Hearing and Speech Evaluation after a Stroke

An elderly man came into the clinic for a speech diagnostic. He has recently had two strokes leaving one vocal fold paralyzed. The patient's vocal fold was left open and caused him to whisper. Automatically, I was thinking about speech testing and if he would be able to be evaluated. However, with just an increase in the talk back, I could hear him perfectly. His hearing was within normal limits and he seemed to do very well with all tasks, even raising his hand. Since the patient was taking many medications, he was dizzy and needed assistance while walking through the clinic.
The biggest concern for this patient was communication. A device was bought to amplify the patient's own voice. However, it was not specific enough to pick up his voice except for at very close proximity. Information was given and he was directed to the augmentative device person in the program. I found a list of tips on choosing augmentative devices here:

http://www.linc.org/ataugcom.html

And # 4 on the list was choosing a device with good speech quality...which is exactly what this patient needs. The list is very informal but gives good general and simple ideas.

Also, I found an article on the information that should be given to family members of a stroke patient. I thought that this article was important since the family is being relied on to take care of the individual and to help with therapy. The patient's daughter came with him to the clinic and showed great concern and attentiveness to all information. Basically, the article found that the patient and family members need three things from their health professionals: information, counseling, and accessibility.

Relatives of hospitalized stroke patients: their needs for information, counselling and accessibility. By: van der Smagt-Duijnstee, Miebet E., Hamers, Jan P.H., Abu-Saad, Huda Huijer, Zuidhof, Arjan, Journal of Advanced Nursing, 03092402, Feb2001, Vol. 33, Issue 3

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/detail?vid=1&hid=107&sid=fff35d66-ce82-4c19-9b67-0cc417fe6594%40sessionmgr107

Adult Student and Auditory Processing

A young adult female came in with complaints of having trouble at work and in classes with understanding speech. She did not believe that she had a hearing loss but was unsure the reason for the difficulties.
Hearing evaluation of tymps, otoscopy, audiometry, speech recognition, and word discrimination was administered. All results were within normal limits and in fact, discrim scores were 100% bilaterally.
For the auditory processing evaluation, the SCAN-A, SSW, and AFT-R were administered. The patient was very attentive and showed great effort to stay on task. The results for the SCAN and SSW were within normal limits. However, a temporal processing disorder was evident after presenting the AFT-R. Her mean ipi was greater than the second standard deviation based on her age.
The good news is that temporal processing disorders can be fixed with programs such as Fast ForWord. The bad news is that the patient has made it through the whole semester without assistance from the school. Hopefully, with correct diagnosis, the patient will get proper management skills to become a successful student.

The article that I found discusses the difference of temporal processing between young (18-40) and old adults (65-76) and also hearing and hearing impaired individuals. The results were consistent with what I expected. The young group had better thresholds and greater percentage correct. Also, the subjects with normal hearing did better than the hearing impaired subjects. These results are an additional piece of evidence for a good prognosis with the present patient. She is considered a young adult with normal hearing. Here is the article:

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/detail?vid=1&hid=101&sid=a0c1956f-addb-4a50-a895-10009397fcef%40sessionmgr106

Profile of auditory temporal processing in older listeners. By: Gordon-Salant S, Fitzgibbons PJ, Journal of Speech, Language & Hearing Research, 10924388, April 1, 1999, Vol. 42, Issue 2

Group Home Patient with Mental Retardation

I had a lady come in with mental retardation, vision problems, and a seizure disorder. She was very sweet but had limited speech and language so evaluation procedures were limited. No responses were observed when presented with pure tones in sound field. However, a speech awareness threshold was found within normal limits with speech stimuli including "hi", "how are you?", "are you ready?", and "come on, let's go". Also, otoacoustic emissions were present in all frequencies except for one that was very low freq. Since we see many patients from the group home with mental retardation, I found an article discussing general information for a physician when dealing with this type of patient. The article includes characteristics, types, diagnoses, and development. I especially found the evaluation and referrals section beneficial to our profession since this is a specialized group to assess. The importance of talking to the parent or caregiver was discussed. In my experience, the caregiver's information and opinions have been essential to testing the individual. Here is the article:

Daily, D., Ardinger, H.H., & Holmes, G.E. (2000). Identification and Evaluation of Mental Retardation. American Family Physician.

http://www.aafp.org/afp/20000215/1059.html