PORTFOLIO

PART 1: CLINICAL ASSESSMENT COMDIS 711

I. Methods
A. 53-year-old woman exhibits speech within normal limits.
B. 58-year-old woman exhibits mild apraxia of speech (AOS) and a right
central VII.
II. Physical Differences
The patient with apraxia of speech exhibits a mild right central VII. In addition, she presents
with a moderate-severe right lateral labial impairment (e.g. pucker lips and move them to both sides
as far as you can). She turned her head to the right to compensate for her inability to move her lips
to the right side. In comparison, her age matched peer exhibits facial symmetry, movement and
strength within normal limits. The apraxia of speech patients laryngeal performance indicated a
normal whisper, shout and scale. Her pharyngeal performance indicates she was unable to
produce a cough without imitation from the clinician, which reveals presence of an oral apraxia. In
comparison, her age matched peers pharyngeal performance indicated she was able to produce a
cough independently. In addition, her age matched peers laryngeal performance indicated ability to
produce a whisper, shout, and scale within normal limits. Lastly, the patient with apraxia of speech
required the clinician to repeat directions and provide a model for various tasks, which the age
matched patient did not. (Duffy, 2013).
III. Speech Differences
The patient with apraxia of speech presented with significantly abnormal SMRs in contrast to
AMRs; however, AMRs were still below average. In comparison, her aged matched peer was only
slightly below average on a few trials of AMRs (i.e., puh and tuh). The patient with apraxia of
speech presented with distorted additions (e.g., tuh kuh/ tuh) and vowel distortions (i.e., ti kuh/
tuh kuh), while her aged matched peer did not. Lastly, the patient with apraxia of speech needed
to be reminded of what sound or sounds to elicit with phoneme and tactile cues provided by the
clinician, unlike her age matched peer who was able to independently complete all tasks (Duffy,
2013). Results are shown in table 1.
Maximum phonation duration (MPD) was completed with both patients. The patient with
apraxia of speech sustained /a/ for 13.5 seconds, which is slightly below the mean (i.e., 14.4
seconds). Her age matched peer was significantly above the mean. The patient with apraxia of
speech sustained a pitch, ranging from high to low and was irregular across all three trials. Her age
matched peer maintained a steady and even pitch across all three trials (Duffy, 2013). Results are
shown in table 2. The CAPE-V voice assessment revealed the patient with apraxia of speech
exhibits a mildly dysphonic voice (15/100) characterized by mild strain (20/100) while producing /a/
and /i/. In addition, the patient presented with mild pitch ranging from high to low while she
sustained /a/ and /i/ (10/20). Results are shown in table 3.

PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

Table 1.
Diadochokinesis: Alternate and Sequential Motion Rates [AMRs and SMRs]
Trial 1
Trial 2
Trial 3
Alternate Motion
Normative
Rates
Data
MSD
Peer
MSD
Peer
MSD
Peer
/puh/
5.0/sec
2.9/sec 4.7/sec 3.5/sec 4.3/sec 3.4/sec 4.7/sec
/tuh/
4.8/sec
2.3/sec 5.6/sec 2.7/sec 4.4/sec 3.0/sec 4.2/sec
/kuh/
4.4/sec
2.6/sec 5.1/sec 2.1/sec 4.5/sec 3.2/sec 4.8/sec
Trial 1
Trial 2
Trial 3
Sequential Motion
Normative
Rates
Data
MSD
Peer
MSD
Peer
MSD
Peer
/puh/ /tuh/
n/a
1.1/sec 3.6/sec 1.5/sec 3.3/sec 1.2/sec 3.6/sec
/tuh/ /kuh/
n/a
1.0/sec 3.9/sec 1.3/sec 3.3/sec 1.4/sec 3.4/sec
/puh/ /tuh/ /kuh/
3.6/sec
1.0/sec 3.9/sec 1.0/sec 3.7/sec 1.1/sec 3.7/sec
Diadochokinesis: Alternate and Sequential Motion Rates
[AMRs and SMRs] Averages

Alternate Motion
Rates
/puh/
/tuh/
/kuh/
Sequential
Motion Rates
/puh/ /tuh/ /kuh/

Normative
Data
5.0/sec
4.8/sec
4.4/sec
Normative
Data
3.6/sec

MSD

Peer

3.2/sec
2.6/sec
2.6/sec
MSD

4.6/sec
4.7/sec
4.8/sec
Peer

1.0/sec

3.8/sec

Table 2.

/a/

Normative
Data
14.4 sec

Maximum Phonation Duration

Trial 1
Trial 2
MSD
11.39
sec

Peer
33.32
sec

MSD
15.34
sec

Peer
37.28
sec

Trial 3
MSD
15.79
sec

Peer
33.76
sec

Average
MSD
14.17
sec

Table 3.
Perceptual Attribute
Overall
Breathiness
Strain
Roughness
Pitch
Loudness
Resonance

Degree of Dysphonia
Mildly dysphonic (10/100)
Normal (0/100)
Normal (20/100)
Normal (0/100)
Normal (10/100)
Normal (0/100)
Normal (0/100)

Presence
Consistent
Consistent
In Consistent
Consistent
In-Consistent
Consistent
Consistent

Peer
34.78
sec

PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

IV. Video
https://youtu.be/gpoRtVzxmIA

V. Results
A fifty eight-year-old female exhibits a mild apraxia of speech and a right central VII. Speech
revealed abnormal sequential motion rates in comparison to alternate motion rates characterized by
distorted additions (e.g., tuh ka/ tuh) and vowel distortions (e.g, ti kuh/ tuh kuh). Voice
assessment revealed a mildly dysphonic voice (15/100) characterized by mild strain (20/100) while
producing /a/ and /i/. In addition, the patient presented with mild pitch ranging from high to low
while she sustained /a/ and /i/ (10/20). Vowel prolongation revealed below average inability to
sustain /a/ at an average of 14.17 seconds. Physical assessment revealed a moderate-severe right
lateral labial impairment and a mild right central VII. In addition, the physical assessment revealed
presence of an oral apraxia characterized by the inability to elicit pharyngeal structures (i.e., cough)
without imitation. Oral apraxia presented with inconsistent trial and error attempts, in addition to
saying the command (i.e., cough) instead of producing a cough.

V. Reflection on Performance
I completed my assessment on a 58-year-old woman who sustained a left cerebrovascular
accident (L.CVA) during a pacemaker ablation, exhibiting a moderate non-fluent aphasia, mild
apraxia of speech (AOS), and a right hemiparesis of the upper extremity. After reviewing my
performance with this patient in the video, I realized I should have decreased the length of verbal
directions, which I did in some cases (e.g., Tongue behind bottom teeth/put your tongue behind
your bottom teeth. However, I should have done this initially for many of the directions because
many of my directions were lengthy. I believe this impaired the patients ability to perform the tasks
independently. As a result, I often had to repeat directions and break them into parts so she was
able to complete the task. In addition, I realized I could have given her a longer period of time to try
and perform various tasks before providing a model. Lastly, I often used the word alright during
assessments. I need to reduce the amount of fillers I use during treatment.
During the assessment portion, I was surprised the patient was unable to follow one-two step
directions without a model. In addition, during the diadochokinesis task, she often had me repeat
various sounds even after she just finished producing it. This may be due to an auditory
comprehension impairment. I believe the primary reason why she often asked me (e.g., Which
one?) to repeat various sounds was because she wanted me to model the correct placement of the
sound or sounds. Lastly, during the patients voice assessment I was surprised to hear a strain
while she produced /a/ and /i/ because I did not hear this while I was assessing her speech
intelligibility through a conversation speech sample.
From this experience, I learned it is important to assess all parameters and get a dynamic
assessment in order to rule out various impairments. In a medical facility, I realize clinicians have
limited time to document treatment and assessments. I look forward to increasing my speed and
accuracy of writing up treatment and assessment notes as the semester progresses.