rewrite my friends work. and make it mines

Isabella DiMeis

Observations and Clinical Methods

SOAP Notes

March 15th, 2024

Bob- Sarah Roelofs

Subjectivity/

Bob is a 72- year old male, who ten years ago had a left cerebral vascular accident as well as right hemiparesis. Bob has difficulties with initiating speech, motor planning skills, as well as reading and spelling words and phrases. Session is led in a clinician directed approach. Clinician uses PROMPT as their main approach to assist in direct following, implementing cues to correct the position of the patient's jaw, lip and face for certain sounds. Patient shows enthusiasm and appears to be motivated throughout the session to work towards goals.

Objective/

Patient works on reading and auditory comprehension, spelling skills, direct following, and cue implementation. When asked to produce the /b/sound followed by vowels, the patient scored very well. For the sound ‘bay’ patient produced 10/10 sounds correct at 100% accuracy, the word ‘bow’ was produced correct 14/14 times at 100% accuracy with positional cues with most of the words produced. During the repetition of the word ‘bow’ Bob produced all of the sounds accurately, but when putting it in a full sentence to say ‘I tied a bow’ the patient lowered jaw and was unable to produce a sentence without a positional cue. Bob practiced both one and two step instructions, he was able to complete the one step instruction exercises easily, but found difficulties with the two-step instructions. With the one step instructions the patient was asked to point to certain objects, Bob got 4/4 correct with a 100% accuracy rate. With the two-step instructions, Bob was able to get 0/3 correct on the first try with a 0% accuracy, then when prompted he had a 66% accuracy rate.

Assessment/

Patient has a motor speech disorder, and severe verbal apraxia. When working on producing single words with assistance to the correct positioning Bob was able to do so at 100% accuracy, but when putting the word into a short sentence Bob is unable to without assistance and drops his jaw. When following one step directions Bob is able to do so very easily, but when asked to follow two step directions Bob struggles to complete both directions. Since the two step directions include longer sentences, Bob has difficulties comprehending the full sentence.

Plan/

-Continue future sessions with utilizing PROMPT for motor planning skills.

-Continue with exercises to improve Bob's ability to follow 2-step directions.

-To enhance Bob’s spelling skills use letter tiles and have Bob.

-Create reading comprehension exercises with short reading excerpts.

Rebecca- Jennifer Dennis

Subjectivity/

Jennifer is a 44-year old female, who is a survivor of a left hemisphere stroke that occurred two years ago. Patient was unable to speak after the stroke. Jennifer went through intensive rehab followed by an intensive speech therapy program. Patient has a goal of writing a book about her experiences since having her stroke, so the clinician is helping Rebecca work up to the goal by building her organizational skills, having her write from dictation, and breaking larger words into smaller ones. Patient works on putting stress in words, production of multisyllabic words, and verbal expression.

Objective/

Rebecca is asked to read a series of sentences created by the clinician, while reading these sentences in a duration of 6 minutes the patient was unable to pronounce 6 words correctly. When she noticed herself struggling she slowed down, focused on where to put the stress in the word, and with help of the clinician was able to correct herself. Within another reading exercise Rebecca read a beauty excerpt from a magazine, in a 6 minute duration she struggled to pronounce 6 different words, such as ‘limited’, ‘pearl’, ‘illuminates’, ‘multi’, ‘’reflecting’, and ‘liquid’. After pausing to examine these words with the clinician Rebecca was able to repeat all of the words with 100% accuracy.

Assessment/

Rebbeca has mild aphasia. Throughout the session Rebecca is very good at self correcting. Rebecca has good motivation to do well throughout the session, is very attentive and does a great job at self correcting when she notices she mispronounces a word. Rebecca will work to decrease the amount of times she has to pause to examine a word while reading an excerpt, for a 6:00 duration she will decrease her self corrections from 6 to 3-4 times.

Plan/

-Patient will continue focusing on using stress in words to promote meaning in the words, more specifically in words that are spelled the same but have different meanings.

-To enhance writing skills, have Rebecca continue practicing writing sentences from dictation.

-Implement exercises of breaking up large words into smaller ones to help improve verbal expression.

-Work with Rebecca to create an outline to begin organizing tasks for her book effectively, which can build on patients' organization skills.

Shirley- Gretchen Rottman

Subjectivity/

Shirley is an 81-year old female who suffered a stroke two years ago, and now lives in an assisted living facility. Patient has difficulties with verbalization, verbal cues, posturing and will work on two-step directions, and intonation. Prior to stroke patient was very active, patient showed great attitude and a will for improvement. Clinician uses a clinician directed approach.

Objective/

Shirley demonstrated a good understanding of one step directions. With objects displayed on the table, Shirley was asked to point to 6 objects, she got 6/6 correct with a 100% accuracy. Afterwards the patient is given the meaning of what the object does, then has to point to that object, with this exercise she scored 4/6 with a 67% accuracy. Then with the two step instructions exercise when Shirley was asked to point to two different objects at once, she got 1/5 correct, scoring a 20% accuracy. In another two step exercise Shirley was told the meaning of two different objects and was asked to point to both objects, when doing so Shirley got 3/4 correct, giving her a 25% accuracy. Throughout the session when prompted, Shirley showed great improvement, for example with the two step exercise when prompted Shirley's accuracy improved from 25% to 75%.

Assessment/

Patient has a moderate adult language disorder. Patient has difficulty following two-step instructions without cues. Next session, the patient will have a goal to reach 4/5 correct with the two-step pointing exercise and 3/4 correct with two-step exercise where the patient is given the meaning of object and must point, both of these goals should be completed with minimal use of cues. Next session will target Shirley's two-step exercises and slowly work up to being able to complete with using no cues.

Plan/

-Use flashcards of single words and have the patient repeat in a certain pitch to practice intonation skills.

-Continue working on verbalization with modeling and posturing cues in future sessions.

-To work on verbalization skills, have patient practice and repeat phrases.

-Create activities to improve Shirley’s comprehension and ability to follow 1-2 step directions.

Works Cited

Dennis, J. (n.d.). Rebecca. Master Clinician. https://app.mcnslp.com/videos/clinical/47623874

Roelofs, S. (n.d.). Bob. Master clinician network. https://app.mcnslp.com/videos/clinical/476 33870

Rottman, G. (n.d.). Shirley . Master clinician network. https://app.mcnslp.com/videos/clinical/4 7623872