Texas Woman’s University

The Stroke Center-Dallas

Speech Language Evaluation
Date: 06/07/2018

Last Name: Borders First Name: Gerlad

Address: 7635 Oak Garden Trail
Telephone: 469-831-1170 Email: Kimco2000@gmail.com
DOB: 11/13/1945 Age: 72 Handedness: Right
Education: BA Occupation: Retired
Medical Diagnosis/ICD-10: Aphasia as late effect of cerebrovascular accident I69.320
Onset Date: 07/11/2018
ST Diagnosis/ICD-10: ICD-10: Developmental Moderate Wernicke's aphasia F80.2
Compounding Deficits: N/A
Relevant Medical History: CVA due to CHF. Patient has hypertension. Patient smoked 1 pack
a day into his 60’s but quit 10 years ago. Patient has a pacemaker.
Prior Level of Functioning: Independent in communication and activities of daily living
Rehab History: Baylor, Scott and White (02/07/18-05/27/18), UT Southwestern TWU Stoke
Center (06/07/2018-03/18/2020)
Presence/Side of Hemiplegia: N/A Motor Status: Ambulatory
Prescription/Non-Prescription Medicine and Dosages: Eliquis (bid), Potassium, Atorvastatin,
Entresto, Carvedilol
Patient’s Goals: Able to read the Bible, recognize time/dosage of medication, conversation
comprehension
Precautions: N/A
Tests Administered: Western Aphasia Battery - Revised, Cranial Nerve Assessment, Oral
Speech Mechanism Screening Exam (OSME-3), Edinburgh Handedness Inventory, Bedside
Swallow Screening, and Hearing Screening

Auditory Comprehension, NOMS 3 Score

Y/N Questions 45/60

One-Step Directions 6/6

Two-Step Directions 8/40

Three-Four Step Directions 10/34

Word Discrimination 53/60

Comments: Mr. Borders was able to follow simple, 1-step directions, but demonstrated
difficulty performing two-step commands or greater. He also showed strength in word
discrimination, but difficulty in identifying the right and left sides of the body.

Writing, NOMS 2 Score

Writing Upon Request 3.5/6

Writing Output 0/34

Writing to Dictation 1/10

Alphabet/Numbers 14/22.5

Dictated Alphabet/Numbers 4,5/7.5

Copying a Sentence 5/10

Comments: Mr. Borders show significant difficulty with written expression, both in
writing to dictation and in copying sentences. Spontaneous writing is present but is not at
sentence level.

Verbal Expression, NOMS 3 Score

Information Content 6/10

Spontaneous Speech Tasks 6/10

Repetition 49/100

Naming 17/60

Word Fluency 2/20

Sentence Completion 8/10

Responsive Speech 7/10

Comments: Mr. Borders demonstrates difficulties with comprehension which interfere

with his expression. He was only able to identify 4 items out of 20 without a cue, and
only able to identify 5 of the remaining 16 even with a cue, demonstrating significant
word finding abilities and difficulty with comprehension. He shows strength in fluent
verbal expression, responses and sentence completion.

Reading, NOMS 4 Score

Comprehension of Sentences 34/40

Reading Commands 13/20

Written Word-Object Matching 6/6

Written Word-Picture Matching 6/6

Picture-Written Word Matching 6/6

Spoken Word-Written Matching 4/4

Letter Discrimination 6/6

Spelled Word Recognition 0/6

Spelling 4/6

Comments: Mr. Borders showed outstanding strength in reading

comprehension, scoring very well on nearly all sections. He had some
difficulty with recognizing spelled words and with reading commands, but
appeared to have far greater reading comprehension than spoken verbal
comprehension.

Speech/Voice NOMS Score

Motor Speech 7

Fluency 4

Prosody WNL

Voice 7

Speech Intelligibility 100%

Comments: Mr. Border’s fluency is variable with inconsistent performance with
confrontational naming. Semantic paraphasia is still evident

Cognition NOMS Score

Attention DNA

Judgment DNA

Memory DNA

Organization DNA

Orientation x1

Problem Solving DNA

Pragmatics DNA

Comments: Cognition was not formally assessed during this evaluation.

Constructional, Visuospatial, and Calculation Score

Drawing 20/30

Block Design 0/9

Calculation 6/24

Ravens 6/37

Comments: Mr. Border’s drawing skills were relatively strong with many of the pictures
showing depth and detail. Spatial relations and mathematic calculation demonstrate
significant difficulty.

Bedside Swallow Screening, NOMS 7 Pass- X Fail-

Comments: Mr. Borders passed the bedside swallow screening and demonstrated no
signs of distress or aspiration.

Hearing Screen Pass Fail

 Hearing Screen Pass

Comments: Mr. Borders demonstrated Noise Induced Hearing Loss at 4,000 HZ, which
is typical for a man of his age. Otherwise, he passed the hearing screen and there
appeared to be no blockage.

Referral For: Vision _______ Hearing _______ Swallow _______ Other _______

Subjective:

Analysis of Evaluation/Test Scores:

Western Aphasia Battery- Revised (WAB-R)
The Western Aphasia Battery- Revised (WAB-R) is an individually administered test designed to
evaluate a patient’s function following a stroke, dementia, or other acquired neurological
disorder. The WAB-R measures linguistic skills including speech content, fluency, auditory
comprehension, repetition, naming, reading, and writing. The WAB-R also measures non-
linguistic skills including drawing, calculation, block design, and apraxia.
The composite scores obtained from Mr. Border’s performances on the WAB-R were: Aphasia
Quotient (AQ)- 52.8; Language Quotient (LQ)- 56.2; and Cortical Quotient (CQ)- 55.25.
Cranial Nerve Assessment
The Cranial Nerve Assessment is a neurological examination used to identify problems with the
cranial nerves. Cranial Nerve I assesses the client's ability to smell something distinguishable to
determine any damage of the Olfactory nerve. Mr. Borders was able to identify the smell
presented to him.
Cranial Nerve II controls optical function. Mr. Borders was presented with a sentence and asked
to read it. He read it aloud, demonstrating no damage to CN II. Cranial nerve III, IV and VI
assess the client's ability to move his eyes upward, downward and medially, and laterally. Mr.
Borders was able to do so without difficulty. CN controls the feeling nerves of the face. The
clinician used a long cotton swab to touch the client's face, who was able to identify it as such, to
assess CN V. Cranial nerve VII allows control of the facial muscles. Mr. Borders was able to
wrinkle his forehead, pucker, raise his eyebrows and show his teeth, showing no damage to CN
VII. Mr. Borders was able to make velar sounds, cough hard, turn his chin against his hand and
protrude his tongue, ruling out any difficulties with cranial nerves IX, X, XI, and XII,
respectively. Mr. Borders’ hearing screening determined o abnormalities with CN VIII.
Edinburgh Handedness Inventory
The Edinburgh Handedness Inventory is a measurement scale screening tool to objectively
ascertain the handedness of a subject in activities of daily living.
For each of the items, the subject is asked to specify the side they prefer to perform the given
activity. If the preference is for either the left or the right side, then a "+" is marked on the
column for that side. If the preference for a particular side is so strong that one wouldn't use the
other side unless forced, then a "++" is marked on that side. If there is no preference for any side,
then a "+" is marked on both sides. The final score is called the "Laterality Quotient". It is
calculated using the formula: Laterality Quotient = (R-L)/(R+L) X 100. Here, R & L refer to the
total number of "+" marked on the right and left side respectively.
If the LQ is less than -40, the patient is classified as left-handed. Between -40 and +40, the
patient is ambidextrous. A score of more than +40 indicates right-handedness.
Mr. Borders' score of 95 indicated right-handedness.
Oral Speech Mechanism Screening Examination – Third Edition (OSMSE-3)
The Oral Speech Mechanism Screening Examination–Third Edition (OSMSE-3) provides an
efficient, quick, and reliable method to examine the oral speech mechanism of all types of
speech, language, and related disorders where oral structure and function is of concern.
Mr. Borders’ lips, tongue, hard palate, soft palate, velopharyngeal mechanism, breathing and
pharynx were all tested and showed no abnormalities. The jaw and teeth subtest was not
administered as the client has dentures on his maxilla and no teeth on his mandible. No notable
abnormalities of color are present on the tongue surface.
Mr. Borders demonstrates an outstanding diadochokinesis rate. 16 /k^/, /t^/, /p^/, 12 /p^tə/, and 8
/p^təkə/ sounds were produced. /p^/ was produced 1.7 times per second, /t^/ at 2.0, /k^/ at 1.6,
/p^tə/ at 1.2 and 8 /p^təkə/ at an excellent 1 production per second. These cleared the cutoff
scores by a wide margin. 16 /k^/, /t^/, /p^/, 12 /p^tə/, and 8 /p^təkə/ sounds at a typical rate.

Bedside Swallow Screening

Swallowing screening is a minimally invasive procedure that enable quick determination of the
likelihood of dysphagia, with a focus on identifying overt signs of aspiration.
Mr. Borders’s swallow function was within normal limits with no signs of dysphagia or
aspiration.

Communication Effectiveness Inventory (CETI)

The Communication Effectiveness Inventory (CETI) is a rating scale completed by the patient’s
family both before and after speech therapy semester. It utilizes a 10cm visual analog scale
(VAS) that is 10 cm long. The family rates the client’s speech as they see it along a 10cm visual
analog scale by placing a mark between the two choices of “Not Able At All” and “As Able As
Before Stroke”.
Mr. Borders’ spouse, Helen, answered all questions and gave Mr. Borders a CETI score of 36.8.
Most questions were rated between 40 and 50, with strengths in answering yes and no questions,
and weaknesses is describing things in depth, being part of conversations and communicating
physical problems.

Speech/Language Diagnosis: ICD-10: Developmental Moderate Wernicke's aphasia F80.2

Treatment Goals Time

Frame
 SPT Objectives

Long-Term Goal: The client will produce and understand complex sentences to 6 months
improve functional communication skills to communicate with others. 

Verbal Expression: NOMS 3 6 weeks

STO 1: The client will produce sentences containing the correct verb and a verb
argument when presented with an untrained stimulus (Probe 1) with 50%
accuracy.

STO 2: The client will produce a coherent sentence with the correct verb and a 6 weeks
verb agreement with no facilitation after treatment of all target stimuli (Probe 2)
with 60% accuracy.

STO 3: The client will produce coherent sentences containing the correct verb 6 weeks
and two verb arguments, with maximum facilitation with 80% accuracy. 

Auditory Comprehension: 6 weeks

STO 4: The client will verbally answer “wh” questions using stimulus pictures
from the SPT program with moderate facilitation with 60% accuracy.

Written Expression NOMS 3: 6 weeks

STO 5: The client will copy the target verb using stimulus pictures from the SPT
program with moderate facilitation with 60% accuracy.

Reading Comprehension NOMS 3:  6 weeks

STO 6: The client will read the sentence using stimulus pictures from the SPT
program with moderate facilitation with 80% accuracy.

Treatment Plan
Evaluation __________ Language Treatment ___x___ Aug
Com __________ Speech Articulation _______
Cognitive Treatment _________ Voice Treatment ______
Dysphagia Treatment ________ Fluency ______

Rehab Potential: Good _x___ Fair ____ Poor ____

Safety Issues / Instructions / Education: N/A

Comments / Additional Information: N/A

Discharge Plan:
_________ To self-care when goals met
____X_____To self-care when max potential achieved
_________ Other:

Speech / Language Evaluation Comments: None 

Therapist Signature: Date:

Fred Arthur Fisher, B. S. 02/14/2022

Supervisor Name: