slurred speech. 4. Apraxia Battery for Adults - 2nd Edition (ABA-2): The ABA-2 is a standardized assessment specifically designed to assess apraxia of speech in adults. It includes various tasks that measure different aspects of apraxia, such as sound sequencing, sound errors, and prosody. By administering this assessment, the clinician can determine the severity and characteristics of Mr T's apraxia of speech and establish a baseline for treatment planning. 5. Apraxia Speech Rating Scale (ASRS):
The ASRS is a clinical tool that allows the clinician to rate the severity of apraxia of speech based on various speech characteristics. It includes scoring for articulatory agility, prosody, phonatory control, and overall speech intelligibility. The ASRS provides a quantitative measure of apraxia of speech severity, which can be useful for tracking progress and evaluating the effectiveness of treatment interventions over time. Interpreting the results of these assessments will help differentiate apraxia of speech from other motor speech disorders, such as dysarthria. In the case of apraxia of speech, the OPE will show normal oral peripheral functioning and the speech tasks will reveal inconsistencies, errors in movement sequencing, and impaired prosody. The ABA-2 and ASRS will provide objective measures of the severity and characteristics of Mr T's apraxia of speech, guiding the development of an individualized treatment plan. By gathering this additional assessment information, the speech pathologist can make a more accurate diagnosis of apraxia of speech and tailor an appropriate treatment plan to address Mr T's specific speech difficulties. Treatment strategies for apraxia of speech typically focus on improving the coordination and sequencing of speech movements through tasks such as repetitive practice, phonetic placement cues, and rate control techniques. Direct behavioral approaches, such as Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT), can also be used to facilitate accurate speech production. The overall goal of treatment is to improve Mr T's speech intelligibility and functional communication abilities, ultimately enhancing his quality of life and participation in activities. https://www.asha.org/practice-portal/clinical-topics/acquired-apraxia- of-speech/#collapse_6 ICF framework Based on the information provided, Mr T may experience activity and participation challenges following discharge home. These challenges may include difficulties in his work, social interactions, and leisure activities. In terms of work, Mr T was previously employed as a human resources manager for a start-up tech company. With his current speech difficulties, he may find it challenging to communicate effectively with colleagues, clients, and employees. This could impede his ability to fulfill his job responsibilities, such as conducting meetings, giving presentations, and providing instructions. Additionally, his slow and unintelligible speech may result in misunderstandings and frustration for both himself and his coworkers. Therefore, intervention priorities may include strategies to improve Mr T's speech clarity and intelligibility in professional settings, as well as developing compensatory strategies to aid in communication, such as the use of written communication or assistive technology.
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