Learning Mode 1 Bubby PDF

Jennifer Gonzalez Soto
jenny.gosoto07@mail.com
Assessment Results
Client Name: Bubby Intervention
Examination Date: November 4th, 2019
Mode: learning
Baseline Data 17/100

Collaborators 50/100
Treatment 20/100
Skills Check 93/100
Client Progress 0/100
Summary 100/100
Completion Time 116 Minutes
Your Competency Score 47%
Overall Competency Rating

Emerging Competency
Skills Check
Rotary Chewing with Solid Foods 100/100
Spoon Presentation of Puree Foods 100/100
Spoon Presentation of Soft Solid Foods 67/100
Thin Liquid from a Straw 0/100
Intraoral Stimulation Prior to Eating 100/100
Tactile and Extraoral Desensitization 100/100
Completed 6 of 5
Clipboard Contents
Baseline Data
Reflective (+): 6
Acceptable (0): 2
Rejected (-): 5
Evaluation Reports
1 minutes 55 seconds
Speech, Language, & Feeding Evaluation Completed 10
months ago
It is recommended that you complete the Bubby-Assessment

case within the Simucase library for information pertaining to
his evaluation which was completed 10 months ago.
Intervention Reports
Intervention Progress Report
It is recommended that you contact the SLP in the

Collaborator section for Bubby's intervention progress report.
Session Objectives
In preparation for treatment Bubby will tolerate 2 minutes of
systematic tactile desensitization with no negative behaviors
(biting, hitting, pinching) prior to the introduction of food.
Session Objective was entered in the clipboard.

Bubby will increase his tolerance of oral and intraoral
stimulation prior to eating by allowing lip, teeth, tongue and
palate to be brushed/stroked 10 times each with a variety of
oral utensils including z-vibe, Ezee-spoon, and toothbrush
with no negative response (biting, hitting, pinching).

Bubby will accept liquids through an elevated straw without
anterior spillage 10 times per session.

Redirect #1
This interview question or objective is not appropriate for the

client.
Bubby will accept liquids through a Honey Bear straw cup
without biting the straw and decreased gradual removal of
pressure to express liquids 10 times per session.

Redirect #2

client.
6 minutes 5 seconds
Bubby will obtain and maintain lip seal/closure from a variety
of cups without facilitated jaw stability 10 times per session
without anterior spillage.

6 minutes 5 seconds
Redirect #3

client.
Bubby will accept pureed food from a spoon utilizing
appropriate lip seal (no biting) to remove puree from the
spoon 5 times per session.

Bubby will accept 10 presentations of soft solid food from a
spoon with less than 3 episodes of turning his head away or
spitting the food out per session.

Bubby will increase his food inventory by adding a vegetable
to his preferred list of foods. To qualify as a preferred food he
should accept 10 presentations of the food with no negative
responses over three different dates within 1 month. A food
journal/diary should be maintained.

Bubby will follow directions with locative concepts in 4 out of
5 opportunities.
Session objective was entered in the clipboard.

Redirect #4

client.
Bubby will further develop his vertical chewing pattern by
using his incisors when chewing a variety of solid foods 10
times per session.

Redirect #5

client.
Bubby will further develop his rotatory chewing by using his
molars as opposed to his incisors when chewing a variety of
solid foods 10 times per session.
Collaborators
Reflective (+): 10
Acceptable (0): 13
Rejected (-): 5
Family
You contact the Grandmother
I'm Bubby's grandmother.

Tell me how Bubby has been doing with eating and drinking
at home.
He's made quite a bit of progress. Um, he's eating anything

you put in front of him, except for peaches or jello. He won't
eat either one of those. Um, drinking from a straw. Can't get
him to drink out of just a plain cup yet, he just don't feel
secure I guess without the straw. He'll drink anything you put
in a cup.
What new foods has Bubby been eating this past month?
Meat, um definitely loves fish. For some odd reason, he you

know I fixed him him some fish. He ate a couple pieces of
fish, one or more I thought that was enough.
Is there anything else you would like Bubby to work on in
treatment this month?
I would like for him to eat out of a fork. For some odd reason
he don't like a fork. Which you know it took a while get him to
eat from a spoon. So that's progress, I'm working on him
getting him to eat out of a fork.
What are your goals for today's session?
Just get him to eat everything possible, to gain his weight to

where he should be.
Is tooth brushing still challenging for Bubby? How has tooth
brushing been going at home?
Yes, he don't like for no one to stick a toothbrush in his teeth

in his mouth. I don't know what it is about a toothbrush but
he does not want a toothbrush in his mouth at all.
Describe the process you do to brush his teeth.
Ah we lay him down on the floor. Um, I try to get his sister get
him singing and stuff so I can just get the toothbrush in there.
But once I get it in there he clamps down on it and pulls all
the bristles out of the toothbrush.
Does Bubby continue to chew on non-food items?
Um, yeah I'm trying to break him from it. Um he ain't had his
chew toy for 4 days now. And that's been really tough, real
tough. I had to go buy bigger balls and stuff so he can't get
them in his mouth. We are trying to wean him off of chewing.
Have Bubby's medications changed since his initial
evaluation?
No.
Can Bubby's medications be given to him orally?
You would have to ask his doctor.

Has Bubby increased his use of grammatical morphemes?
I don't know what that is.

Redirect #6
The is incorrect based on previous case history and/or the

referral.
Allied Professions
You contact the Speech-Language Pathologist
Hi, I'm Mary Bell. I am the speech-language pathologist who

has been working for Bubby. I recently completed his
intervention progress report and I'll send a copy of the report
to your clipboard. Thank you for seeing Bubby for his
treatment session this week.
What is Bubby's feeding history?
The information you are looking for is in the report I sent you.
What goals should be targeted during today's session?
I completed his intervention progress report earlier this week

that outlines the goals to target. I sent his progress report to
your clipboard for review.
What foods does Bubby prefer?
Bubby continues to prefer crunchy food items over any other

texture however he has made tremendous progress in his
acceptance of other textures.
What is Bubby's current diet?
He has gradually been accepting more food and drink by

mouth which has allowed for less use of his G-tube. He has a
dietitian that monitors his growth who determined an amount
that he should eat and drink for each meal and if the caloric
intake is not obtained orally he is given the rest of his
nutrition via his G-tube.
Do you recommend using a Haberman bottle system with
Bubby?
Bubby has been accepting thin liquids from a straw and does
not require a Haberman bottle system.
Redirect #7

referral.
Do you have concerns for Bubby's ability to protect his
airway?
When I first started working with Bubby for feeding treatment

that was a very big concern of mine and a possible
explanation for why he was not accepting any liquids. As he
gradually began to accept liquids his respiratory status
remained stable and he did not have any clinical signs or
symptoms of difficulty. Due to his complicated medical history
and previous concerns for aspiration a video swallow study
was completed to further assess his airway protection and
ensure moving towards full oral feeding was a feasible goal.
Bubby accepted thin liquid, puree and solid consistencies
during the MBS. You can review his recorded MBS in the
baseline data section.
What thickening agent do you use with Bubby?
Bubby accepts thin liquids. He does not use any thickening

agents.
Redirect #8

referral.
How long have you been seeing Bubby?
The information you are looking for is in the report I sent you.
Describe Bubby's family involvement in his therapy.
Bubby's grandma is usually the one who brings him to his

weekly treatment sessions. She is very motivated to have his
G-tube removed so she is typically involved in every session.
How does Bubby communicate with you?
When given a choice between 2 items he will reach towards

his preferred item. He uses intermittent single phrase length
utterances however his vocalizations are not always
purposeful and at times are echolalic. Bubby sings along with
familiar songs.
Do you think Bubby's G-tube should be removed?
That is a question his medical team needs to determine with

input from all team members and his family. I know he still
needs to transition his medication to oral administration
rather than through his G-tube.
Describe Bubby's written narrative development.
Written narrative development has not been a focus during

our treatment sessions.
Redirect #9

referral.
Educational
You contact the Special Education Teacher
I'm Sara Hayden, Bubby's classroom teacher.

Tell me about Bubby's eating and drinking at school this year.
Yes, um beginning of school he was not ah eating foods, table

foods any kind of table foods for us just crunchy foods like
chips. He'd would you know go all day and not eat a thing but
when you put chips in front of him, he would eat chips. Now
at the end of the school year I had him eating food from his
tray from the cafeteria. He does like meat more than he likes
the vegetables. But he will eat vegetables if I tell him, you
can't have chips until you eat that. And it's not just like one
green bean. You know I put several green beans down for him
to pick them up. He can pick up just about any kind of food
and take it to his mouth now. But now I'm working on feeding
him with a spoon. Beginning he did not even want to touch
the spoon to his mouth so as we did before with the food "Kiss
the spoon." You know that technique has worked. He started
using the spoon. Now I can get food on the spoon to his
mouth. But he still doesn't like the slimy, canned fruits, he'll
eat mashed potatoes from the spoon any kind of food that's
kind of thick that will stay on the spoon. He likes macaroni
and cheese, spaghetti, you know as long as you cut it up and
use a spoon to take it to his mouth.
Do you have any additional concerns with his eating and
drinking?
Ah, just learning how to scoop the food and use the spoon
properly.
Medical
You contact the Nursing Home Aide
I'm sorry I don't know the patient you are referring to.
Redirect #10

referral.
Treatment
Food and Drink
Rotary Chewing with Solid Foods
Spoon Presentation of Puree Foods
Spoon Presentation of Soft Solid Foods
1 hours 12 minutes 52 seconds

Thin Liquid from a Straw

Thin Liquid from a Honey Bear Cup
Results: Goal was achieved. Bubby is able to drink thin liquid

via a straw independently and no longer requires an assistive
squeeze.
Oral Motor Kit

Oral Motor Exercises
Results: Enter notes in the clipboard after viewing Bubby's

responses.
Redirect #11
This selection is incorrect based on your client’s age or plan

of care.
Oral Stimulation

Intraoral Stimulation Prior to Eating

Oral Stimulation for Rotary Chewing
Sensory Integration

Earmuffs for Sound Reduction
Results: Inappropriate for client referral.

Redirect #12

of care.
Tactile and Extraoral Desensitization
Results: Enter notes in the clipboard after viewing Bubby's

response.
Tactile Therapy Ball


Redirect #13

of care.
Weighted Vest

Redirect #14

of care.
Client Progress
Objectives

2. Goal Met: Tolerate 2 minutes of tactile desensitization with
no negative behaviors.

Redirect #15
This statement does not reflect the client’s current progress.

2. Goal Not Met: Tolerate 2 minutes of tactile desensitization
with no negative behaviors.

3. Goal Met: Increase tolerance for lip, teeth, tongue, and
palate brushed 10 times each.

Redirect #16

3. Goal Not Met: Increase tolerance for lip, teeth, tongue, and
palate brushed 10 times each.

1. Goal Not Met: /r/ phoneme in the initial word position with
minimal cues.

Redirect #17

1. Goal Not Targeted: /r/ phoneme in the initial word position
with minimal cues.

1. Goal Met: /r/ phoneme in the initial word position with
minimal cues.

Redirect #18

4. Goal Met: Accept liquids through an elevated straw 10
times per session.

4. Goal Not Met: Accept liquids through an elevated straw 10
times per session.

Redirect #19

4. Goal Not Targeted: Accept liquids through an elevated
straw 10 times per session.

5. Goal Met: Accept liquids via Honey-Bear straw cup to
express liquids 10 times / session.

5. Goal Not Met: Accept liquids via Honey-Bear straw cup to
express liquids 10 times / session.

Redirect #20

5. Goal Not Targeted: Accept liquids via Honey-Bear straw cup
to express liquids 10 times / session.

6. Goal Met: Maintain lip seal for an open cup without
facilitated jaw stability 10/session.

Redirect #21

6. Goal Not Met: Maintain lip seal for an open cup without
facilitated jaw stability 10/session.

6. Goal Not Targeted: Maintain lip seal for an open cup
without facilitated jaw stability 10/session

7. Goal Not Met: Accept pureed food from a spoon with
appropriate lip seal 5 times/session.

Redirect #22

7. Goal Met: Accept pureed food from a spoon with
appropriate lip seal 5 times/session.

8. Goal Met: Accept 10 spoon presentations of soft food with
no averse behaviors.

Redirect #23

8. Goal Not Met: Accept 10 spoon presentations of soft food
with no averse behaviors.

9. Goal Met: Increase food inventory by adding a vegetable to
his preferred food list.

Redirect #24

9. Goal Not Met: Increase food inventory by adding a
vegetable to his preferred food list.

9. Goal Not Targeted: Increase food inventory by adding a
vegetable to his preferred food list.

Redirect #25

10. Goal Met: Develop rotatory chewing by using molars when
chewing foods 10/ session.

Redirect #26

10. Goal Not Met: Develop rotatory chewing by using molars
when chewing foods 10/ session.

11. Goal Not Met: Develop vertical chewing by using incisors
when chewing foods 10/session.

Redirect #27

11. Goal Met: Develop vertical chewing by using incisors

when chewing foods 10/session.

11. Goal Not Targeted: Develop vertical chewing by using
incisors when chewing foods 10/session.

12. Goal Met: Follow directions with locative concepts in 4 out
of 5 opportunities.

Redirect #28

12. Goal Not Met: Follow directions with locative concepts in 4
out of 5 opportunities.

12. Goal Not Targeted: Follow directions with locative
concepts in 4 out of 5 opportunities.
Take-Home Activity

Simon Says: Following Directions with Locative Concepts

Redirect #29

Maintain Food Journal

Turtle Speech and Easy Onset Coloring Worksheet

Redirect #30
Summary
Summary

Bubby was engaged throughout with some resistance to
certain activities. He continues to exhibit aversive behaviors
with intraoral stimulation. He met 1 goal and continues to
make progress with his remaining goals. Provided take-home
activity for continued collaboration with home and school.
Continue plan of care. Recommend family discuss medication
administration with medical team.
Goals
Long Term Goal: En un periodo de 6 meses, Bubby aumentará

la ingesta de alimentos de diversas consistencias para
ampliar su repertorio de alimentos consumidos con ayuda del
clínico con un 80% de adecuación.
Short Term Goal: En un periodo de 3 meses, Bubby logrará

ingerir alimentos sólidos y líquidos con ayuda del clínico con
un 80% de adecuación para ampliar la variedad de alimentos
consumidos.
Skills Check
Rotary Chewing with Solid Foods
Describe his posture and chewing pattern.

mal posicionamiento ya que permanece masticando con la cabeza hacia bajo y su espalda
inclinada hacia al frente. Su patrón de masticación es inadecuado ya que mastica de un solo lado,
haciendo pocketing
Select behavior(s) observed:
A. Refusing foods by turning away or covering mouth
B. Spitting food out
C. Overstuffing / Pocketing Correct
D. Swallowing without chewing
Has Bubby used rotatory chewing by using his molars as opposed to his incisors when chewing a variety of solid
foods 10 times this session?
A. yes
B. no Correct
Spoon Presentation of Puree Foods
Does Bubby accept the spoon presentation without biting on the spoon?
A. yes Correct
B. no
A. yes Correct
B. no
A. yes Correct
B. no
A. yes Correct
B. no
A. yes Correct
B. no
Calculate the number of presentations of puree Bubby accepted from the spoon without biting the spoon.
5
Spoon Presentation of Soft Solid Foods
Does Bubby accept the spoon presentation without turning his head away or spitting the food out?
A. yes
B. no Correct
A. Opening for the spoon, accepting, and swallowing
B. Requesting more
C. Reduced mouth opening for the spoon
D. Refusing foods by turning away, blocking spoon, covering mouth
E. Saying “no”
F. Spitting food out Correct
G. Drinking instead of eating
H. Refusal to sit in chair
A. yes
B. no Correct
B. Requesting more
C. Reduced mouth opening for the spoon Correct
D. Refusing foods by turning away, blocking spoon, covering mouth Correct
E. Saying “no” Incorrect
F. Spitting food out Incorrect
G. Drinking instead of eating Correct
H. Refusal to sit in chair Incorrect
A. yes
B. no Correct
B. Requesting more
E. Spitting food out Incorrect
F. Drinking instead of eating Incorrect
G. Refusal to sit in chair Incorrect
Why do you think Bubby accepts the peach when it is presented on a chip?
Por la textura del melocotón que es más suave, bubby prefiere los alimentos crujientes como la
galleta
Does Bubby accept the first spoon presentation without turning his head away or spitting the food out?
A. yes
B. no Correct
A. Opening for the spoon, accepting, and swallowing Incorrect
B. Requesting more Incorrect
E. Spitting food out Correct
F. Drinking instead of eating Incorrect
G. Refusal to sit in chair Incorrect
Does Bubby accept the second spoon presentation without turning his head away or spitting the food out?
A. yes Correct
B. no
Why do you think Bubby accepts the green bean when he feeds himself?
Porque se lo introduce él mismo, pudiera ser también por su sabor o textura, o porque ya lo ha
probado
Why do you think the final presentation is a preferred item presented with a spoon?
Porque se está trabajando con la aceptación de alimentos con cuchara, y es más factible que se
acepte la terapia con el alimento de su preferencia.
Calculate the number of soft solid food presentations Bubby accepted from the spoon without turning his head
away or spitting the food out.
0
Thin Liquid from a Straw
Select any clinical signs or symptoms of swallow dysfunction.

A. Coughing
B. Choking
C. Watering eyes
D. Increased congestion
E. Wet vocal quality
F. Refusing to drink
G. No clinical signs or symptoms of swallow dysfunction
Select any signs and symptoms of swallow dysfunction.
A. Coughing
B. Choking
C. Watering eyes
Select any signs and symptoms of swallow dysfunction.
A. Coughing
B. Choking
C. Watering eyes
Intraoral Stimulation Prior to Eating
Where was oral stimulation provided?

A. Lips Correct
B. Teeth Correct
C. Tongue
D. Palate
A. Smiling
B. Requesting “more”
C. Turning head away Correct
D. Pushing hand away Correct
A. Lips Correct
B. Teeth Correct
C. Tongue
D. Palate
A. Smiling
A. Lips Correct
B. Teeth Correct
C. Tongue
D. Palate
A. Requesting “more”
B. Turning head away Correct
C. Biting on utensil Correct
E. Clenching jaw shut and preventing stimulation to tongue or palate Correct
Why is it important to provide breaks and reinforcement?

Para que no se fatigue durante el proceso de alimentación, y los refuerzos son importantes para
motivar al paciente
Describe Bubby's acceptance or nonacceptance of the vibrating toothbrush.
Quiere manipular el cepillo, jugar con el, y lo aprieta cuando se lo pasan y no quiere usarlo.
A. Smiling Correct
C. Turning head away
D. Biting on utensil
E. Pushing hand away
F. Clenching jaw shut
A. Smiling
D. Biting on utensil Correct
Does Bubby allow his tongue to be brushed?
A. yes
B. no Correct
Tactile and Extraoral Desensitization

A. Crying
B. Requesting "more"
D. Pinching Correct
E. Pushing hand away Correct

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Jennifer Gonzalez Soto

Baseline Data 17/100

Your Competency Score 47%

Overall Competency Rating

It is recommended that you complete the Bubby-Assessment

his evaluation which was completed 10 months ago.

It is recommended that you contact the SLP in the

Session Objective was entered in the clipboard.

Session Objective was entered in the clipboard.

Session Objective was entered in the clipboard.

This interview question or objective is not appropriate for the

Session Objective was entered in the clipboard.

This interview question or objective is not appropriate for the

Session Objective was entered in the clipboard.

This interview question or objective is not appropriate for the

Session Objective was entered in the clipboard.

Session Objective was entered in the clipboard.

Session Objective was entered in the clipboard.

Session objective was entered in the clipboard.

This interview question or objective is not appropriate for the

Session Objective was entered in the clipboard.

This interview question or objective is not appropriate for the

Session Objective was entered in the clipboard.

You contact the Grandmother

I'm Bubby's grandmother.

He's made quite a bit of progress. Um, he's eating anything

Meat, um definitely loves fish. For some odd reason, he you

Just get him to eat everything possible, to gain his weight to

Yes, he don't like for no one to stick a toothbrush in his teeth

Can Bubby's medications be given to him orally?

You would have to ask his doctor.

I don't know what that is.

The is incorrect based on previous case history and/or the

Hi, I'm Mary Bell. I am the speech-language pathologist who

I completed his intervention progress report earlier this week

Bubby continues to prefer crunchy food items over any other

He has gradually been accepting more food and drink by

The is incorrect based on previous case history and/or the

When I first started working with Bubby for feeding treatment

Bubby accepts thin liquids. He does not use any thickening

The is incorrect based on previous case history and/or the

Bubby's grandma is usually the one who brings him to his

When given a choice between 2 items he will reach towards

That is a question his medical team needs to determine with

Written narrative development has not been a focus during

The is incorrect based on previous case history and/or the

I'm Sara Hayden, Bubby's classroom teacher.

Yes, um beginning of school he was not ah eating foods, table

The is incorrect based on previous case history and/or the

1 hours 12 minutes 52 seconds

1 hours 13 minutes 18 seconds

Results: Goal was achieved. Bubby is able to drink thin liquid

Oral Motor Kit

1 hours 13 minutes 33 seconds

Results: Enter notes in the clipboard after viewing Bubby's

This selection is incorrect based on your client’s age or plan

1 hours 13 minutes 52 seconds

1 hours 35 minutes 24 seconds

1 hours 36 minutes 18 seconds

Results: Inappropriate for client referral.

This selection is incorrect based on your client’s age or plan

Results: Enter notes in the clipboard after viewing Bubby's

Results: Inappropriate for client referral.