MEDICAL DX: ADULT ONSET FLUENCY DISORDER

TREATMENT DX: FLUENCY DISORDER

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