Subjective: Crystal, a 34-month-old female, is currently receiving individual speech-language therapy through the Vanderburgh County First Steps Program. Therapy is currently provided 1x/wk., for 60-minute sessions within her home environment. Crystal presents with a diagnosis of spinal muscle atrophy. Throughout therapy, she remains pleasant and cooperative. Crystal willingly participates in therapy activities. She is a strong-willed child who asserts her independence and shows her excitement during therapy. Crystal has excellent support from her mother, who follows through with therapeutic suggestions and advocates for Crystal's every need. 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 articulation deficit and is monitoring feeding/swallowing skills. Therapy objectives are addressed through structured language, articulation 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 achieved. Crystal spontaneously produces action words in various forms during connected speech. Furthermore, within the past several months, Crystal's vocabulary has expanded to include a variety of word types. Discontinue goal.
2. Child to produce first name, age and gender upon request. Goal partially achieved. Crystal currently states her first name and imitates her age and gender. Modify goal for producing full name, age, and gender upon request.
3. Child to produce basic sentences to relate personal experiences. Goal achieved. Crystal uses basic sentences frequently and consistently to relate personal experiences and daily occurrences. Discontinue goal.
4. Child to improve overall intelligibility by decreasing misarticulations. Goal partially achieved. Crystal has greatly improved her intelligibility at the single word level; however, she becomes harder to understand during rapid connected speech. She continues to exhibit misarticulations characterized by speech sound substitutions and omissions. Continue goal.
5. 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. Suggestions have been made to her mother 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 if needed 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 has improved her expressive language skills to within the average range for a child of her chronological age. According to her May 2002 performance on portions of the Rossetti Infant-Toddler Language Scale, Crystal demonstrates language comprehension and expression skills scattered within the 33 to 36-month level. During the past quarter of speech-language therapy, Crystal has continued to make significant improvements in her expressive language skills. 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 and Crystal seems to be tolerating her diet modifications.
Plan: It is recommended that Crystal continue to receive individual speech-language therapy 1x/wk, for 60-minute sessions within her home environment. Current therapy will continue to focus on increasing Crystal's articulation skills and monitoring her feeding/swallowing skills. Therapy will focus on the following therapy goals: 1) Child to produce full name, age, and gender upon request. 2) Child to improve overall intelligibility by decreasing misarticulations. 3.) Child to name 3 colors consistently. 4) Child to execute safe and efficient swallow of various textures and consistencies without evidence of aspiration. As Crystal will be turning 3 years old in July 2002 and will be exiting the First Steps program at that time, it is recommended that she continue to receive speech-language therapy in order to facilitate improved articulation skills and to continue to monitor her feeding/swallowing skills. It is felt that crystal would benefit from participation in a therapeutic preschool program where she would receive additional speech-language stimulation from her peers during structured educational activities. 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