9/13/24, 5:04 PM Transcript

Janet Ramirez

sa214867@atsu.edu

Assessment Results
Client Name: Bubby- Assessment (SLP)

Examination Date: September 13th, 2024

Mode: learning

Case History 100/100

Collaborators 94/100

Hypothesis ✓
Assessments 100/100

Diagnosis 100/100

Recommendations 100/100

Completion Time 2 Minutes

Your Competency Score 99%

Overall Competency Rating

Mastering Competency

Clipboard Contents

Case History
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Reflective (+): 40

Acceptable (0): 15

Rejected (-): 0

Identifying / Family Information

24 seconds
Tell me about your family. Does Bubby have any siblings?

Having me, and then his pawpaw and then his sister Michaela and
his uncle Robert.

31 seconds
What language do you speak in your home?

English.

Areas of Concern

38 seconds
Why are you here today?

Bubby was beaten at 7 months old, which left him with brain
injuries. His development is slow. He's not standing, sitting,
drinking, eating, talking. Of course they tell me it's TBI, so.

42 seconds
What are your goals for Bubby?

I would like to have the G-tube removed.

54 seconds
Is he receiving therapy? If yes, what types of therapy?

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He's receiving PT. They're working on standing and stuff. OT is

working on his left arm. And speech, he's getting speech. And he
gets TBI, I'm not sure what she does with him with that. That's in
the school, yes.

Prenatal / Birth

1 minutes 4 seconds
Were there any complications during labor?

No, normal birth.

1 minutes 8 seconds
How much did Bubby weigh at birth?

It was 5 pounds 9 ounces.

Developmental

1 minutes 16 seconds
Describe Bubby before the injury.

Bubby was a normal little boy. He was just starting to sit up. He
was so happy, always happy, always. I mean he was-- loved his
sister, they done a lot together. Bubby was a real good kid when he
was small.

1 minutes 25 seconds
Is Bubby able to hold his head upright? If yes, please tell me more.

Ah, he does. And when he gets tired, he drops it.

1 minutes 29 seconds
How does Bubby get around?

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He commando crawls.

Hearing / Vision

1 minutes 38 seconds
Does Bubby have a history of ear infections and/or hearing
problems?

I don't know.

1 minutes 40 seconds
Does he have any visual impairments?

Yes, he, his left eye, he's blind in his left eye.

Medical

1 minutes 46 seconds
Please describe his present health.

Healthy.

1 minutes 48 seconds
Does Bubby have any ongoing medical conditions?

Not really, I mean he's coming along pretty good.

1 minutes 51 seconds
How is Bubby's weight?

He weighs 44 pounds.

1 minutes 54 seconds
Does he take any regular medications?
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Yes, he does. He's taking Baclofen. It's a muscle relaxer to help him
with his left arm and his legs.

1 minutes 59 seconds
Does Bubby have any allergies?

No.

2 minutes 4 seconds
Has Bubby had any surgeries?

He had brain surgery. They had to go in and remove part of his

skull from where he had head trauma. And he had a G-tube put in
while he was in the hospital. He had his esophagus and stuff in
here tied off because he had acid reflux real bad. He had, his right
hip was set wrong and it grew out of socket, so they had, Shriner's
had to go in and reshave his bones and put his hip back in and put
him in a body cast for sixteen weeks.

2 minutes 51 seconds
Does Bubby have a history of frequent respiratory illness such as
pneumonia?

No.

2 minutes 54 seconds
Does Bubby see any medical specialists?

He sees a neurologist for Botox.

2 minutes 58 seconds
Does Bubby have regular bowel movements?

Pretty regular.

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Educational

3 minutes 3 seconds
Tell me about his school experience.

He's doing pretty good in school. They got him on like an eighteen-
to twenty-four-month level. He's learned quite a bit since he's been
in school around other kids. He enjoys it. He comes home excited.

3 minutes 6 seconds
Does he receive therapy services at school?

Yes, he does.

3 minutes 8 seconds
Does he have an Individualized Education Plan (IEP)?

Yes, he does.

3 minutes 11 seconds
Are you concerned with Bubby's eating at school?

Yeah, I pretty much know when he ain't had enough to eat when
he comes home wanting a bite.

Feeding / Swallowing

3 minutes 25 seconds
Was Bubby drinking from a bottle and starting to eat cereal prior
to the injury?

Yeah, he was eating cereal. Actually, he was also drinking out of a

cup.

3 minutes 27 seconds

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How is Bubby currently getting his nutrition?

Through a G-tube.

3 minutes 31 seconds
How long has he had a G-tube?

He was almost 8 months old when he had the G-tube put in.

3 minutes 34 seconds
How much nutrition do you give him through his G-tube?

He gets eight ounces, three times a day.

3 minutes 39 seconds
What types of liquid do you give him through his G-tube?

That's with Pediasure. Well then, he gets sixteen ounces of water in

between.

3 minutes 45 seconds
How much does Bubby drink by mouth currently?

Nothing.

3 minutes 55 seconds
What happens if you try to give him liquids by mouth?

He turns his head.

4 minutes 12 seconds
Describe what Bubby is eating and drinking at this time.

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If you give him a Goldfish, he'll eat it. As long as it's crunchy, he'll
eat it. But he won't eat nothing else.

4 minutes 15 seconds
What are Bubby's favorite foods?

There're tortilla chips, Goldfish, animal crackers. As long as it's

crunchy, he'll eat it.

4 minutes 17 seconds
Are there specific foods that Bubby refuses to eat?

Yes, quite a few. Like I said, if it ain't crunchy, he won't eat it.

4 minutes 25 seconds
What is Bubby's response to you if you try to feed him foods that
are not crunchy?

He just turns his head.

4 minutes 27 seconds
Have you noticed if Bubby prefers food a certain temperature?

He will eat nothing cold. He'll eat it lukewarm, but nothing hot.

4 minutes 29 seconds
Does he gag when eating?

No.

4 minutes 31 seconds
How is Bubby positioned when you feed him?

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Sitting up.

4 minutes 33 seconds
Does he use utensils or accept food presentations from a utensil?

A spoon. He won't eat from a spoon. I keep trying, he just clams his
mouth up and turns his head.

4 minutes 35 seconds
Can Bubby feed himself?

No, he plays with it.

4 minutes 39 seconds
Does he ever throw food or play with his food?

Yes he throws it, I mean he plays in it.

4 minutes 41 seconds
Does Bubby chew on items or bring things to his mouth often?

Just has a chewing fetish. He likes to chew. Anything you put in his
hand, he chews it up.

4 minutes 43 seconds
Does he grind his teeth while awake or asleep?

Yes, he does.

6 minutes 30 seconds
Is eating a positive or negative experience?

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Positive.

6 minutes 33 seconds
Have you been encouraging Bubby to eat and drink more?

Yes, plus I try to push him eating through his mouth with
breakfast, lunch, and dinner, and having no luck with it.

Speech, Fluency, and Voice

4 minutes 51 seconds
Describe the sounds that Bubby makes.

He likes to repeat. He can say "hi," "bye."

Language / Literacy

5 minutes 11 seconds
How does Bubby communicate with you?

He nods his head yes or no. And when he does something wrong,
he knows he does it, and he tells me "no," and I tell him that's not
nice.

5 minutes 13 seconds
What would you like for Bubby to communicate with you?

I'd like to see him talk like a normal little kid.

5 minutes 27 seconds
Has he used a communication system or pictures to help him
communicate?

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Yeah, I'd like to find some kind of switchboard that he can operate
to let me know, you know, when he's hurting or when he wants
something.

5 minutes 33 seconds
Does Bubby respond to you if you ask him to stop or tell him no?

He does both.

Social / Behavioral

5 minutes 42 seconds
What is the best part of your day with Bubby?

All day long.

5 minutes 47 seconds
What is the most challenging part of your day with Bubby?

Getting him to sit up.

5 minutes 49 seconds
What does Bubby like to play with?

Anything.

5 minutes 51 seconds
Is there anything he doesn't like?

No.

Collaborators

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Reflective (+): 16

Acceptable (0): 16

Rejected (-): 0

Medical

6 minutes 45 seconds
You contact the Pediatrician

Hello, I'm Bubby's pediatrician. As you know, Bubby's had a

complicated medical history as a result of the nonaccidental
traumatic brain injury he sustained when he was an infant. I'll send
you pertinent medical reports from his hospital admission,
neurology clinic notes, and evaluations to your clipboard.

6 minutes 52 seconds
How old was Bubby at the time of his traumatic brain injury (TBI)?

Seven months old.

6 minutes 56 seconds
What was Bubby's diagnosis?

After an extensive workup, it was determined that he sustained a

nonaccidental trauma. He had multiple fractures, bruises, subdural
hematoma, retinal hemorrhage and seizures. He required hip
surgery, which resulted in Bubby wearing a full-body cast.

6 minutes 59 seconds
Describe Bubby's history with feeding.

Following his TBI, it was determined that he was aspirating without

a cough reflex. Since he was unsafe to eat orally, a G-tube was
placed when he was 9 months old, and he was NPO. Oral feeding
was never a top priority as he had many other medical problems
to manage. In the past two years, he started taking a few things by

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mouth. I know his family is eager to get him orally fed, and their
hope is to someday remove his G-tube.

7 minutes 2 seconds
Anything else to note?

Yes, his vision was impacted by the trauma. I recommend

consulting with the vision teacher prior to evaluating Bubby.

7 minutes 6 seconds
Does Bubby take any medications?

Bubby gets all of his medication via his G-tube. He's currently
taking baclofen and Maalox. Previously, he was also taking Keppra,
renadine, and lactulose PRN.

Educational

7 minutes 47 seconds
You contact the Vision Teacher

Hello, I'm Sara Brown. I'm a vision specialist who works with
Bubby. I have a copy of his most recent ophthalmology report that
I will send to your clipboard.

7 minutes 53 seconds
What are you working on with Bubby?

I have been working on visual training with emphasis on his right

eye. He is working on visual attention or the ability to focus on
specific visual information while filtering out unnecessary
information.

7 minutes 58 seconds
What suggestions do you have for best evaluating Bubby?

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Always remember to take his visual deficits into consideration

when you are working with and evaluating Bubby. If you are
approaching Bubby, try to approach him from his right side so he
is aware of your presence. If you are presenting him items,
remember to present them from his right side to give him the
optimal opportunity to see and experience what you are
presenting. He may tire easily and require short breaks between
activities.

8 minutes 3 seconds
What types of adaptations have you made to Bubby's everyday
activities?

I try to make Bubby's experiences concrete or interactive. I pick

objects of interest. I take the classroom lighting into consideration
and avoid glare while working with Bubby. I make every attempt to
work with Bubby in a quieter area away from the noise of the
classroom.

8 minutes 10 seconds
You contact the Special Education Teacher

I'm Sara Hayden, Bubby's classroom teacher. I have a copy of his

IEP which I'll send to your clipboard.

8 minutes 12 seconds
Describe Bubby's typical morning school schedule.

Well, when he arrives at school, we tour our classroom. And we do

circle time. Well, first we do a little bit of table time, working on
letters, and then we go to circle time. And I have other students in
my classroom that are at circle time from another special ed
classroom because that's when the other teacher has her
planning. So we do circle time, we do music, we do, they call it
brain exercises where we get up and we move around a little bit
with some music. Bubby loves music. Then we have our, we start
our rotations at about 9:15; in between there, he goes to the
bathroom. The classroom aides take him to the bathroom. You
know if he needs changed, we change him. Then we have, first
thing he goes to is the computer, and then he goes to the table
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where he's putting blocks in and out of the box. Then he comes to
me for one-on-one classroom work. I work with him on his speech
with his, we didn't have his device at the beginning of school so we
were just using pictures, picture cards where I would ask him,
"Where's the dog?" And he'd have two pictures down where he'd
have to touch the picture. Beginning of school, he was not
touching anything. He would pick up a picture, but he'd want to
put it in his mouth. So then we had to work on that. Also, I would
work on his letters of his name for him to recognize his name and
kinda made up a little tune to B-I-N-G-O Bingo is your name, that
little song. Instead of saying the dog, I would say, "Mommy has a
boy, his name is Bubby." And we would sing B-U-B-B-Y and go
through that. So that's what I worked on all school year.

8 minutes 27 seconds
Describe his typical afternoon school schedule.

Then after lunch, we would have recess. And during recess in the
winter time, we would just get him out of his chair, put him on the
floor, and give him blocks to play with. He has his musical thing
where he had to use his hands to move it around to make music.
So we would do that. Then when spring come, we would take him
outside and have him swing in the handicap swing. Then after that,
we would do table time where we'd come back to the table and
we'd do math, then I would do my planning then. He would go to
another special ed classroom with other students and they, she
did a little bit of math things with him, blocks, counting. Then he
would go to pull out with his regular students. And you know one
day he would have gym, one day he would have music, one day he
would have swimming, one day he would have technology, and
then he would come back to classroom and it was snack time, and
of course, he loves chips so snack time was his favorite because he
would get chips during snack time. And his grandmother provided
him snacks. And then it was time to go home.

8 minutes 32 seconds
What does Bubby enjoy doing at school?

Going in the swing. He enjoys it and there are times he fallen

asleep in the swing, it calms him that much. And I think it was good
because he's so rigid and stiff that the swing kind of comfort him
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and, you know, relaxed his body so you know he sat up very well in
the swing.

8 minutes 36 seconds
What are Bubby's educational goals?

Well, we are working on counting and recognizing his name, saying

his name, his full name, you know. If he would, if something would
happen and he would be lost, his phone number. Just a lot of
functional skills is what I'm going by for goals.

8 minutes 40 seconds
Describe how Bubby communicates with you.

Speaking. The speech therapist is now working with him on a talk

device for his wants. So we're working on that now.

8 minutes 46 seconds
What is the most challenging part of school for Bubby?

I think everything is challenging for him because of his disability,

but like I said, he's made lots of progress. And the principal had
used me in one of their data team meetings because she said I had
high expectations for my students, and I feel I do have high
expectations because I feel everyone can learn and take care of
themselves.

8 minutes 49 seconds
What strategies have you used to help him?

Singing. He loves music.

8 minutes 56 seconds
Are there other professionals who work with Bubby at school?

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He has lots of different people. There's like five different regular ed

teachers that work with him. We have, I have two classroom aides,
a classroom aide that's part-time that works with him, a physical
therapist, an occupational therapist, speech therapist, the TBI
teacher, and then the vision teacher.

8 minutes 59 seconds
Describe how Bubby interacts with his peers.

He'll say, "Hi." He'll high five 'em or shake their hands.

9 minutes 1 seconds
Describe how Bubby eats at school. Is eating easy or challenging
for him?

He does have a tough time eating. The only thing that he does eat:
crunchy foods. So that is a challenge to get him to eat other foods
beside crunchy foods.

9 minutes 6 seconds
Who is the primary feeder at school?

I am. I've worked with severely handicapped children. So it's been a

challenge, but it's been a good challenge. We've seen lots of
progress, the principal of the school has seen progress. She comes
in the cafeteria. The cooks in the cafeteria--because when I first
started feeding him I'd say, "Can you kind of crunch up that food
for me?" They were really helpful with french fries, whatever they
could you know make harder, they did for me. So that was a big
challenge. But everyone in the school building can see his
progress, especially in his feeding.

9 minutes 10 seconds
Where does he eat when he is at school?

That was in the cafeteria with other classmates, other students in

the school building. Bubby is very well known in our school
building. Beginning of school, he wasn't so much into speaking to
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everyone that would walk by, but by the end of the school year, he
has learned to say, "Hi." And we now have him shaking the
students' hands instead of pulling on them, cause he would pull at
them.

9 minutes 14 seconds
Do you ever feed him through his G-tube?

No. Beginning of school his grandmother said she did not want us
to feed tube him. That she wanted him to start eating. It was a
challenge because he was not drinking at all from a straw or
drinking from a cup. So we were kind of worried at the beginning
of school not giving him his feeding out of his tube because we
didn't feel he was getting enough nutrition. So by the end of the
day, he would probably eat two or three bags of chips at snack
time because I felt he needed it. But yeah, it's very challenging.

9 minutes 17 seconds
Does Bubby ever cough or choke when you are feeding him?

No.

9 minutes 50 seconds
Does Bubby communicate when he wants to eat or if he is hungry?

He'll say, "eat," "bite."

9 minutes 53 seconds
Describe how Bubby tells you if he's full or doesn't want to eat.

He'll start spitting it out.

9 minutes 55 seconds
Does he have any favorite foods?

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Yes, anything crunchy is his favorite food.

9 minutes 59 seconds
How do you know when Bubby likes a food?

Well, he eats a lot of it, and just continues eating it and says, "Bite,
bite." He continues saying the word bite and he'll say, "Eat."

10 minutes 1 seconds
What are his least favorite foods?

Anything that's slimy. And he doesn't mind getting his hands dirty, I
don't think, it's just the texture of the slimy foods, he does not like
it.

10 minutes 5 seconds
How do you know when he doesn't like a food?

He'll spit it out and he'll push it away.

10 minutes 8 seconds
How much does he typically eat at lunch?

Well, the beginning of school, like I say, he didn't hardly eat

anything at lunch time. Now, I have him eating a little bit.

Hypothesis
Hypothesis #1

16 minutes 38 seconds
.

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Assessments
Augmentative and Alternative Communication

10 minutes 45 seconds
Functional Communication Profile- Revised Non-Oral
Communication Subtest

Dysphagia

10 minutes 59 seconds
Clinical Swallow Assessment: Part 1

11 minutes 15 seconds
Clinical Swallow Assessment: Part 2

Oral Peripheral

12 minutes 16 seconds
Oral Mech-Pediatric

Receptive Language

12 minutes 23 seconds
Functional Communication Profile- Revised Receptive Language
Subtest

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Expressive Language

12 minutes 46 seconds
Functional Communication Profile- Revised Expressive Language
Subtest

Diagnosis
AAC/ Augmentative Communication

10 seconds
Augmentative/Alternative Communication

Cognition/ Executive Function

15 seconds
Severe Cognitive Impairment

Attention/ Behavioral

34 seconds
Acquired Attention Deficits

Dysphagia/ Feeding

44 seconds
Dysphagia-Oral Phase

53 seconds

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Dysphagia-Pharyngeal Phase

57 seconds
Feeding Difficulties

Language

1 minutes 4 seconds
Expressive Language

1 minutes 11 seconds
Receptive Language

Neurological

1 minutes 54 seconds
Traumatic Brain Injury

Recommendations
Recommendations

32 minutes 30 seconds
Client qualifies for services. Recommend targeting with Bubby an
increase of intake of liquid consistencies, further development of
rotary chewing, and expanded acceptance of food consistencies.
Also target comprehension of one-step directions, and
recommend collaboration with school speech-language pathologist
and family to establish a functional communication system.
Recommend close supervision with feeding and drinking and
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continued monitoring of respiratory status as Bubby accepts larger

volumes of food and drink. Recommend referral to dietitian to
ensure Bubby maintains adequate nutrition. Recommend
continued follow-up with vision teacher and audiologist.

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