Analyse the information gathered through case history taking and assessment results

Speech and Language Therapy – Clinical Process

What you have to do:

Written coursework:

You will be presented with the results of assessment for two clients (1 adult, 1 child). One of these will be used as a formative piece of work, the second will act as your summative assessment. This assignment is designed to allow you to demonstrate very practical skills which mirror the expectations of these core skills in practice, so it does not need to be in essay form but does need to clearly demonstrate teach of the skills below. A template has been developed to provide you with headings and a structure to scaffold your writing.

Formative Case Study

The first of these cases will be used to work through as a formative piece of work, for which you will be able to draw on what you are learning about goal setting/intervention planning on placement, as well as link to the content of the taught sessions. This will be submitted as a draft and you will receive feedback on it.

You will need to show that you understand how to:

1. Analyse the information gathered through case history taking and assessment results,

2. Decide which information is relevant in terms of initial goal setting; what additional information you may need and a plan as to how to get it.

3. Demonstrate structured clinical reasoning/ development of a rationale to devise goals for evidence-based intervention, demonstrating collaboration with the individual and the functional holistic context of the intervention chosen.

4. Identify a range of possible interventions which would be applicable to this client’s needs and context, and the evidence base supporting these choices.

5. Include the process for measuring the outcomes of intervention selected.

Once you have completed the formative case study, you will have the option of submitting it for feedback, which you can then use to apply to the second case study, along with a brief paragraph to describe how you used the feedback to work on the summative case study.

Paediatric Case History

Formative Assessment

Attention and Focus 

Samantha is a five-year-old girl who lives at home with her family. During the evaluation she presented herself as a curious, happy and eager to interact child. It was reported she had woken up at approximately 3:00 am the morning of the present evaluation. It was noted by her mother and the therapist she had been putting her hand in her mouth which she described as a sign of increased generalized anxiety. Nonetheless, overall performance levels did not have a visible effect on her responses and overall performances in comparison to other times she is in the clinic for speech and language interventions services.

Optimal attention periods were observed between 2 and 3 trials per exercise, before Samantha got up from the chair or became visible distracted. At home Samantha’s mother reported necessary the use of clapping twice and using phrases such as “time to go” to signal transitions between activities or places. This suggests the use of attention and focus protocols that facilitate individual responses to specific visual or verbal instructions (receptive instructions drills, avoiding the use of visual or auditory attention-getting devices).

During the structured testing period Samantha was presented with short (2-6 trials) drills, followed by 1-2 play-based periods in which Samantha lead the therapist in play-based activities. For the first of the testing drills she sat on her own without the therapist asking her to do so, while engaging in intermittent eye contact as if apparently requesting interaction from the clinician. She smiled constantly and leaned over to the therapist to get hugs, laughing and vocalizing (unintelligibly, but with proper intonation and volume) in between instructions or at times in lieu of responses to them.

Sustained attention during play-based periods ranged from 1-4 actions with a toy or activity before seeking an alternative object or game. She also joined the therapist on her own in playing with putty for a short while.

Receptive Language

Samantha was able to object-cued instructions such as “give me” (while extending the therapist’s hand) and “hug” (by stretching her arms). She required physical cueing to complete non-cued instructions such as “come here”, those to identify parts of her body and to imitate gross motor actions (“do this”).

When presented with vocabulary related to daily living routines (foods, animals, vehicles, articles of clothing) Samantha required prompting to provide clear responses, with intermittent periods towards the visual field (composed of three pictures or objects) and eye contact. She also left the chair intermittently after a few trials and appeared evasive (in body orientation and eye contact) when receiving verbal directions or greetings by the clinician (e.g. “where’s your head?”, “hello”).

Throughout the session she remained affable, receptive to physical cueing and consistently. eager to interact with the clinician.

Expressive Language

Samantha’s primary means of communication is by guiding others to what she wants or needs, or by using a handful of signs such as please, more, water, stop and her mother is currently teaching her to produce the sign for bathroom. Her home language is Spanish, with intermittent use by Samantha’s family as everyone speaks both Spanish and English. Over the years the frequency and duration of eye contact (especially with immediate communicative intent) has gradually increased.

During the evaluation she consistently vocalized (variegated babbling) and sang distinguishable, particular songs she has memorized with unintelligible speech (protowords), approximating some of the occasionally and following intonation and rhythm consistent with the songs.

During motor planning and execution exercises she required physical cueing to imitate gross motor actions such as “do this”, while the therapist raised her hands, touched her head or moved her feet.

Social Language and Behavioural Impressions

Samantha and her siblings spend time with their maternal grandparents about twice per week. Her relationship with her grandparents was described as loving, even though Samantha does not pay much attention to any particular family member and does not yet seek out play-based interactions in a regular manner. At times she pulls people in to watch videos on the tablet with her and pushes them away after a few moments. However, most times she prefers to watch videos on her mother’s bed under a blanket while eating popcorn on her own.

Consistent with her mother’s reports, Samantha was observed as a curious, energetic and affable girl with consistent desire to interact with those around her. Her responses to others around her were consistent, with apparent shyness, avoidance or reluctance to follow verbal directions, but with consistent intermittent levels of eye contact and bids for interaction.

She explored toys independently for periods of 4-5 turns per object or toy, with exploratory quality to attention to detail, and intermittent bids for interactive play (for example, placing a cardboard hat on the therapist’s head. Samantha displays encouraging interaction patterns, appropriate for the development of an inventory of reinforcers that instructors and family members can use to maintain engagement and gradually shape length and complexity of attention and focus periods.

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