1. Child to increase spontaneous expressive vocabulary to 50 different words. Goal achieved. Crystal has increased her expressive vocabulary from approximately 30 to at least 50 different words. Many of her productions remain approximations of the target word due to developmentally appropriate misarticulations. In addition, Crystal's vocabulary consists of mostly nouns. Modify goal for producing 10 different action words upon request.
2. Child to name objects/pictures 10x/session. Goal achieved. Crystal currently names approximately 10 objects/pictures upon request. She names the same 10 pictures each session, often calling all food items "apple" and all animals "woof woof." Modify goal for naming at least 3 items within a variety of categories in order to expand expressive vocabulary.
3. Child to imitate names of new objects/pictures 10x/session. Goal partially achieved. Crystal recently started attempting to imitate the names of new objects/pictures. She repeats the names of approximately 5 objects/pictures per session. Continue goal.
4. Child to increase breath support and maximize respiration for functional communication. Goal achieved. Crystal blows bubbles independently during therapy. Per parent report, she blows whistles and blow toys during play at home. Though her voice remains generally quiet, Crystal demonstrates breath support within the functional limits for adequate communication. On occasion, when excited or upset, Crystal demonstrates an increase in her loudness level. It is recommended that her family continue to provide her with opportunities to exercise her breath support through blowing activities in order to continue to maximize her breath support. Discontinue goal.
5. Child to execute safe and efficient swallow of various textures and consistencies without evidence of aspiration. Ongoing goal. Crystal appears to demonstrate a safe and efficient swallow of a variety of table foods, though she consumes small quantities at a time. 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. Suggestions have been made to her mother and day care provider for preventing aspiration. 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 mildly 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 solidly within the 24 to 27-month level and language expression skills scattered within the 21 to 24-month level with a few emerging skills beyond this range. During her first quarter of speech-language therapy, Crystal has made significant improvements in her expressive language skills. She has started increasing her expressive vocabulary, producing true words within jargon-like utterances, producing phrases occasionally, and frequently using the pronoun "mine." In early August 2001, Crystal participated in a modified barium swallow study at St. Mary's Medical Center due to concerns expressed by her mother and physician regarding her coughing/choking on liquids from her mother's water bottle. No signs of aspiration were noted during the evaluation and suggestions were made to Crystal's mother for encouraging safe swallowing of liquids (i.e. upright positioning, cup recommendations to reduce flow rate, eliminating drinking from the water bottle, and using thickener to nectar consistency as a precaution). Furthermore, Crystal's diet has been supplemented with amino acids and protein has been eliminated 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 or day care environment. Current therapy will continue to focus on increasing Crystal's expressive language 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 name at least 3 items within a variety of categories in order to expand expressive vocabulary. 3) Child to imitate names of new objects/pictures 10x/session. 4) Child to produce first name and age upon request. 5) Child to produce 3-word phrases 10x/session. 6) 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
Katrina M. Newkirk, MA, CCC-SLP