Case Study: Stroke

Clinician
Shelley E. Adair M.S. CCC/SLP; Austin Speech Labs

Presenting Problems
The client, “M”, was diagnosed with a CVA (stroke) in early 2007 in his early forties. At onset he exhibited severe expressive and receptive aphasia and severe apraxia. Over the past six years he has made tremendous progress with his expressive aphasia but continues to have significant difficulty with reading and writing skills.

Therapeutic Goals
Improve Reading Skills
The client continues to have severe difficulty reading. He has spent many hours addressing this need with various therapy techniques. Overall, progress has been very slow and very limited. The goal is to use iLs to improve the client’s overall reading skills from single words to short phrases and sentences.

iLs Program Used
The iLs Reading & Auditory Processing (R&AP) Program was used for “M’s’’ program. A total of 40 one-hour sessions were completed.

Other Interventions used
The R&AP Program was completed during an intensive speech therapy boot camp. Each session was 180 minutes in length, three times a week for 14 weeks. The client would receive:

• 60 minutes of group-based therapy, which focused on speech communication, word finding and writing
• 30 minutes of iLs’ Interactive Language Program (ILP) (microphone/headphone voice feedback system), which focused on repetition of numbers
• 30 minutes of writing therapy, where he practiced writing single words
• 60 minutes of iLs’ R&AP Program

He would start the R&AP with a ten-minute rigorous walk around the clinic with a clinician. They would return to the office and begin therapy while listening to music through the iLs’ air and bone conduction headphones. Therapy involved reading individual words, sentences and short children’s books. The client also reported that every night he would call his mom on the phone, and she would read a book to him over the phone. They each had the same book, and he would follow along listening while she read aloud. This lasted around an hour every night.

Summary of Changes
At the onset of therapy, the client was able to read single words with 44% accuracy. He was able to read basic sentences with 20% accuracy. At post-testing, the client was able to read single words with about 80% accuracy and simple sentences with 55% accuracy. Initially, the client would read only the nouns in the sentences, but now the client is able to read the full sentence word for word, in order. The client also improved his Aphasia Quotient Score on the Western Aphasia Battery from 78 to 84.

Recommendations
The client reported that he really liked using the headphones because it seemed to help him remain focused on the task. Without the headphones, reading was such a struggle for him that he would often zone out and start listening to other conversations in the room and not be able to focus on his task. He also felt that it relieved the pressure to perform and relaxed him so he could read better.

The progress made in the last 14 weeks was very significant, as evidenced by his improved test results. Not only was the client better able to read, but also his confidence in his reading skills has gone up considerably. Based on the results of this study, I would definitely continue to use this system with this client and others, as well.

Western Aphasia Battery

	July	December
Spontaneous Speech	16/20	17/20
Auditory Verbal Comprehension	9/10	10/10
Repetition	6/10	7/10
Naming	6/10	7/10
Aphasia Quotient	78/100	84/100

Informal Reading Assessment

	July	December
Single Words	44%	80%
Sentences	20%	55%

Dr. Minson’s Comments
The clinician’s astute use of the iLs receptive R&AP Program combined with the expressive ILP enabled this gentleman to successfully achieve the therapeutic goals. Thanks to the everlasting ability of the brain to change and improve function, goals were achieved even seven years after his stroke. It wasn’t mentioned, but I imagine his stroke, from the clinical presentation, was left frontal and temporal involving both the expressive and receptive areas of language. Remember, the cerebellum has connections to the frontal lobe and language functions; the vigorous walk and the iLs bone conduction input were important components to his success.

I love the way the intensive speech therapy boot camp was structured! The vigorous walk is powerful as a way to get the brain geared up to learn. I’m sure he will continue to make further gains through continued listening and use of the ILP.