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Ms.

AnetteBasile
3805WandaLynnDrive
Metairie,LA70002

Re:
MaryNelsonWade
StudentClinician:MaggieDyer,B.S.
DOB:2/3/48

Supervisor:MeherBanajee,Ph.D.
Age:668

DateofEvaluation:11/13/14
Telephone:
(504)4002649

LengthofEvaluation:1.5hours

Diagnosis:ALSwithfrontotemporaldementia

ICD:335.2,331.19

I.CURRENTCOMMUNICATIONIMPAIRMENT

A.GeneralStatements

MaryNelsonWade
wasseenforanevaluationatLSUHealthSciencesCenter
SpeechLanguageCliniconNovember13,2014.BarbaraMazzanti,CCCSLPattheVA
Hospital,recommendedthatshebeevaluatedforaspeechgeneratingdevice(SGD)toaidin
hercommunicationneeds.AccordingtoMs.Mazzantisnotes,
Mary
wasdiagnosedwithmotor
neurondisease,specifically,amyotrophiclateralsclerosis(ALS)withconcomitantright
frontotemporaldementia.Afterthecompletionofthepresentevaluation,itwasrecommended
that
Mary
usethe
TobiiI12
forfunctionalcommunicationneeds.

B.AnticipatedCourseofImpairment

AnnetteBasile,Marys
daughter,reportedthatin2012shenoticedchangesinher
mothersbehavioraftershemovedinwiththefamilytocarefornewborntwingrandchildren.
Mary

sawaneurologistandwasdiagnosedwithALSandmotorneurondisease.Further
genetictestingrevealedadiagnosisofrightfrontotemporaldementiaaswell.(Extensivenotes
canbefoundwithDr.England,LSUHSC.)Itwasreportedthat
Mary
sfatherdiedof
dementialikedisease,andhersisterpassedatage58fromALS.Ms.Mazzanti,CCCSLPof
theVAhospitalreportedonOctober23,2014,that
Mary
scommunicationislimited.Herverbal
outputconsistedofyesornoresponsesonlywhenpromptedandthatherdaughterprimarily
communicatedforher.
Ms.Basile
alsoreportedthathermotherhaswordfindingdifficulties
likelyattributedtothedementia.Motorskillsforupperextremitiesaregood.Amodifiedbarium
swallowstudywasadministeredinOctober,andthepatientisonanadapteddietofsoftfoods
andthinliquids.
Mary
residesinassistedliving,andusesawalker,buthasfrequentlyfallen.
Sherecentlyacquiredamotorizedwheelchair.Sheisacurrentsmoker,oftenwanderingoutat
nighttosmoke.Herdaughterisseekingoutnursinghomefacilitiesforhermothertopossibly
moveintoformoreintensivecare.

II.ComprehensiveAssessment

A.

Hearing

Mary
hasnohearingimpairmentsthatwerereportedorobservedduringtheevaluation.
InformalobservationoffunctionallisteningperformanceduringtheSGDassessmentrevealed
thatsherequirednomodificationsregardingauditoryoutputtouseaSGDeffectively.She
attendedandrespondedtoauditoryinformationpresentedatnormalconversationloudness
level.

B.

Vision

Noproblemswithvisionwerenotedhowever
Mary
wasobservedwearingprescribed
eyeglasses.InformalobservationoffunctionalvisualperformanceduringtheSGDassessment
revealedthat
Mary
requirednomodificationstouseaSGDeffectively,givenhercurrentvision
status.

GrossMotor

Marys
grossmotorskillswereobservedatthetimeofevaluation.Shearrivedtotheclinicina
poweredwheelchairtherefore,awheelchairmountingsystemwillberequiredtotransporther
SGD.Arollingfloormountisalsorecommendedsothatthedevicemaybeaccessedfromher
bedside.

FineMotor

Marys
finemotorskillswereobservedthroughouttheevaluation.Shedemonstratedthe
abilitytoaccessthelocationsontheSGDwithoutdifficultyusingherpointerfingeranddirect
selection.ShepossessedthephysicalabilitiestoeffectivelyuseanSGD.

C.

Language

InformalEvaluation

Marys
languageskillswereinformallyevaluatedduringthesession.AsreportedinMs.
Mazzantisnotesandviaherdaughter,
Mary
hadlimitedexpressiveskillsandhaddifficultywith
verbalexpression.WhenSGDswerepresented,sheeffectivelyusedeachonetocommunicate
wantsandneedsbyaccessingthecorrectsymbolsafterreceivingminimalpromptingand
modelingfromtheclinician.SGDsexploredwerethe
Accent1200
(
PrenkeRomichCompany)
,
the
TouchTalk(Lingraphica)
,theiPad(Apple)usingthe
Compass
application
(Dynavox
),and
the
TobiiI12(TobiiTechnology).

FormalEvaluation

The
MiniMentalStateExam(MMSE,adapted)
wasadministeredatthetimeof
evaluation.TheMMSEisaseriesofquestionsandtestsofwhichpointsaregivenifanswered
correctlywithamaximumof30pointspossible.Cliniciansusethisevaluationtoassessthe
progressionandseverityofdementia.Theexamwasadaptedfor
Mary
topointat
multiplechoiceanswersandawritingportionoftheexamwasomittedforatotalof28possible
points.
Mary
scored26pointstotal,whichindicatedshewaswithinnormallimits.

D.

OralMechanism:

Anoralmechanismexaminationwascompleted.
Marys
lipsweresymmetricalandthe
upperlipwasofnormallength.Bothlipstouchedwhentheteethwereinocclusion.She
protrudedandretractedherlipsnormally.Hertonguesizewaswithinnormallimitsinrelationto
dentalarches.Sheprotruded,elevated,andlateralizedhertongue.Anormalocclusion(class1
neutrocclusion),inwhichtheteethandjawwerealigned,wasobserved.Dentalhygienewas
good.

Thevelopharyngealmechanismwasapinkishcolorwithaveragepalatalvaultingand
adequateclosure.

Withinthenasalcavity,theseptumandcolumellaappearednormal.Thesizeofher
nostrilswasaverageandnoobviousnasalobstructionswerepresent.

PreviousoralmechanismreportsfromMs.Mazzanti,CCCSLP,indicatethat
Mary
ison
amodifieddietofthinliquidsandsoftfoods.

Diadochokinesiswasattemptedbut
Mary
wasunabletosustainanyrepetitions.

E.

CognitiveSkills

Marys
cognitiveskillswereinformallyobservedduringtheevaluation.Shefollowed
singlestepdirectionsandwasobservedtobealertandcooperativethroughoutthesession.
Duringthisevaluation,herattention,memoryandproblemsolvingskillsappearedfunctionalto
learntouseanSGDsuccessfullyasdemonstratedbyusingthe
Accent1200,TouchTalk,a
nd
Compass
torequestsomethingtoeat,expressherlikesanddislikes,andtoidentifyher
daughter,sonandgrandchildren.Basedonherperformanceduringtheevaluation,
Mary
demonstratedthenecessarycognitiveabilities(i.e.attention,memory,andproblemsolving
skills)tolearntouseaSGDtoachievefunctionalcommunicationgoals.

III.DAILYCOMMUNICATIONNEEDS

A.
SpecificDailyCommunicationNeeds

Marys
abilitytocommunicateislimitedtosomeverbalexpressionsandislargelycomprisedof
gestures.Sheneedstofunctionallycommunicatewithherfamilymembers,caregivers,peers,
andothersinlife.Itwasimportantthatsheexpressedherneedsandwants,maderequests,
andgaveresponsestoaidinfunctionalcommunication.

B.
AbilitytoMeetCommunicationNeedswithNonSGDTreatment

Marys
dailyfunctionalcommunicationneedscannotbemetusingnaturalcommunication
methods.Duetoherlimitedverbaloutput,sheprimarilyreliesongesturingtoobtainherwants
andneeds.Furthermore,itwasdifficultforbothfamiliarandunfamiliarlistenerstoobtaina
completeunderstandingof
Marys
verbalattempts.Itwasofhighimportancethatshe
communicatedherwantsandneedsinallenvironments,daytodayactivities,andduring
emergencies.Shealsoneededtoparticipateindecisionmaking,tellstories,engagein
conversation,askquestions,respondtoquestions,andmakemedicalcomplaintsandgive
medicalreportsaboutherself.

Itwouldbein
Marys
bestinteresttoobtainadevicesothatsheisnotleftunableto
communicateherwants,needs,andideasincludingmedicalandemergencyinformation.
Mary
wasinapoweredwheelchairthereforeshewouldneedadurableandportableSGDdevicethat
canbetransportedinallenvironmentsandmeetfunctionalcommunicationgoalsduringalldaily
lifeactivitiesandemergencymedicalsituations.

IV.FUNCTIONALCOMMUNICATIONGOALS

UponreceiptofanSGD,therapywilltargetthefollowinggoals.

Mary
will:

Goal1:UseanAACdevicetouseappropriatepragmaticskills:
Objective1:

Mary
willuseanAACdevicetoinitiateanactivitywhilecommunicatingwith
avarietyofcommunicationpartnerswithinsixmonths.

Objective2
:
Mary
willuseanAACdevicetotaketurnsinteractingwithavarietyof
communicationpartnersbycombiningtwosymbolsonherdevicewithinsixmonths.

Objective3:

Mary
willuseanAACdevicetoterminateanactivitywithinsixmonths.

Goal2:UseanAACdevicetoexpressmedicalemergencysituationsorhealthrelated
informationindependentlytoanunfamiliarlistenerwithinsixmonths.
Objective1:
Mary
willuseanAACdevicetoindicatemedicalwantsandneeds
independentlytoanunfamiliarlistenerwithinsixmonths.
Objective2:

Mary
willuseanAACdevicetoexpressemotionsindependentlytofamiliar
andunfamiliarlistenerwithinthenextsixmonths.

V.RATIONALEFORDEVICE

Basedontheabovecomprehensiveassessment,dailycommunicationneeds,andfunctional
communicationgoals,
Mary
requiresaSGDwiththefollowingfeatures:

A.GeneralFeaturesofRecommendedSGDandAccessories

Basedontheabovecomprehensiveassessment,dailycommunicationneeds,andfunctional
communicationgoals,
Mary
requiresaSGDwiththefollowingfeatures:

Input/MessageCharacteristicFeatures:

Visualword/picturesymboldisplays
Dynamictouchscreen/directselectionandencodingusingmultimeaningicons
Builtingazetechnology

OutputFeatures

Synthesizedvoiceoutput

OtherFeatures:

Durableandportable

Minimumbatterytime5hourstoinsureavailability

Accessories:

Carryingcasesodevicecanbetransportedsafelyandindependently

Wheelchairmount

Rollingfloormount

C.

TrialwithSGDs

Mary
participatedina90minuteevaluationtoformallyassesstheuseofa
communicationdevice.ShewasintroducedtofourSGDs,whichofferword/picturedisplaysand
voiceoutput.

TobiiI12TobiiI12

isanSGDthatenableseffectivecommunicationinallformsfromvoice
output,environmentalcontrolandcomputeraccess,tolongdistancecommunication
.
Itcanbe
controlledmanuallybytouch,orthroughgazeinteractionviaabuiltineyetracker.Thisfeature
ishighlydesirablegiven
Marys
diagnosisofALS,andsheexpressedthatshewantedthis
option.Whengivenamodel,
Mary
wasabletoaccess,viaeyegaze,socialexpressions(How
areyou?)andrequestactivitiessuchasshopping.Further,thisSGDusesacombinationof
coreandfringevocabularyalongwithpicturesforcommunication.Thiswasidealasthepictures
canbeprogrammedfor
Marys
specificneeds.Shealsoaccessedpicturesmoreeasilythan
words.Thisdevicewasalsoaprimechoicefor
Marys
usewithinanassistedlivingcenter.Ithas
analwaysonfeatureallowinghertoaccessitatalltimes.Further,
Mary
indicatedthatthiswas
thedeviceshemostwantedtouse.ItwasrecommendedthatMaryacquirethisdeviceforher
dailycommunicationneeds.

Accent1200Accent1200
usesacombinationofcoreandfringevocabularyfeaturingthe
Unitylanguagesysteminmultipledisplayconfigurationsettings.Whengivenaprompt,
Mary
demonstratedtheabilitytousethe
Accent1200
toexpresshername,requestdinnerand
breakfast,stateherlikes(music,reading,TV),andaccessnamesofherfamilymembersand
caregivers.Despitethe
Accent1200
havingeyegazecapability,becauseitdoesnothave
environmentalcontrols,itwasnotrecommended.

TouchTalk(Lingraphica)

TouchTalk(Lingraphica)i
sacommunicationdevicethatis
tabletstyleanddesignedforanonthegolifestyle.Whengivenaprompt,
Mary
wasableto
accesstheaboutmeandexpressherpreviousprofessionasanarmynurseandidentifyher
favoriteTVshow,N.C.I.S.ThisSGDdoesnothaveeyegazecapability,andthereforeitwasnot
recommended.

iPadwith
Compass
The
Compass(Dynavox)
applicationisforuseonaniPad.This
applicationallowsonetoengageinconversationswithfastaccesstomessagesthroughTopic
Pages,QuickFiresandQuickPhrases.Whengivenamodel,
Mary
wasabletorequestthatshe
wantedacigarettesheaccessedthekeyboardandspelledhername,Disneyland,andher
daughtersname.Shewasalsoabletoexpressemotions(Imfeelinggood.)BecausetheiPad
isapopulardevice,concernwasexpressedthatitmightbestoleninanassistedlivingsituation,
asitcanbeusedforothermeansbesidescommunication.Also,itdoesnothaveeyegaze
capability.Forthesereasons,thisdevicewasnotrecommended.


C.AACDeviceandAccessoriesRecommendation

BasedonAACdevicetrialsandpatientpreference,itisrecommendedthat
Mary
be
fittedwitha
TobiiI12device
.

D.PatientandFamilySupportofSGD

Mary
attendedtheevaluationwithherdaughterandson.Shewashighlymotivatedand
acceptingofthedevice.

E.PhysicianInvolvementStatement

Acompletereportwillbeforwardedtothetreatingphysician,whowillthenbeaskedto
writeaprescriptionfortherecommendedSGDandaccessories.

VI.TREATMENTPLAN
UponreceiptoftheSGD,itwasrecommendedthat
Mary
receiveAACtherapytoaddressgoals
listedinSectionIVofthisreport.

VII.SIGNATURES/SLPASSURANCEOFFINANCIALINDEPENDENCE

Thespeechlanguagepathologistperformingthisevaluationisnotanemployeeof
Tobii
Technology
anddoesnothaveafinancialrelationshipwiththesupplieroftheSGD.

EvaluatingSLPname:MeherBanajee
ASHACertification#:01025801
StateLicense#:2216

___________________________
______________________________
MeherBanajee,PhD,CCCSLP
MaggieDyer,B.S.
ClinicalSupervisor
GraduateStudentClinician
SpeechLanguagePathology
SpeechLanguagePathology
LSUHSC
LSUHSC