Katrina M. Newkirk, MA, CCC-SLP
Independent Speech-Language Pathologist
P.O. Box 4571
Evansville, IN 47724


Quarterly Summary

Child's Name: Crystal Allbritton Report Period: 10/19/01 to 01/11/02
DOB: 07/18/99 Date: 01/11/02
Initial Evaluation: 10/07/00

Subjective: Crystal, a 30-month old female, is currently receiving individual speech-language therapy through the Vanderburgh County First Steps Program. Therapy is currently provided 1x/wk., for 45-minute sessions within her home and/or day care environments at the Goodwill Family Shelter. As of the end of January 2002, Crystal's therapy location will be switched to the family's new apartment. Crystal presents with a diagnosis of spinal muscle atrophy. She remains generally pleasant and cooperative and willingly participates in therapy activities. Crystal is a strong-willed child who asserts her independence during therapy. In addition to speech-language therapy, Crystal receives developmental, occupational, and physical therapies and social work services through the First Steps program. Dietary services are provided to Crystal's family through St. Mary's Medical Center.

Objective: Therapy is addressing an expressive language delay and is monitoring feeding/swallowing skills. Therapy objectives are addressed through structured language and play activities. The following progress has been made toward meeting current therapy goals:

1. Child to produce 10 different action words upon request. Goal partially achieved. Crystal continues to produce a few action words spontaneously; however, many of her productions remain approximations of the target word due to misarticulations. Crystal's vocabulary continues to consist of mostly nouns, though she is starting to use verbs occasionally in phrases. Continue goal.

2. Child to name at least 3 items within a variety of categories in order to expand expressive vocabulary. Goal achieved. Crystal has expanded her spontaneous expressive vocabulary to include the names of several items within various categories. Discontinue goal.

3. Child to imitate names of new objects/pictures 10x/session. Goal achieved. Within the past quarter, Crystal has started attempting to imitate the names of new objects/pictures more frequently. Per parent report, Crystal imitates words and phrases frequently during daily activities. Discontinue goal.

4. Child to produce first name and age upon request. Goal partially achieved. Crystal currently imitates her first name and age; however, she does not spontaneously answer questions requesting this information. Continue goal.

5. Child to produce 3-word phrases 10x/session. Goal achieved. Crystal has increased the length of her phrases and now produces spontaneous 3-word phrases frequently. Many of her phrases are difficult to understand due to multiple misarticulations, which affect her overall intelligibility. Discontinue goal.

6. Child to execute safe and efficient swallow of various textures and consistencies without evidence of aspiration. Ongoing goal. Crystal appears to continue to demonstrate a safe and efficient swallow of a variety of table foods. She also seems to tolerate thin liquids from an Infa-Trainer and/or sipper cup without excessive coughing or choking. When Crystal is congested, she exhibits more difficulty managing thin liquids. Her mother reports that Crystal's excessive secretions have been controlled with the introduction of a supplement suggested for children with spinal muscle atrophy. Suggestions have been made to her mother and day care providers for preventing aspiration (i.e. upright positioning, cup recommendations to reduce flow rate, eliminating drinking from a water bottle, pacing her liquid intake, and using thickener to nectar consistency as a precaution). Crystal continues to demonstrate a weak cough and has a limited ability to cough and clear due to hypotonia. Due to the degenerative nature of her diagnosis, Crystal's swallowing skills should be closely monitored and addressed as necessary. Continue goal.

Assessment: Crystal continues to demonstrate age appropriate language comprehension skills and slightly delayed expressive language skills for a child of her chronological age. According to her performance on portions of the Rossetti Infant-Toddler Language Scale, Crystal demonstrates language comprehension skills scattered within the 30 to 33-month level and language expression skills scattered within the 24 to 27 & 27 to 30-month levels. During the past quarter of speech-language therapy, Crystal has continued to make significant improvements in her expressive language skills. She has started producing phrases frequently, imitating new words and phrases, producing a few action words, and repeating her first name and age. Though Crystal's expressive language skills continue to improve, her speech remains difficult to understand on occasion due to multiple misarticulations. Her breath support remains adequate for functional communication and her swallowing skills appear safe and efficient at this time. Furthermore, per parent report, Crystal's diet has been supplemented as part of a dietary protocol recommended for children with spinal muscle atrophy.

Plan: It is recommended that Crystal continue to receive individual speech-language therapy 1x/wk., for 45-minute sessions within her home environment. Current therapy will continue to focus on increasing Crystal's expressive language skills, facilitating improved articulation skills, and monitoring her feeding/swallowing skills. Therapy will focus on the following therapy goals: 1) Child to produce 10 different action words upon request. 2) Child to produce first name, age, and gender upon request. 3) Child to produce basic sentences to relate personal experiences. 4) Child to improve overall intelligibility by decreasing misarticulations. 5) Child to execute safe and efficient swallow of various textures and consistencies without evidence of aspiration. Please feel free to contact me should you have questions and/or concerns regarding this child's progress and/or therapy goals. Thank you.

 Katrina M. Newkirk, MA, CCC-SLP

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