Seton Hall University

Adler Aphasia Center

Speech/Language Evaluation

Name: E.M. Date of birth: 7/7/71; 45 years old

Diagnosis: Aphasia Date: 6/7/17
Left Subdural Hematoma
Left occipital hematoma
Onset of Diagnosis: 5/4/05
I. History

A. Medical History
E.M. acquired aphasia at the age of 33 years, after experiencing left subdural and occipital
hematomas on May 4, 2005, while running a marathon. He was in a coma for approximately
a month after the CVA. He experiences right hemiparesis, reports decreased sensation on the
right side of his face and right leg. The patient reports that in the years since his stroke, he
was recovered some sensation and movement in his right arm.

B. Background and Social History

E.M., a 45- year old man, currently lives in Hawthorne, New York with his parents. He is
married with twin teenage boys, but both his wife and sons live in Florida. Prior to his
stroke, the patient received a bachelor's degree from Barry University in Athletic Training.
During his career as an athletic trainer, the patient worked with the Miami Beach Hightide
and Miami Fusion. The patient also reported that during his free time, he enjoys fishing,
going to baseball games, and NASCAR races.

A. Primary Presenting Concerns affecting communication

In conversational speech, E.M. demonstrated difficulty with auditory comprehension and

forming cohesive sentences. When asked questions about his diagnosis or personal life, E.M.
would repeatedly ask clinicians to repeat questions, and then required several moments to
process the question. When formulating his answer, the patient would respond in one to two-
word phrases, one after another, with little cohesion. When experiencing difficulty in
answering questions, the patient would point to his iPad and use an app that had visual and
 auditory information. However, the patient was able to appropriately select the information
that would answer the clinician's questions. In the interview, the patient was able to express
that his ability to comprehend questions and formulate answers orally was difficult for him.
However, he utilized strategies, such as asking his conversational partner to repeat
themselves and uses the iPad appropriately to express his wants and needs. The patient
reported that he consistently takes time out of his day to call his family but has some
difficulty in talking on the phone. He reported that while living with his parents, he typically
does not answer the phone, as the caller will often ask for his parents rather than him.
II. Behavioral Observation
E.M.is an upbeat, delightful person. He came into the session with a smile on his face and
introduced himself to each clinician in the room. When clinicians introduced themselves to him,
the patient would make eye contact and occasionally repeat clinician's names to himself in order
for him to remember their names. When asking the patient about his personal life and recent
events, he showed excitement when discussing a recent trip at Adler group. He traveled to
Alaska and showed pictures from the trip. He expressed that photography was one of his
passions and a means of communication for him, as he has difficulty orally expressing himself.
During testing, E.M. patient would gesture towards his iPad by pointing to the device and state
"this?", but clinicians instructed that he had to answer questions orally. He would respond in a
string of short phrases or single words, with minimal cohesion. Despite some struggles, the
patient was willing to participate in tasks and demonstrate humor and positivity.
III. Evaluation Results
The Western Aphasia Battery (WAB), the Quality of Communication Life Scale (QCL), and
informal observation were used to assess E.M.'s behavior and communication skills.
A. Western Aphasia Battery
a. Spontaneous Speech- Mild-Mod Impairment
i. Information Content Score: 8/10
Spontaneous speech was primarily characterized by word finding problems
with the patient often labeling objects in the picture presented. Sentences
were incomplete and grammatically incorrect, with fillers such as "um, um"
often noted. Gestures were frequently used to supplement speech and to
communicate the patient's ideas.
ii. Fluency, Grammatical Competence and Paraphasias Score: Mild-Mod
impairment 4/10
This score corresponds to the patient having halting, telegraphic speech;
mostly single words; paraphasias; occasional prepositional phrases, severe
word finding difficulty. No more than two complete sentences with the
exception of automatic sentences were produced. A score of 4 corresponds
to nonfluent aphasia.
 b. Auditory Verbal Comprehension- Severe Impairment
i. Yes/No Questions: 51/60
ii. Auditory Word Recognition: 30/60
iii. Sequential Commands: 20/80

c. Repetition- Severe Impairment

i. Repetition: 66/100

d. Name and Word Finding- Profound Impairment

i. Object Naming: 32/60
ii. Word Fluency: 5/20
iii. Sentence Completion: 9/10
iv. Responsive Speech: 2/10

e. Aphasia Quotient Score- On the WAB, E.M. received an overall Aphasia

Quotient Score of 56.9/100, which correlates with moderate aphasia

B. Informal Observation of Communication Skills

a. Auditory Comprehension: E.M. was able to understand single words and simple
sentences but often requested repetition. During conversation, he was usually able
to understand the main topic but was unable to recall or understand small details.
b. Verbal Expression: In spontaneous speech, E.M. used single words, speaking in
mostly incomplete sentences. His speech was non-fluent, including several pauses
due to word retrieval difficulties. Content consisted of vague details and semantic
paraphasias were produced often.
Supplemental Tests
A. Cognition and Orientation
a. Sequencing
Sequencing tasks were not formally assessed.
b. Neglect
i. E.M. experienced weakness on his right side, thus he used his non-
dominant hand.
c. Thought Organization
i. Thought organization was not formally assessed. E.M. did demonstrate
difficulty orally expressing his thoughts. It is difficult to assess though
organization, given the severity of Aphasia that was noted.
d. Memory
i. Memory tasks were not formally assessed.
 e. Attention
i. E.M. maintained attention and stayed focused on each task presented to
him.
f. Planning
i. Planning tasks were not formally assessed.
B. Reading and Writing
a. E.M.'s reading and writing skills were informally observed throughout the
session. The patient would utilize a white board to demonstrate thoughts, ideas,
and information to clinicians by writing down words and numbers that he had
trouble saying orally. He would circle and draw lines to pieces of information he
wrote to connect these words/ideas in a cohesive manner. In terms of reading, it
appeared that the patient could read short words and phrases from apps within his
iPad.
C. Gestures
a. Gestures were informally observed during the evaluation. E.M. would
occasionally gesture by pointing to items when he could not orally state a word.

Quality of Communication Life Scale (QCL)

E.M. received an overall total score of 3.76 with 5 being rated the highest. His general
quality of life score was 4.0. Following his stroke, he continues to like himself, and follows
news and sports stories on television. E.M. continues to see the funny things in life, which he
demonstrated to the clinicians by making jokes about the assessment throughout the session.
He also gets out of the house to do things despite his communication difficulties, by
participating in Adler social groups and going on different trips. Areas where E.M.'s QCL
scores were lower included meeting the communication needs of his job, and confidence in
his communication skills.

IV. Summary and Impressions

Mr. Morgan has a moderate-severe receptive and a moderate-severe non-fluent expressive
aphasia. According to the WAB-R Aphasia Classification Criteria, E.M. has Broca's Aphasia. He
reports a mildly reduced quality of life.
V. Prognosis
E.M.'s prognosis appears to be good for improvements in his ability to name common objects,
follow multi-step directions, understand and answer questions in his everyday life, and express
thoughts to his communication partners. Prognosis for improving auditory comprehension is
good to understand conversations with friends and family and follow sequential commands.
VI. Recommendations
1. Individual therapy two times a week for 45-minute sessions for four months. It is
recommended that the Semantic Feature Analysis technique be used to improve word
finding skills.
2. Group therapy for psychosocial support and functional communication skills.
3. Re-evaluation at the end of four months to determine if continued therapy is
recommended.

VII. Treatment Goals

A. Long Term Goals (1 year):
1.0 Auditory Comprehension: The client will follow two-step directions with 90% accuracy
independently over 10 consecutive trials.
2.0 Verbal Expression: The client will name 5-7 common nouns related to his everyday activities
with 90% accuracy independently.

B. Short Term Goals (1 month):

1.1. Auditory Comprehension: The client will hear a direction (ex. "Please place the pen on
top of the book") and be able to follow it with 80% accuracy over 10 consecutive trials.
1.2. Auditory Comprehension: The client will be able to comprehend questions relating to his
everyday life (ex. "Can you tell me about your career?") independently, with 80% accuracy
over 10 consecutive trials.
2.1. Verbal Expression: The client will be able to complete a partially presented sentence (ex.
"They fought like cats and _____"), independently, with 80% accuracy over 10 consecutive
trials.
2.2. Verbal Expression: The client will be able to verbally name 3-5 nouns when presented
with a scenario picture independently with 90% accuracy.

A. Client’s Goals:
"I would like to feel more confident when speaking. I want people to understand me when I
speak."
___________________________ _______________________________
Sarah Poplawski, BS Lisa Gelmetti, MSPA, CCC-SLP
Speech Intern Speech-Language Pathologist