Speech sound errors at school
MediumDiego's Speech Therapy Reluctance
Setting: Hospital speech pathology room. Your role: Speech Pathologist
You are a Speech Pathologist. Ms Sofia Garcia is the mother of 12-year-old Diego, who has been referred due to persistent speech sound errors, specifically 'r' and 'th' sounds, impacting his clarity at school. You recommended a course of weekly speech therapy, but Ms Garcia has returned today expressing reluctance to proceed.
- Explore Ms Garcia's specific reasons for her reluctance regarding Diego's recommended speech therapy, particularly given his age and upcoming high school entrance exams.
- Validate Ms Garcia's concerns about the time commitment, potential impact on Diego's self-esteem, and her focus on his academic priorities without dismissing their validity.
- Share specific information about how persistent 'r' and 'th' sound errors can impact a 12-year-old's academic performance and social confidence, referencing Diego's individual needs.
- Offer an adjusted or flexible option for Diego's speech therapy, such as tele-health sessions, a focus on specific high-impact sounds, or a short-term, intensive block, that respects her stated values and constraints.
- Agree on one concrete, manageable step Ms Garcia is willing to take this week to move forward with addressing Diego's speech sounds.
Practise this cardMotor planning for speech (CAS)
HardDiego's CAS Therapy: Family Conflict
Setting: Hospital speech pathology room. Your role: Speech Pathologist
You are a Speech Pathologist meeting with Ms Sofia Garcia, mother of 12-year-old Diego. Diego has been diagnosed with Childhood Apraxia of Speech (CAS), characterized by inconsistent speech sound errors and difficulty coordinating speech movements. Today's consultation is to discuss initiating a new, intensive motor-based speech therapy program, but Ms. Garcia has indicated family disagreement.
- Acknowledge Ms. Garcia's concerns and her husband Roberto's skepticism about the proposed intensive therapy, validating both perspectives.
- Name the shared goal that both parents likely have for Diego, focusing on his long-term communication skills and confidence.
- Clarify the medical facts regarding Childhood Apraxia of Speech (CAS), explaining that it is a neurological motor planning disorder requiring specific, frequent, and repetitive intervention, regardless of age.
- Mediate a compromise for the therapy plan, perhaps suggesting a trial period or flexible scheduling for the three 45-minute sessions per week for 12 weeks, to address family concerns while maintaining clinical effectiveness.
- Confirm a specific shared plan for Diego's therapy that all parties can realistically commit to, outlining next steps and expectations for home practice.
Practise this cardCough control and voice care
MediumHannah Lee: Persistent Cough & Voice Care
Setting: Hospital speech pathology room. Your role: Speech Pathologist
Ms Hannah Lee, 29, a hospital administrator, has a persistent cough affecting her voice and causing larynx irritation. Two weeks ago, you provided her with a vocal hygiene plan, including hydration targets and specific voice rest techniques. She has reported no improvement, and you suspect non-adherence to the previous recommendations.
- Explore the specific barriers that prevented Ms. Lee from consistently following her prescribed vocal hygiene strategies and daily hydration plan from our last session.
- Validate Ms. Lee's difficulties in adhering to the plan, acknowledging the challenges of her demanding job without minimising the clinical importance of protecting her larynx.
- Co-design a revised, more manageable vocal care plan with Ms. Lee, focusing on 1-2 key strategies she genuinely feels confident she can integrate into her daily routine.
- Safety-net what Ms. Lee should do if she finds herself struggling again with the new plan, ensuring she knows how and when to seek further support.
- Schedule a follow-up phone consultation in one week to review her progress with the revised plan and offer ongoing support.
Practise this cardCommunication strategies in dementia
HardDignity in Dementia Communication: A Cultural Request
Setting: Stroke unit consultation room. Your role: Speech Pathologist
You are meeting with Ms Priya Shah, daughter and primary carer for her 85-year-old mother, Mrs Asha Shah, who is 3 months post-stroke. Mrs Shah is experiencing increasing word-finding difficulty. Ms Priya has requested this consultation to discuss communication strategies for her mother.
- Listen carefully to Ms Priya's specific request regarding how communication strategies for her mother should be discussed and implemented.
- Understand the underlying cultural context and importance of preserving Mrs Asha Shah's dignity and status as an elder in your approach.
- Assess the clinical feasibility and potential benefits or drawbacks of accommodating Ms Priya's cultural request in the context of speech therapy for word-finding difficulty.
- Propose a specific, adapted communication strategy or consultation approach that respects cultural norms while still addressing Mrs Shah's clinical needs.
- Confirm with Ms Priya that the proposed accommodation is acceptable and meets her expectations for her mother's ongoing care.
Practise this cardThickened fluids and swallowing safety
MediumThickened Fluids Reluctance - Mr. O'Connor
Setting: Stroke unit consultation room. Your role: Speech Pathologist
Mr. Frank O'Connor, primary carer for his 65-year-old wife, Mary, is here for a follow-up. Mary suffered a stroke 3 months ago, resulting in dysphagia, and has been prescribed Level 2 (mildly thick) fluids to prevent aspiration. Mr. O'Connor has expressed significant difficulty getting Mary to consume these, leading to concerns about adherence and dehydration.
- Explore the specific reasons behind Mr. O'Connor's reluctance to continue administering Level 2 thickened fluids to his wife, Mary.
- Validate Mr. O'Connor's concerns regarding his wife's distress and the challenges he faces as her primary carer.
- Share evidence and specific information about Mary's individual aspiration risk and the importance of thickened fluids, referencing her previous chest infection post-stroke.
- Offer adjusted options or alternative strategies for fluid intake that respect Mary's comfort and Mr. O'Connor's stated values, such as a trial of Level 1 fluids or specific hydration techniques.
- Agree on one concrete, manageable step Mr. O'Connor is willing to implement this week to improve Mary's fluid intake and safety.
Practise this cardAugmentative and alternative communication
HardMr Aziz: Reluctance with AAC Device Post-Stroke
Setting: Stroke unit consultation room. Your role: Speech Pathologist
Mr. Omar Aziz, 45, a self-employed builder, suffered a stroke 3 weeks ago, resulting in severe expressive aphasia and right-sided weakness. He was recommended a tablet-based Augmentative and Alternative Communication (AAC) device to aid communication, but he has shown reluctance to use it during follow-up. This consultation aims to understand and address his reservations.
- Explore Mr. Aziz's specific concerns and fears regarding the use of the tablet-based AAC device, particularly how it might impact his identity as a builder.
- Validate Mr. Aziz's feelings and concerns about the device, emphasizing that his feelings are understandable given his situation.
- Share evidence or examples of how similar AAC devices have helped other patients with expressive aphasia regain independence and return to their work or hobbies, focusing on practical benefits for a manual worker.
- Offer an adjusted option that respects Mr. Aziz's stated values, such as starting with a simplified version of the device for use at home or exploring more discreet communication aids for specific professional interactions.
- Agree on one concrete, manageable step Mr. Aziz is willing to take this week, such as trying the device for 15 minutes daily with a specific family member, or reviewing a video demonstration of a successful user.
Practise this cardVoice strain and hoarseness
MediumVoice Care & Prayer Schedule
Setting: Hospital speech pathology room. Your role: Speech Pathologist
Ms. Laura Bennett, a 38-year-old primary school teacher and single mother, has been referred to you for persistent hoarseness and vocal fatigue for the past 6 weeks. She is concerned about her ability to continue teaching her Year 2 students effectively and is seeking strategies for vocal hygiene, but has a specific request regarding her daily prayer schedule.
- Listen actively to Ms. Bennett's specific request about her daily prayer schedule and its potential impact on her voice treatment plan.
- Understand the cultural and religious significance of her daily prayer times with curiosity and without judgment, allowing her to explain the context.
- Assess the clinical feasibility of integrating Ms. Bennett's prayer schedule with recommended vocal rest, exercises, and hydration strategies for her persistent hoarseness.
- Propose a specific, flexible vocal hygiene plan and exercise routine that accommodates her daily prayer times, suggesting practical adjustments or compromises.
- Confirm with Ms. Bennett that the proposed adjusted treatment plan is acceptable and addresses her concerns about balancing vocal health with her religious practices.
Practise this cardVoice change after thyroid surgery
HardPost-Thyroidectomy Voice Therapy Decision
Setting: Hospital speech pathology room. Your role: Speech Pathologist
Mrs. Aisha Rahman, 41, a restaurant owner, had a total thyroidectomy 3 weeks ago. She is experiencing significant voice weakness and fatigue, impacting her ability to manage her restaurant. Her husband, Tariq, believes she should avoid any vocal exercises for now, fearing it will worsen her condition, while Aisha is keen to regain her voice quickly. The consultation today is to discuss initiating vocal fold movement assessment and therapy.
- Acknowledge Mrs. Rahman's desire to improve her voice and her husband Tariq's concern about overstraining her vocal folds.
- Name the shared goal of both Mrs. Rahman and Tariq as ensuring Mrs. Rahman's voice recovers safely and effectively, allowing her to return to her business.
- Clarify the medical facts regarding the importance of early, gentle vocal fold movement assessment and therapy to prevent long-term voice issues after thyroidectomy, specifically mentioning potential nerve irritation or mild vocal fold paresis.
- Mediate a compromise that involves starting with a very gentle, short vocal assessment and therapy plan, emphasizing controlled movements rather than strenuous exercises, ensuring it aligns with safe recovery.
- Confirm a specific plan for commencing a short, initial vocal assessment session today, with clear guidelines on the type and duration of exercises, and a follow-up schedule that both Mrs. Rahman and her husband can agree upon.
Practise this card
