Parker, a 5-year old boy, is enrolled in kindergarten. His mother has a hard time
understanding him, but has gotten good at guessing what he wants. Parker always seems
to understand what she says. He always responds back using 4+ word sentences, but the
longer his response, the harder it is to understand. The teacher reported that Parker
doesn’t talk much at school, and when he does, he is unintelligible. He attempts to repair
breakdowns by repeating his utterance a few times before disengaging in
frustration. This has a negative effect on peer relationships.
a) How would you perform a comprehensive evaluation on Parker? [be sure to
include assessment tool(s) and rationale]
b) Following your comprehensive evaluation, you will be required to talk to Parker’s
mom and the teacher about your evaluation results. Describe Parker’s current
communication using age-matched peers as a reference.
c) What strategies can you recommend to Parker’s mother to use at home to increase
effective communication?
John, a 5-year old boy, has received speech-language services for one year at Head
Start. He is currently enrolled in kindergarten at the local elementary school. The
previous IEP progress notes stated that he has made limited progress towards his speech
sound goals. During your in-class informal observation, you noted evidence of ageappropriate sentence length, but inconsistent production of final consonants and stridents.
The kindergarten teacher has asked you for immediate assistance because she cannot
understand what John is saying in class. Additionally, John is having difficulty keeping
up with the class during circle time (i.e., rhyming and letter names/sounds). John’s
mother is very active in his speech therapy at home, but is not able to attend any IEP
meetings; therefore all information is shared via phone.
a) Mom has asked for a re-evaluation. Please describe to John’s mother what
assessments you will use to determine his current level of performance.
b) How would you describe to John’s mother and teacher what you expect to see in
your evaluation? What impact will this have on John’s academic progress in
kindergarten?
c) Based on your informal observations, what will your therapy sessions look like
prior to your full evaluation results?
Mateo is the 22-month old only son of a Spanish-speaking Latino father and a bilingual
mother (English – L1; Spanish – L2). The family comes to you because Mateo isn’t
talking as much as two close cousins (ages 20 and 24 months). They bring you a list of 8
single words that Mateo says: no, mami, papi, gimme, “mine”, nuni (home word for
‘pacifier’), an approximation of “mira” (Spanish for “look”), and an approximation of
“leche” (Spanish for “milk”).
Describe your process for evaluating Mateo. Be sure to include
(a) the various factors you would need to rule in/out;
(b) questions you would want to ask the parents;
(c) the behaviors you would try to observe as part of your assessment;
(d) how you would determine if there is a delay/disorder/difference present;
(e) what would you advise the parents to do between the evaluation and the time they
receive the report?
Zoe is 9 and has cerebral palsy. She is independently mobile in her power chair. Her
speech intelligibility is very poor, but she is literate and performing on 4th grade
level. She answers questions in class, does homework and takes tests with the assistance
of two child-specific aides employed by Zoe’s parents. They interpret Zoe’s speech and
letter-by-letter spelling as she painstakingly points to a homemade alphabet board. Zoe’s
parents and teachers have two main concerns now that Zoe is in middle school: (1) how
to improve Zoe’s socialization with same-age peers, and (2) how to ensure that Zoe is
able to reach her cognitive/academic potential, and not be limited by her communication
challenges.
As the lead SLP,
a) what would you propose for Zoe’s evaluation?
b) what would be important elements of her intervention?
c) what factors should be considered in educating her peers, family, and the educational
staff?
Mrs. Abbott, 72 YO, had a stroke 8 months prior to the referral for a speech and hearing
evaluation. She presents with delayed responses to verbal questions, asks that
information be repeated, and she has less than an adequate speaking volume.
a. Describe screening procedures for
• Hearing
• Voice
b. Describe the criteria for failing the respective screenings for
• Hearing
• Voice
As the SLP, you have all of Mrs. Abbott’s results from the hearing and voice
evaluations. Given these evaluation data, discuss how you determine if a disorder exists
in hearing and voice, its type and severity.
Mr. Gonzales, a 63 YO, works as a laborer, and has a significant health history. He has
been diagnosed with a moderate bilateral high-frequency noise-induced hearing loss and
congestive obstructive pulmonary disease.
Given his diagnoses,
a. Thoroughly describe your expectations regarding Mr. G’s functional
communication disabilities.
b. Identify the acoustic parameters you would expect to be evaluated given his
history and how those parameters would have been measured.
Provide communication counseling for Mr. G to improve his functional communication.
The parent of a 4-year-old boy, De’Shawn, brings her child to your office for a speech
evaluation. The mother’s complaint is that her son is “stuttering”.
a.
You have to collect a case history in order to determine if a fluency evaluation is
warranted. List the questions that are pertinent to this case history and justify
why you are asking each question.
b. The information from the case history indicates that De’Shawn needs a fluency
evaluation. Describe the assessment procedures you would employ.
c. You recommend that De’Shawn be enrolled in fluency therapy. There are 2
major approaches you could employ. Select one of the major fluency approaches
that you would employ and explain your choice.
d. You should include communication counseling in De’Shawn’s therapy. Discuss
the important communication counseling topics you would discuss with his
parents.
Emily, a 12 year old 7th-grade student, has been classified as Speech or Language
Impairment-Fluency by the school district’s pupil appraisal team. She has been receiving
speech therapy for stuttering since 2nd grade and she is “up” for a reevaluation for
continuation of services.
a. You have to collect a case history in order to determine if continued speech
therapy is warranted. List the questions that are pertinent to this case history and
the people to whom you would ask the questions. Justify why you are asking
each person and each question.
b. The information from the case history indicates that Emily needs a fluency
reevaluation. Describe the assessment procedures you would employ.
c. Emily reports that she learned fluency strategies from the 2 major approaches.
Discuss at least 2 strategies she may have learned for
a. Fluency Enhancement
b. Stuttering Modification
d. You determine that Emily should be discharged from speech therapy; however,
you want to ensure that she maintains her current levels of fluency. Therefore,
you need to provide communication counseling for her and the important people
in her life. Explain which communication counseling topics you would include
and why.
Mrs. Smith is a 65-year-old female who is a retired school teacher. She suffered a left
CVA 3 months ago. Before her stroke she was substitute teaching at her neighborhood
school and wants to return as soon as possible. She lives with her husband who is also a
retired teacher. His is very supportive of her returning to her previous activities.
You met Mrs. Smith at the hospital as the SLP because she has fallen and broken her hip
and had surgery. You have orders to assess and treat this patient.
She is slow to respond, has slurred speech, difficulty with word finding, and the nurse
reported she was coughing during mealtimes.
a) Describe the language, speech, swallowing and cognitive symptoms you would
most likely see with Mrs. Smith.
b) How would you assess Mrs. Smith (please include any instrumental assessments
you would do)?
c) What type of evidence-based treatment activities would you use to treat her?
d) What are the social barriers to communication that you would need to address
with this patient?
Mr. Johnson is a 65-year-old male who has an active carpentry business. For the past year
he has experienced a slight, unremitting resting tremor of both hands, a mild problem
with gait, speech, and swallowing. He has also demonstrated some confusion, gradual
loss of cognitive function, and he is starting to get lost in his neighborhood while driving.
He received a full medical evaluation at the onset of symptoms and has been on a drug
therapy regime for the past year. However, his symptoms have gradually worsened.
Therefore, he needs a re-evaluation.
a) What etiologies do you suspect with Mr. Johnson? Describe the language, speech,
swallowing and cognitive symptoms you would most likely see with Mr. Johnson.
b) How would you assess Mr. Johnson (please include any instrumental assessments
you would do)?
c) What type of evidence-based treatment activities would you use to treat him?
What are the social barriers to communication that you would need to address with this
patient?
Mr.Nolanisa56-yearoldbusinessexecutive.OnTuesdaymorning,he
suffersaCVAinthefrontallobeofhisleftcerebralhemisphere.Asanacute
careSLP,youreceiveaconsulttoseeMr.NolanonThursdayafternoon(55
hourspostonset).
a. Describe the language, speech and swallowing symptoms that Mr. Nolan
may present at this time, and tell why you might expect to see those
symptoms.
b. Discuss how Mr. Nolan's language, speech and swallowing symptoms
might change over the next 2 weeks, and explain why.
c. Discuss how Mr. Nolan's language, speech and swallowing symptoms
might change further over the next 6 months, given excellent prognostic
indicators and consistent therapeutic treatment.
A51-year-oldwoman,Ms.Jayhadahistoryofhypertensionwasinadepressive
stateforseveralyearsafterthedeathofherhusband.Onedayshesaidshefeltdizzy
andweak.Shesaidherspeechsoundedslurredandstutter-like.Overthecourseofa
weektheweaknesscontinuedandherspeechworsened.Shestartedtodrooland
regurgitateliquidsthroughhernose,andlaughandcrywithoutprovocation.
Anevaluationrevealedbilateralweakness,reducedmobility,andresistanceto
passivemovementsofthelips,mandible,andtonguewithoutanyindicationof
atrophyorfasciculations.Herarticulationwasextremelyslow,labored,and
imprecise.
a) What type of dysarthria do you suspect with Ms. Jay?
b) With this type of dysarthria, what other speech and perceptual voice symptoms do
you think Ms. Jay may exhibit?
c) Stuttering-like disfluencies are generally different than “other non-typical
disfluencies”. Explain the differences in disfluencies in these two general
disfluency categories?
d) Where do you think the damage is located in the brain?
e) Describe the assessments procedures you would use with her?
YouareanSLPatrehabilitationcenteratahospital.YougetachartforMr.Rick,a
70year-oldmanthatindicateshehashadacerebrovascularaccidentintheleft
middlecerebralartery2weeksago.AnMRIshowsalesionintheleftfrontalarea.
Beforeyouassesshimyoutalktothefamilyandtheysaid“Dadisn’ttalkingtoo
muchrightnowandwhenhedoeshe’sslurringhiswords.”Theyalsotellyouthat
heisretiredbutisextremelyactiveinthecommunity,likestoplaywithhis
grandchildren,andtravelsinternationallywithhiswifeafewtimesayear.The
familyisveryconcernedandconfusedaboutwhatisgoingon.
a) Describe what you would tell the family about what is going on with Mr. Rick.
What is his prognosis? What type of disorder(s) do you suspect?
b) How would you do evidence-based practice with this patient?
c) How would assess him?
d) Write two goals and two objectives of treatments you would do with him?
Youareworkinginalargepublicschoolinalargeinnercityareaschool.You
havejustbeenasktoassessSarahJonesayear7oldchildwhohasbeenhome
schooledbyhermotheraformerteacherpriortothissemester.However,her
parentsareworriedaboutherprogressduetoherlackofprogress.Shehas
seentheeducationalpsychologistsforassessmentandherstandardized
generalIQtestsalthoughslightlylowerthanherpeersbutarewithinone
standarddeviationofthenorm.Shehadnochildhoodillnessesorprenatal
traumaandcomesfromamiddleclassfamilywhospeakstandardAmerican
dialect.
Aftershowingsomepicturesofchildrenplayinginaschoolyardyouask
Sarahtodescribethescene(aboyandgirlarguingoverabag)andthechild
producesthelanguagesamplebelow.Reviewthesampleand
(a)CompareSarah’slanguagetodevelopmentalnormsandthendescribethe
featuresofherlanguagethatappeartobeproblematic
(b)Whattypeofdisorderdoyouthinkshemightbemanifesting?
(c)(Decidewhataspectsofherlanguageyouwouldfocusonintherapy?
(d)Giveexamplesofactivitiesyoumightbeabletouseinyourtherapy
sessionsthatwouldhelpimplementyourtherapy
(e)Givearationalebasedontheresearch/evidenceyouhaveencountered
whilestudyingchildlanguagedisordersthatinfluencedyourdecisionsin
yourtherapygoalsorchoices?
1 Whatistheboy
2 /Ummtheboyiskickingatthegirl/
3 /Becausesheshe’stryingtorunattoher/
4 /He’stryingtokicktheitgirl/
5 /Becausetheboyummisbad/
6 there’sabagonground/
7 /theboywillgetthebagatthefloor/.
8 /UmmIdo/
9 /butbaditwasbad/
10
/Ummshekickdoesn’taboys/
11
/Shejustplay/
12
13
14
15
16
17
18
19
20
21
/Shedoesn’tkickitboys/
/Shehavedoesn’tbag/
/Shecan’tplaynice/
Becausehecan’tbringherbag.
Ummwedon’therhavenobag.
/Wecan’thaveherkick/
havenobags/
/wellyougetyourboykickcan/
/Thegirlcanrunback/
WellummwellIshedoesn’tsithowtolearndown.
ProfessorPerkins,a68-yearoldmale,recentlysufferedastrokethatdestroyedthe
brainstemnucleiofcranialnervesIX,X,XIandXIIontherightsideonly.
a. Whatsymptomswouldyouexpecttosee?Why?
b. Whattreatmentapproachesmightbeappropriateforthispatient?
Pleasebethoroughinyourexplanation.
A16-y-oldEnglishL2-speakerwasreferredtoyoubecauseof"poorEnglish".His
parentsdonotspeakEnglishwellenoughtoprovidebasiccasehistoryinformation,
andnooneinyourcommunityisfluentinthespeaker'sL1language.
a. Thoroughlydescribetheproceduresyouwillemploytodetermineif
thisindividualwillbeaddedtoyourcaseloadbecauses/hehasa
communicationdisorder.
b. WriteanexplanationofaLanguageDisordervsaLanguageDifference
thatyoucouldusetohelpnon-professionalsunderstandthe
differencebetweenthetwocategories.
Rachelhastwochildren,a4-yearoldboyanda15month-oldgirl.Rachelhas
contactedyourclinicbecauseneitherofherchildrenaretalking.Whenyoumeet
Rachel,sheisnotconcernedbecause“thechildrenwilltalkwhentheyareready”
andshehasjustcometoyourclinic“becausehermomsaidto.”Racheldescribes
theirdaysathomeasloudduetocontinuousscreamingandprotests.Rachel
indicatesthatshehasbecomea“goodguesser”toknowwhatthekidswantthrough
outtheday.Whilethechildrenareinthewaitingroom,youobservethe15month
oldjoyfullyplayingagameofpeek-a-boowiththe4-yearold,andyouseethe15
montholdvocalizingandpointingwhenthechildseesanewtoytheylike.Provide
Rachelwithanexplanationof:
a.thekindsofinformationsheshouldbringtotheassessment
b.thedevelopmentallevelofatypicallydeveloping15montholdchild
c.thedevelopmentallevelofatypicallydeveloping4-yearold
d.thetechniquesshecanbegintouseathometoincreasetheexpressivelanguage
forbothofherchildren
e.theprocessyouwouldfollowasyouattempttodiscoverthemostlikely
reason(s)forthechildren’sdelay.
Toplananauralrehabilitationprogram,knowledgeofacousticsandauditory
developmentareessential.Pleaseanswerthefollowing:
a.Howdoweuseourknowledgeofacousticsinanalyzinganaudiogramandin
developingappropriategoalsforindividualswithhearingloss?Inyouranswer,
pleaseincludetheparametersofsound,howhearinglosscanimpacttheir
perception,andhowultimatelythisimpactsspeechandlanguage.
b.Listanddescribethehierarchyofauditoryskilldevelopmentandhowthisis
appliedtothedevelopmentofgoalsinauditorytraining.
Sarahisa7-yearoldgirlwhohasjustenteredthefostercaresystem.Herfoster
motherhasjustenrolledherinschoolforthefirsttimeinyourruraltown.Sarah
presentsasessentiallyanon-verbalchild.Whenshedoesspeak,shespeakswitha
softvoice,usesshortphrases,andhasahypernasalquality.Sarahdoesnotexhibit
theabilitytointeractwithorenjoystorybooks.Furthermore,youhaveonlyheard
herspeakinfragmentedsentencesconsistingof3-4words.Sarah’sfostermother
doesnothavechildrenofherownandthisisherfirstfosterchild.Pleaseprovide
herwithanexplanationof:
a. Details of how you will proceed with the assessment
b. Aspects of language and literacy development relative to Sarah and her same-age
peers
c. The importance of language development in terms of Sarah’s future academic
success
EdnaJonesisa38-yearoldfemalephysicaleducationteacheratahighschoolin
TangipahoaParish.InadditiontoteachingPEclassesthroughouttheday,Ednais
alsothecoachoftheVarsityGirl’sVolleyballTeam.Sheismarriedandamotherof
threechildren.Ednapresentswiththefollowingvocalcharacteristics:hoarseness,
breathiness,lowpitch,andintermittentaphonia.Ednaadmitsthatsheusesher
voicefrequentlyandloudly;thatsheoften“yells”atherownkidsathomeandather
studentsduringcoachingandvolleyballgames.Ednaisalsoasmoker(onepacka
day).Ednarecentlysawherprimarycarephysician(PCP)abouthervoiceproblems.
HerPCPimmediatelyreferredhertotheENT,whomadeadiagnosisofbilateral
vocalnodules.TheENTalsonotedthepresenceofpre-canceroustissuechangesin
herlarynxandvocalfoldsduetosmoking.TheENTthenreferredEdnatoyou(the
SLPatalocalclinic)forvoicetherapy.
a. BrieflydescribetheabnormalacousticvocalparametersEdna
islikelytopresent.
b. Discussthelinkbetweentheetiologyandsymptomatologyof
Edna’svoicedisorder(s).
c. OutlineadetailedtreatmentplanforEdna.Discussher
prognosis,goals/objectives,specifictherapytechniques,
measuringtreatmentprogress,dismissal/exitcriteria,etc.
Joe’sfatherisanxiouslysurfingtheInternettofindoutaboutthepossibletreatment
methodsforhissonwhohasbeenrecentlyfoundtobe“stuttering”.Hefinds
“StutterCure”,adevicethatthemanufacturerclaimscan“cure”astutteringproblem
inanyperson.So,Joe’sfatherrushestoyou(hehappenstoknowyouareworkingas
aspeech-languagepathologist)andasks“Canthisdevicehelpmychild?CanIbuy
anduseit?”Howwouldyouanswerthisfather’squestions?Explain.
RoycePowellisa53-yearoldmalewhosufferedastroke3monthsagoandwas
diagnosedwithmildtomoderateBroca’saphasia.Royceisnowreceivingphysical
therapyandspeech-languagetherapythroughahomehealthagency.Hewas
employedasanarchitectpriortotheCVA,andhopestoreturntoworkatsome
pointintime.Royceismarriedto“Barbara”(ahousewife)andtheyhavetwo
children(oneincollege;oneinhighschool).YouareRoyce’shomehealthSLP.
a. DiscusstheetiologyandsymptomatologyofBroca’saphasia.
SpecificallydiscussthesymptomsRoyceislikelytoexhibit.
b. DesignadetailedtreatmentplanforRoyce,takingintoaccounthis
personalhistory.Includeaprognosticstatementinyourplan.
Forthefollowingthreescenarios,detailtheSLP’sscopeofpracticeandroleasit
relatestoaudiologicalissues.Then,selectonecaseanddevelopatreatmentplan
foryourfirstone-hourtherapysessionwiththispersonand/orhis/herfamily.
Includeobjectivesandactivitiesthatareappropriateforthisindividual.
a. Annaisan80-year-oldfemalewithdementiaandmacular
degenerationwhichhasleftherlegallyblindinbotheyes.Youare
seeingAnnafordysphagiatherapyinhernursinghome,butrecently
hercaretakerreportedthatshehasbeendiagnosedwithhearingloss.
Annawillreceivetwobehind-the-earhearingaidsnextweek.
b. Sidneyisa40-year-oldmalewithbilateralseveretoprofound
sensorineuralhearingloss.Hehaswornhearingaidsforhisentire
life,untilrecentlywhenanadditionalworseningofhearingprompted
himtoseekacochlearimplant.Hewasraisedasanoraldeafchild;
hisfunctionalcommunicationandspeechintelligibilityseemedpretty
goodwhenhewasbeinginterviewedasacandidatefortheimplant.
Sidneyhasjustreceivedhisimplant,andyouwillseehimafterhis
firstprogrammingsession.
c. Joshuaisan18-month-oldmalerecentlydiagnosedwithhearingloss.
Youhavenotseenhisaudiogramandknownothingabouthowhehas
beenmanagedaudiologically.Thesecretarywhomadethe
appointmentsaysthatJoshua’smotherreportedthattheydidnot
knowwheretobeginandarecomingtoyouforinformationanda
“startingpoint”inhistreatment.
Alocalwomen’shospitalisproviding4monthsofparentingclassesforadolescent
mothers(ages12-17)ofinfantsandtoddlerswhoareatriskfordevelopmental
delays.Manyofthesechildrenwereprematurelybornand/orhadlowbirthweight.
Someofthemwereexposedtodrugs/alcoholinutero,andsomerequiredintensive
medicaltreatmentduringtheirfirstmonthsoflife.One-fourthoftheparenting
classesarededicatedtocommunicationdevelopment,andyouarebeingpaidto
developthecontentthatwillbeincluded.
c. Listthemajorcontentareastobeaddressedinclass
d. Provideadetaileddescriptionofthekindsofinformationthatwillbe
taught
e. Includeadiscussionofwhytheseparentswouldneedthis
information.
Estherisan80-year-oldfemaleatSunnyPasturesNursingHome,whereyouarethe
attendingspeech-languagepathologist.Esthercomplainsthatthenursingstaff
“mumbles”.Youdiscoverthatshehashearingaidsinherbedsidetablethatshe
neverwearsb/c“theydon’twork”.Howcanyoucheckthehearingaidstoseeif
theydo,infact,work?IftheyareNOTfunctioningproperly,whatstepscanyoutake
totroubleshootproblemswiththehearingaids?Iftheydowork,what
recommendationsand/orcounselingcouldyouofferEsthertoimprove
communication?
Youareemployedataprivatepractice.Aparentbringsathree-yearmalechildto
youwithconcernsaboutdysfluency.Accordingtocasehistoryinformation,the
childbegantoexperiencedysfluencyapproximately4monthspreviously.The
dysfluencyischaracterizedprimarilybywholewordrepetitions,phraserepetitions,
andsomesyllablerepetitions.Thereisnofamilyhistoryofstuttering.Thechild
doesnotappeartobeawareofhisdysfluencies,andthereisnosignoftensionor
strugglebehaviors.Basedonthisdata,wouldyourecommendspeechtherapyat
thistime?Explainyourrationale.Whatadvicewouldyougivetotheparentofthis
childwithregardtofluency-enhancingstrategiestoimplementinthehome
environment?