(Simucase details at end)

Directions:

Write a treatment plan for Rob (Simucase) using the format depicted below:

Your treatment plan should contain the following elements:

• Summarize the significant speech findings for the case
• Find an evidence-based treatment article for this case, summarize the article, and describe how you will carry out this treatment.
• Article: https://doi.org/10.1002/mds.27460

Ramig, L., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018).Speech treatment in Parkinson's disease: Randomized controlled trial (RCT).Movement Disorders,33(11), 1777-1791.https://doi.org/10.1002/mds.27460

Note: Selecting the LSVT treatment is not allowed for this assignment, because you are not yet certified in using this intervention. Please use any other evidence-based treatment approach that will be appropriate for your Simucase patient.

• Write goals across the ICF model for this patient. This includes a goal/objective that is impairment-oriented, activity/participation-oriented, and environment-oriented. *One goal must be directly tied to the EBP treatment article.

Template:

Group Treatment Plan Assignment for Rob

SLP 5345 Motor Speech Disorders

1. Write a treatment plan for Rob with the following elements:
   1. Summarize the significant history and assessment findings for the case (use the template below)
   2. Find an evidence-based treatment article addressing a treatment approach that would be suitable to use with Rob, based on his clinical presentation. Summarize the article. Describe how you will carry out that specific treatment for Rob. Upload the article to Blackboard, along with your treatment plan.
   3. Write one long-term goal and three short-term goals, associated with the long-term goal, across the ICF model. This includes a short-term goal that is impairment-oriented, activity/participation-oriented, and environment-oriented. Ensure that these goals are created with your patient, Rob, in mind.

*One goal will be directly tied to the EBP treatment article that your group selected.

*Goals must be measurable (For more information, review: SMART Goals for adults) Reminder: Your goals must have the 5 components of a SMART goal for adults. This includes: a clear performance (target skill/impairment), a condition (task/activity that can be measured objectively), an objective criterion (% acc., # of opportunities, etc.), a quality marker (type & level of cues), and a rationale.

6 points Description of the case history, assessments & significant findings, and plans/recommendations (sections 1-III on template)

3 points Selection of evidence-based article, article summary, and description of providing that treatment approach for Rob (section IV on template)

4 points Long-term goal

4 points Impairment goal (short-term goal)

4 points Activity/Participation goal (short-term goal)

4 points Environmental goal (short-term goal)

25 points TOTAL

Below is an example of a treatment plan format with the suggested language for a treatment plan. Please note that you may adjust the language as needed. Use clinical language to describe the signs and symptoms. Fix or add to background history and assessments if needed. just what i have so far.

Client Name: Rob Clinician names:

DOB:

Date of Evaluation: February 5, 2025

Chronological age: 65....

I. Background information and history:

Rob is a 65-year-old male with a medical diagnosis of Parkinson's disease. He has a history of hoarseness and sore throats with GERD, which is phase 3 esophagitis. His medical history is also significant for diagnoses of Barrett's esophagus, esophagitis, and Chiari malformation type I. He is currently taking carbidopa-levodopa for PD; tizanidine, as needed, for muscle spasms; alprazolam for sleep; pantoprazole to reduce stomach acid; promethazine, as needed, for nausea; sucralfate for stomach ulcers; and uses a budesonide inhaler. Rob was referred to speech-language pathology by his primary care physician, Dr. Justin Phillips, due to concerns about hypophonia and impaired communication. His doctor is planning to scope him to rule out any other issues. Rob reports that he is a professional painter and works at a hospital nearby. He attended Emerson Vocational School and studied mechanics. Rob reports moderate difficulty with his voice volume and quality, as well as his ability to be heard by others. He reports that he has had difficulty with his memory and motor movement due to his Parkinson's diagnosis. He states that he is often asked to repeat himself when communicating with others and that his voice gives out at times. He reported that he has difficulty swallowing and chokes on his saliva after he has eaten food. He has changed his diet to a soft diet to help with these symptoms.

II. Assessments and findings: To assess Rob's motor speech,the Robertson Dysarthria Profile (Revised) (RDP-R) assessment was administered. Rob's performance indicated that his rate of speech is slowed, and his respiration is shallow but normal speed at rest. His facial musculature appeared to be within normal limits, and his pitch is normal, but his voice quality is breathy and weak. The Cognitive Linguistic Quick Test (CLQT) was administered and indicated that he presents with a Mild Cognitive Linguistic Impairment. His Modified Barium Study (MBSS) was reviewed, and he is following the recommended sick diet. The Parkinson's Disease Questionnaire (PDQ-39) was administered, and he reported that he is often lonely and worries about his future due to difficulty with communication. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was administered and indicated difficulty with voice loudness, monopitch, and moderate roughness. To assess his cognition, the Montreal Cognitive Assessment Version 7.1 (MoCA) was given and the results showed difficulties with Language, Abstraction and orientation with a score of 24 out of 30. ... [provide a brief summary of the assessment findings in terms of the interpretation. Be sure to interpret the results of any formal assessments, but you do not need to specify the scores. If multiple assessments are given, then write one short sentence for each]. Results of this assessment demonstrated that Rob presents with a moderate/severe Hypokinetic Dysarthria. The following clinical signs were observed during the [test name or particular subtest of the assessment]: monotone speech, vocal tone weakness, breathiness, [list of speech related speech characteristics to support your diagnosis], .... III. Plans/recommendations: Rob would benefit from [[Name of the EBP treatment you selected with citation]. [treatment name] is a treatment that targets ... [describe what the treatment is about in a few sentences]. Rob would benefit from this treatment due to his [list the signs/symptoms that made you choose this particular treatment]. Plan of Care (POC): [Dose, duration, frequency (the intensity as appropriate for the intervention you suggested)] IV. Researched treatment: Description of the researched treatment and how you will carry it out. (Be sure to use your own words and include APA citations.) V. Long-term goal: What you would like to see by the end of the duration you suggested.

Impairment focused goal: should directly target the patient's impaired skills. The primary function is to reduce impairment (e.g., increase naming, reduce episodes of anomia, length of utterance, etc.).

what i have so far??? Rob will demonstrate improved speech intelligibility and vocal loudness by increasing ...

Activity/participation focused goal: should consider an area of the patient's life that is impacted by his/her impairment. The primary function is to facilitate client-centered activities (e.g., talking on the phone, ordering food at a restaurant). Environment focused goal: should consider the patient's relationship to his/her environment and how he/she can manipulate/navigate this environment to compensate or manage his/her impairment. Think about how the patient can restructure his environment to fit his/her needs (this may include partner training or self-advocacy).

References: Evidence-based treatment article full citation in APA formatting.

References

Ramig, L., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018).Speech treatment in Parkinson's disease: Randomized controlled trial (RCT).Movement Disorders,33(11), 1777-1791.https://doi.org/10.1002/mds.27460

SIMUCASE INFORMATION:

Rob- Assessment (SLP)

Rob is 65-year-old with a medical diagnosis of Parkinson's disease. You are a speech-language pathologist at a neurorehabilitation clinic assigned to evaluate for hypophonia and impaired communication.

Identifying / Family Information

Name: Rob

Age: 65 years old

Family: Two daughters, two sons, four grandchildren

Frequent Communicator: Youngest son (17), described as a talker

Living Arrangement: Lives with his 17-year-old son; describes all four children as wonderful

Typical Day:

Wakes between 5-7 AM

Watches the news, weather, Sports Zone, and entertainment shows

Does physical and occupational therapy exercises

Previously active at the gym, now experiencing stiffness due to Parkinson's

Areas of Concern

Primary Concerns:

Loss of vocal volume, tone, and sound

Difficulty dressing and balance issues

Slower daily tasks

Learning to live with Parkinson's disease

Communication Difficulties:

Soft-spoken voice; frequently apologizes for being hard to hear

Difficulty initiating conversation and making business calls

Feels shy and more self-conscious than before

Diagnosis Story:

Symptoms started 8 months ago (tremors, facial issues, weakness)

Diagnosed with atypical Parkinson's and memory loss

Additional symptom: unexplained runny left eye

Symptom Duration:

Symptoms began about a year ago following a strep infection

Significant changes noted since then

Recent worsening aligns with Parkinson's progression

Previous Therapy:

Speech Therapy: No previous speech therapy

PT/OT: Yes, enjoys it and finds it informative regarding Parkinson's symptoms

Speech Therapy Goals:

Be evaluated

Improve speech and vocal confidence

Hearing / Vision

Hearing: No difficulties reported

Vision:

Used to have 20/20 vision until early 50s

Uses reading glasses

Reports blurred vision at night and sometimes during the day due to Parkinson's

Medical

New Medical Issues:

Hoarseness

Sore throat

Acid reflux (GERD, phase 3 esophagitis)

Upcoming esophageal scope

Medications:

Carbidopa-Levodopa (Parkinson's medication)

Protonix (acid reflux)

Xanax (as needed for stress)

Avoids pain medications

Feeding / Swallowing

Eating/Drinking Modifications:

Occasional choking on saliva, especially when reclining

Switched to a soft, moist diet; symptoms have improved

Avoids some foods

Drooling:

Occurs when relaxed; has improved with medication

Speech, Fluency, and Voice

Previous Vocal Issues: None prior to diagnosis

Current Voice:

Very soft by nature

People frequently ask him to repeat himself

Can get louder with effort

Voice sometimes gives out

Language / Literacy

Conversation:

Easier with familiar people

Friendly and attempts humor, but reports flat affect and reduced expressiveness

Communication Strategies:

Uses Post-its and a calendar to manage memory and tasks

Word-Finding:

Experiences anxiety and overthinking

Struggles with expression and confidence

Memory:

Frequently forgets purpose of tasks

Reports some improvement with medication

Reading/Writing:

Needs to re-read material

Writing affected by tremor in dominant (right) hand

Social / Behavioral

Anxiety:

Reports increased anxiety since diagnosis

Desires to get better and regain confidence

Coping Strategies:

Reading comic books

Playing catch with neighborhood kids

Supportive son

Enjoyable Activities:

Watching sports and action/western movies

Walking and biking

Visiting fossil beds at the Falls of the Ohio

Support Group Participation: None

Daily Activities:

Difficulty with hand stiffness and grip

Trouble dressing (e.g., shoes)

Prone to losing balance

Proud of his independence and housekeeping

Education and Work

Educational History:

Emerson Vocational School: Trained in machine shop and mechanical drafting

Finished top of class; placed 3rd on state exam

Vocational History:

Professional painter

Currently works at a hospital

Collaborators / Allied Professions

Physical Therapist:

Name: Doug

Rob was evaluated a few months ago

PT will send report

Fall Risk:

Yes

Impaired balance and decreased flexibility

Mini-BEST: score of 2 for sit-to-stand

Sometimes needs standby assist

Vision Impact on Balance:

No known vision-related balance issues

Continued Interview & Provider Collaboration Notes:

12:23 - How often do you see Rob?

Initially, I saw him twice a week for therapy. Currently, I am seeing him once a week.

13:18 - What goals are you working on in therapy?

Rob is working on stepping strategies, balance, and flexibility.

Occupational Therapy Collaboration

13:29 - You contact the Occupational Therapist

"Hi, I am Diane, Rob's occupational therapist. I will send you his report to your clipboard. If you have any other questions, please let me know."

13:59 - How are Rob's fine motor skills?

Rob has decreased upper body extremity strength and is having issues with dressing and functional use of his hands. More details are in the OT report.

14:06 - Does the patient have any vision difficulties that might affect participation in treatment?

Rob wears glasses for reading. During the evaluation, decreased smoothness of eye movement was noted with horizontal tracking. Additional information is in the report.

14:14 - Have you noticed any feeding or swallowing issues?

Not that I am aware of.

14:27 - How often are you seeing the patient?

I see him twice a week.

Neurology Collaboration

14:36 - You contact the Neurologist

"Hello, I'm Dr. Sam Johnstone, Rob's neurologist. I sent his report to your clipboard."

14:47 - How is the patient responding to medications?

We're continuing to monitor his response. More details are in the report.

14:58 - Is the patient on a set medication regimen?

Yes. More information is in the report.

Primary Care Collaboration

15:05 - You contact the Primary Care Physician

"Hello, this is Dr. Justin Phillips. I am Rob's PCP. Rob has a history of Barrett's esophagus and esophagitis, as well as a type 1 Chiari malformation. He was diagnosed with Parkinson's Disease one year ago and is being followed by neurology."

15:05 - Describe Rob's medical history.

See above statement.

Hypothesis

18:22 - Hypothesis #1

Rob is presenting with Parkinson's disease. He has low vocal volume, forgetfulness, shakiness, drooling on the left side, and is at risk for falls.

Assessment Results

Dysphagia 20:31 - Clinical Swallow Assessment & MBS Review

Rob tolerated thin liquids via straw with no overt signs of difficulty. He is on a modified slick diet per physician orders.

Psychosocial 20:54 - Parkinson's Disease Questionnaire (PDQ-39)

Total Score: 67 Subscores:

Mobility: 70

ADL: 75

Emotional: 42

Stigma: 75

Social Support: 100

Cognition: 75

Communication: 33

Bodily Discomfort: 67 Notes: Rob reports frequent difficulty with speech, isolation, and worry about the future.

21:49 - Voice-Related Quality of Life (V-RQOL)

Social-Emotional Domain: 62.5 Physical Functioning Domain: 45.83 Total Score: 29 Notes: Consistent with individuals who rate their voices as fair/good.

Voice and Resonance 22:22 - Intensity Rating

Baseline /a/: 61.7 dB Rainbow Passage: 61.5 dB Reading Rate: 206 SPM (norm: 210-265)

26:11 - Pitch Glides

Pitch range = 12 notes

29:30 - S/Z Ratio

s = 11.3, z = 15 s/z ratio = 0.75

31:53 - Maximum Phonation Time

17 seconds

32:57 - CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice)

Overall Severity: 50/100

Roughness: 15/100

Breathiness: 30/100

Strain: 0/100

Pitch (Monopitch): 36/100

Loudness (Hypophonia): 45/100

Cognition and Achievement

33:50 - Cognitive Linguistic Quick Test (CLQT)

Total Severity Rating Score: 3.4 Mild deficit

Attention: WNL (4)

Memory: Mild (3)

Executive Function: Mild (3)

Language: Mild (3)

Visuospatial: WNL (4)

Motor Speech & Intelligibility

34:58 - Dysarthria Profile Revised

Respiration: 19/25 (shallow at rest)

Phonation: 51/55 (breathy/weak voice, monotone)

Musculature: 77/80

Diadochokinesis: 23/25

Communication Competence: 16/30

Eating & Swallowing: 17/25

Articulation: 20/20

Intelligibility/Rate/Prosody: 32/35 (slowed rate, normal rhythm)

Diagnosis

Cognition/Executive Function: Mild Cognitive Impairment Dysarthria: Hypokinetic Dysarthria Neurological: Parkinson's Disease

Recommendations

Treatment Plan

Client qualifies for outpatient speech therapy.

Target: Improved intelligibility and voicing, vocal production education (esp. effort in PD).

Incorporate amplitude-based speech exercises.

Develop a structured home exercise program.

Educate client and family on disease progression and importance of ongoing participation.

Recommend counselor referral and connecting with local support groups.