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FLUENCY EVALUATION

Name: ------------- DOE: --------------


Address: ---------------------------------------- DOB: ---------------
Age: 15
Phone: -------- Sex: Male

Background Information:
Client is a 15 year old bilingual (English and Korean) male was seen for an initial speech
evaluation on August 30th, 2017. He sought an evaluation due to his inability to control his
speech rate and speech fluency. During the evaluation client participated in motor speech
testing, speech fluency analysis, and completed the OASES.

Medical History:
Clients medical history is reportedly unremarkable for previous hospitalizations, illnesses, and
surgeries. Client has seasonal allergies to pollen for which he takes medication. As well, he is
allergic to Aspirin, and some fruits (peach and kiwi). There was no reported history of
neurological conditions affecting the patient or his family. Additionally, his most recent hearing
examination revealed normal hearing.

Patient Reported Concerns:


Client previously underwent speech therapy for fluency in elementary school, but feels he needs
continued therapy to improve his speech fluency. He states that, at times, people find it difficult
to understand what he saying. He wishes to speak more fluently, and describes his speech goal
as speaking as clearly and eloquently as Hillary Clinton.

Behavioral Observations:
Client presented as polite, friendly, and engaged. The patient, at times, demonstrated reduced
eye contact but otherwise showed appropriate social-pragmatic skills, and remained alert and
attentive throughout all session tasks. Client demonstrated high levels of motivation, as he
consistently provided detailed and honest responses to all questions. Patient showed high
levels of interest when topics involved mystery genre podcasts and fantasy baseball.

Oral Peripheral Examination:


An oral peripheral examination was conducted in order to assess the structural and functional
integrity of the oral motor mechanism. The results of this examination revealed that the speech
mechanism is intact and sufficient for speech production. Clients posture was within normal limits,
and his head was held upright with adequate support from his neck. The range of motion, speed,
and steadiness of the facial, labial, buccal, mandibular, and lingual structures were within
functional limits. The strength and tone of the lingual, labial, buccal, and mandibular structures
were also within functional limits. All of the speech structures demonstrated accurate movement.

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Although, it was noted that there was minor jaw assistance when moving the tongue in an upward
motion.
Motor Speech:
Clients motor speech skills were evaluated through several speech and non-speech tasks to
assess the coordination and integrity of the speech subsystems including respiration,
phonation, resonance, and articulation. The assessment measures and results are described
and interpreted as follows.

Respiration and Phonation:


The integrity of the respiratory and phonatory speech subsystems was assessed through
measurement of the maximum phonation time (MPT) and vocal intensity of sustained
/a/. Client sustained /a/ for an average of 18.67 seconds at approximately 71dB. The duration in
which /a/ was sustained is considered below the average of 25.89 sec. while the intensity in
considered within the normal limits of 70-80 dB (SPL).

Trials Vocal Intensity (dB SPL) Time (sec)

1 71 dB SPL 17 sec

2 70 dB SPL 20 sec

3 69 dB SPL 19 sec

Average 71B SPL 18.67 sec

Norm* 70 - 80 dB SPL 22.6 - 34.6 sec

*Interpretation WNL ONL

KEY: ONL= outside normal limits; WNL= within normal limits


*Source: Duffy, R.J. (2005). Motor Speech Disorders, Substrates, Differential Diagnosis, and
Management (2nd ed.).Missouri: Elsevier Mosby.
Vital Lung Capacity
Respiratory function was further assessed through measurement of forced vital lung capacity
using a Buhl Spirometer. Client demonstrated a maximum vital lung capacity at an average of
3,433 cc, which is outside normal limits for his age and gender (3600 cc).

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Trials Measurements (cc)

1 3400 cc

2 3500 cc

3 3500 cc

Average*: 3433 cc

Norm*: 3600 cc

Interpretation*: ONL

Articulatory Precision:
Diadochokinetic (DDK) measurements were collected to assess the speed, coordination, and
accuracy of clients articulators. DDK rates provide information about an individuals ability to
sequence rapid and precise articulatory movements. Both the patients alternating motion rate
(AMR) and sequential motion rate (SMR) were assessed. The AMR measures yielded results
that were considered within normal limits (WNL), as he produced 5.9 repetitions of /p/ per
second, 6.1 repetitions of /t/ per second, and 5.3 repetitions of /k/ per second. Clients SMR of
/ptk/ was 1.9 repetitions per second, which is outside normal limits (ONL) for his age.

Motion Rate Task Norms* Results Interpretation*

/p/ 5.0-7.1 5.9 WNL

/t/ 4.8-7.1 6.1 WNL

/k/ 4.4-6.4 5.3 WNL

/ptk/ 3.6-7.5 1.9 ONL

KEY: ONL= outside normal limits; WNL= within normal limits


* Source: Duffy, R.J. (2005). Motor Speech Disorders, Substrates, Differential Diagnosis, and
Management (2nd ed.).Missouri: Elsevier Mosby.

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Voice & Resonance:
Perceptually, Clients vocal quality fell within normal limits for his age and gender. Vocal
characteristics including pitch, loudness, resonance, and prosodic intonation were not determined
to be areas of concern.

Stuttering Description:
According to client, his disfluencies occur in both English and Korean. Client's speech was
characterized by moments of rapid speech where multisyllabic words were unclear. At times,
client exhibited part word and whole word repetitions.

Fluency:
Clients speech fluency was assessed through clinical judgment during speech tasks including
conversational discourse and oral reading, as well as through patient interview. Additionally, the
patients overall experience of stuttering, including its impact on his daily life and quality of life,
was assessed through the Overall Assessment of the Speakers Experience of Stuttering
(OASES) and patient report. Stuttering severity was assessed using the Stuttering Severity
Instrument-4 (SSI-4) after transcribing and analyzing both reading and conversational speech.
An oral reading and conversational task was provided to determine clients speech
characteristics in a more structured context. Transcription and analysis of clients reading
showed 0.33% Stuttering-Like Dysfluencies (SLD) (i.e., part word repetitions, single syllable
word repetitions, and dysrhythmic phonations), and 0.67% Other Dysfluencies (OD) (i.e.,
repetitions, abandonments, interjections, and phrase repetitions). Clients dysfluencies
consisted of part-word repetitions and revisions. Conversational speech was transcribed and
analyzed. Analysis of his transcription showed 2.3% SLD and 3.67% OD. Clients dysfluencies
consisted of part-word repetitions, single syllable word repetitions, dysrhythmic phonations,
abandonments, and interjections. At times, client's speech was rapid and his production of
multisyllabic words were not clear; these are signs that are indicative of cluttering.

Results from both reading and conversational speech were used to complete the SSI-4. The
SSI-4 is a reliable and valid norm-referenced stuttering assessment. It measures stuttering
severity in both children and adults in four areas of speech behavior: frequency, duration,
physical concomitants, and naturalness of the individuals speech. Clients frequency of
stuttering during a Reading Task scored a 2, and during Speaking task scored a 3 (Total 5).
Clients longest stuttering moment scored a 2 (Fleeting, .5 sec or less). Throughout the
interview, client presented with minor physical concomitants: noisy breathing, jaw moving
upwards to support the upward movement of tongue, and poor eye contact. These physical
concomitants were given a score of 3. Clients Total score equated to a 10 giving him a
speech scored within the 1-4 percentile, being rated as having very mild dysfluencies.

Stuttering Severity Instrument-4

Subtest Score
Frequency 5
Duration 2
Physical Concomitants 3

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Total Score* 10
Percentile* 1-4
Severity* Very Mild

Subtests of the OASES were administered to determine and describe the impact of clients
dysfluency on his communicative ability and quality of life. The assessment is divided into four
subtests: General Information, Your Reactions to Stuttering, Communication in Daily Situations,
and Quality of Life. The questionnaire contains 100 questions, and responses are indicated
through a 5-point rating scale. It should be noted that the Section IV-Quality of Life of the test
was not completed, and thus the Total Score could not be achieved. Client scored himself in
Section I- General Information with an impact score of 2.7 giving which equates to an impact
rating of Moderate, in Section II-Your Reaction to Stuttering with an impact score of 2.1 which
equates to an impact rating of Mild/Moderate, and scored himself in Section III-Communication
in Daily Situations with an impact score of 1.1 which equates to an impact rating of Mild.

OASES Scoring Summary

Subtest Impact Score Impact Rating

General Information 2.7 Moderate

Your Reactions to Stuttering 2.1 Mild/Moderate

Communication in Daily Situations 1.1 Mild

Summary:
Client, a 15-year-old English and Korean-speaking male, was seen for an initial speech
evaluation at New York Neurogenic Speech Language Pathology, PC. On August 30, 2017. He
and his mother sough an evaluation due to concerns regarding his speech fluency, and its
impact on his communication as he reports that people, at times, have difficulty understanding
him. According to the results of his evaluations, client presents with very mild dysfluent speech,
characterized by rapid speech, and the blending of words together. The patients speech fluency
was assessed during conversational discourse, a brief oral reading task, and through
comprehensive interview. The impact of speech on his daily life was quantitatively measured
and described through the administration of the Overall Assessment of the Speakers
Experience of Stuttering (OASES). Furthermore, oral motor examination revealed structural
and functional integrity of the oral-motor mechanism.

Perceptually, clients speech was predominantly fluent and approximately 96% fluent, with mild
moments of rapid speech. According to patient responses during the interview and assessment
tasks, stuttering behaviors occur in both English and Korea. Client states that he is less fluent
when speaking Korean. According to the results of the OASES, clients dysfluencies has a mild
to moderate impact on his communicative effectiveness and quality of life. His reaction to

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stuttering (i.e., thoughts, feelings, and behaviors) were deemed mild/moderately impacted. Due
to present findings, it is recommended that client receive speech therapy addressing rate of
speech. Prognosis for improvement is good, as client is highly motivated to achieve his goals.

Recommendations:
It is recommended that client receive speech therapy sessions (1-2x weekly) focusing on
controlling the rate of his speech to increase reduce dysfluencies and increase intelligibility.

Therapy should target the following objectives:

1. The patient will identify the 5 aspects of speech (airflow, voicing, tension, timing and
movement) with 80% accuracy and moderate support
2. The patient will utilize a slow rate of speech when reading phrases with 80% accuracy
and moderate support
3. The patient will utilize phrasing and pausing when reading a paragraph with 80%
accuracy and moderate support

Diagnostics Codes:
ICD10: F80.81: Childhood onset fluency disorder
R47.82: Fluency disorder in conditions classified elsewhere
___________________________________________
Marissa A. Barrera Phd, MSCS, CCC-SLP
Owner, New York Neurogenic SLP, PC
Speech-Language Pathologist
ASHA #: 12078921 / State License #: 016751-1
___________________________________________
P. Olivia Goodel, MS, CCC-SLP
New York Neurogenic SLP, PC
ASHA #: 14037214/ State License # 023427

Christopher Donoso, B.S.


Speech-Language Pathology Graduate Clinician, Seton Hall University

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Appendix A
Client Transcription
Client Reading
The talk over salad and fromage was about ghosts (13). My English friend Christopher Neville
informed me that two of them haunt his house in southern France (23), on the sunny terrace of
which we were now having lunch (14). I dont normally believe in spirits, but it seemed wise to
suspend disbelief for the moment, since I would be soon (R) since I would soon be entering a
region of sorcery and hidden Grails (44), where heretics once marched defiantly into the bonfires
of bloodthirsty crusaders: the land of the Cathars (29). Christophers ghosts were said to be
knights from those medieval times (15). I dont know whether he began studying the Mi-Mid E-
Middle (PWR) Ages because of the ghosts or whatever (R) or whether the ghosts arrived one day
(30) because he had taken an unusually keen interest in the Cathars (29). I do know that his
knowledge proved invaluable (13).
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The Cathars, I had read, were a kind and gentle people (14). They were dualists (man is
bad, the spirit is good), they viewed the material world as corrupt (23), and they rejected certain
important tenants of the powerful Catholic Church (20), including priests, the Trinity and the
sacraments (13). The laying on of hands was thought to transform believers into the Perfects or
(20) Good Christians (23), who were from then on expected to abstain from sex and meat (15).
The popularity of this gnostic faith threatened the reign of Pope Innocent III (21). In 1208, he
sent Simon de Montfort (11) on a crusade against the heretics (10). The crusade took its name
from the town of Albi and was founded 25 years later by the Inquisition (28).
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300 Syllables:
Part Single Dysrythmic Revision Abandoned Interjection Phrase
Word Syllable Phonation Rep
Rep Rep
1 0 0 2 0 0 0
%SLD = 1/300 X 100 = 0.33 % SLD
%OD = 2/300 X 100 = 0.67 % OD

Client Conversation

Im trynaa (DP) start ahh (I + DP) fantasy baseball club. Yea (I). Oh (8). Well I- I (SswR)
w- watch (PWR) Money Ball like this past like two months or li-(Ab) I dont remember quite
when, but I watched it sometime this summer and it was pretty cool (35). So, I met another
friend who goes to college and he kinda sh- (Ab) told me that he started a club and its very
analytical and its statistical (38). Um (I) He even told me like the Cubs manager (12), whos now
with the Red Socks, was with the Cubs (10) when they won the World Series, and he perp-
(PWR) purposely (12) like traded undervalued players or something (12). He did some math and
he figured it out, he-hes (PWR) a genius (14). And then he won the World Series, of course,
cause he got the good players (17). And then hes moving teams and they all want him (11). But
its pretty f- (Ab) pretty cool actually ta see that some people just look at baseball (19) by the
numbers instead of by what they hear on the street. Thats pretty cool (18). Yea (I). And Im
plannin tah start a podcast on that, if I can. Yea (I) (16)

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And I think only fantasy football is popular so theres ah (I) definitely an open market for thee
(DP) fantasy baseball (32). But I think baseball has like (I) its own niche (10). But I think
football is more fun because everyone watches football (12). In wo- (Ab) and the super bowl is
like the biggest event in America in terms of sports (21). Its like you
300 Syllables:
Part Single Dysrythmic Revision Abandoned Interjection Phrase
Word Syllable Phonation Rep
Rep Word Rep
3 1 3 0 3 8 0
%SLD = 7/300 X 100 = 2.3 % SLD
%OD = 11/300 X 100 = 3.67 % OD