QLI

CASE STUDY 1

SITUATION

Case study 1 consists of a 63 y/o women who has sustained an acute stroke. The injury has resulted in
weakness in her right side. Looking specifically at speech, the resident presented with global aphasia and
severe expressive language difficulties. At time of admission, the resident needed maximum to moderate
assistance in communication tasks. Which included basic phrase completion while also benefiting from
phonemic cues. After completing initial assessments, the residents care and clinical team identified a
vision for the 63 y/o female and what her day would look like after QLI. The team wanted to target areas of
staying active in home management tasks, adaptive techniques, being involved with grandkids, recreational
activities, and effective communication strategies.

CONTRIBUTIONS

Date My Contributions to the Resident’s Rehabilitation Progress

10-17-18 Initial therapy session with resident—consisted of observing lead speech-language pathologist
(SLP), Tana, and how the residents speech therapy session is structured.

10-19-28 Over lunch (11:30-1 PM) created instructions on how to access and navigate an AAC app,
Snapscene, for residents family and care/clinical team to continue implementing the device during
unstructured/structured programming.

10-31-18 Lead resident’s therapy session with oversight from lead SLP. Therapy sessions consisted on
working on phonetic production of /ʃ/ /z/ and voiced /ð/. After getting initial speech sounds down we
began by adding /ʃ/ /z/ and /ð/ into sentence structures. Then ending with adding items to
Snapscene and getting resident comfortable with the use of this communication app. For example,
after adding items found around her room I asked her “What would you use to brush your teeth?”
probing her to search for the toothbrush picture on Snapscene.

11-02-18 Lead resident’s therapy session independently, worked on starting to add basic phrases/sentences
into resident’s daily programming through script training. This included phrases such as “I want…”
“I need…” “Can you…” “How are you?” and greetings/goodbyes.

11-07-18 Lead resident’s therapy session solo. This therapy time began with oral motor exercises. In order
for the resident to feel sensation and placement of articulators in her oral cavity lemon swabs were
used to sweep across her mouth. Lemon swabs help correctly recognize where the articulators
need to fall for certain speech sounds. After this experiment, reading comprehension tasks were
given to the resident to assess processing speeds and level of understanding. From this tasks, it
was seen that the resident was unable to complete reading comprehension without maximum
support. Then, “I need…” phrases were implemented into the therapy session following repetition
of utterance.

Following 11-07-18 session I began leading resident’s therapy session independently with
the oversight of Tana initially and then follow-up check-ins sporadically.

11-14-18 Therapy session began with orientation. Some examples of orientation with this particular resident
include: where are you at?, what therapy are you currently in?, what is the current month?, what
day is it?, what’s the date? With an unsuccessful attempt, in having the resident initiate orientation

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 QLI

I stepped in by using the resident’s planner as a visual aid. Then, I continued to point to and
verbally state the exact day and month while having the resident repeat what I said. Following
orientation, we worked on oral motor exercises and continued with working on Snapscene. At the
end of the session, I also was asked to assess resident’s writing. In order to do this, I asked her to
write a simple sentence of “My name is _____” (Due to HIPPA guidelines I am not able to reveal
resident’s name). This task was difficult for the resident to complete so we ended the session
shortly after.

11-16-18 Continue working on Snapscene, find an object around the room, say what it is, then use a carrier
phrase with the object in a sentence.

11-21-18 Found an object around the room and gave phonemic cues

11-28-18 Collaborative time together with another resident, where we all played UNO together. Focused on
verbal communication in a social setting. Practiced saying the color and number of the card and
then repetition of the phrase: “Your turn”

Starting after 11-28-19 resident’s time changed to working on functional home tasks:
folding laundry, putting away laundry, and making the bed.

12-30-18 Began doing House 3 laundry to simulate at home tasks—resident put laundry in the washer, took
it out of the dryer, and folded them independently with little to no support.

1-31-19 Resident discharged home.

My time at QLI from August to December of 2018 consisted of Wednesday’s and Friday’s from 8:30 AM- 2 PM.
December to May of 2019 consisted of Wednesday’s 1- 4:30 PM and Friday’s 8:30 AM- 2 PM. Therapy sessions
were in 30-minute increments with this specific resident.