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Answer the following: SLP5220- Adult Neurogenic Disorders 1.Why is knowledge of the WHO-ICF and the A-FROM frameworks important in clinical practice with people who have acquired neurogenic communication disorders? Select exactly 5 that apply. If you select more than 5, points will be deducted. We can become attuned to how individuals prioritize their personal life participation goals We are reminded that our clinical aim is to address all aspects of communication that impact a person’s life, rather than focusing solely on assessing and treating language impairments. We can understand what will and will not be covered by medical insurance We can recognize the role of family and friends and how they may be helpful or unhelpful regarding communication tasks and social inclusion This framework has the SMART goal framework embedded within it, which helps with goal creation. We can consider social exclusion related to communication disability as an important area to address in treatment. We can commit to enhancing optimal life participation in the people we serve 2. You get 2 clients on your caseload at an outpatient rehabilitation center. They both have had a left MCA VA in the last 6 months, but in different areas of the brain. They received SLP treatment for a month in the hospital following their stroke but haven’t received any further services since. They both express to you that they would like more help with their communication skills. During your assessment, you get a narrative language sample from each talking about the “cat rescue” picture below. Here are the transcripts of their language sample, which are typed without punctuation. The number of dots indicates the relative durations of pauses. *Mrs. Li’s Transcript (110 words per minute) Hmm.. okay. ..well I guess the cat is barking and ……uh…. the dog is barking under the tree and the police ..um…firefighters are arriving and it’s …. they have that thing….to go up..stairs…. they are gonna….trying to bring him down…..the man… bring the man down…and here….the girl…the cat…hmm… the girl wants to help the cat…..hm……well … um not too good a deal I’d say. *Mr. Martin’s Transcript (40 words per minute) Um…um…uh….tree.and…um…and…..and dog….dog bark..and…and…..trouble…….dad stuck…..and…and…um..um..dog .dog …and….and… firefighfer…..firefighfer is coming Select 2 similarities between the two transcripts: Phonemic paraphasia Semantic paraphasia Anomia Use of fillers Fluent Speech Agrammatism 3.Based on the language sample and case information, you determine that the possible type of aphasia for Ms.Li is Wernicke’s aphasia Global aphasia Mixed transcortical aphasia Anomic aphasia 4.Based on the language sample and case information, the probable lesion site for Ms. Li is Angular gyrus; BA 39 Inferior frontal lobe; BA 44 and 45 Large perisylvian lesion; BA 40, 44, 45, 39, & 22 Posterior portion of the superior temporal gyrus; BA 22 5. Based on the language sample and case information, you determine that the possible type of aphasia for Mr. Martin is Transcortical sensory aphasia Broca’s aphasia Wernicke’s aphasia Global aphasia 6. Based on the language sample and case information, the probable site of lesion for Mr. Martin is Large perisylvian lesion; BA 40, 44, 45, 39, & 22 Temporal lobe watershed regions; BA 37 and 39 Inferior frontal lobe; BA 44 and 45 Posterior portion of the superior temporal gyrus; BA 22 7. Match the mechanisms of brain changes following a stroke or brain injury with the correct terminology. ______ Reperfusion ______ Cortical reorganization ______ Reduction of edema ______ Unmasking of preexisting pathways Answers Brain-behavior relations are modified as areas of brain tissue take on new functions that they did were not responsible for prior to the injury. The restoration of blood flow to areas of hypoperfusion, with the surrounding brain tissue becoming more functional. Inactive or inhibited neural connections may be activated and help compensate for neural connections lost due to injury. When swelling improves, the compression of surrounding brain tissue is reduced and areas that were temporarily malfunctioning will return to normal functioning. 8. Match the following neuroplasticity principles with the correct definition: Prompts: A. Use It or Lose It B. Transference C. Interference D. Salience Matters E. Specificity Answers: ______ The nature of the training experience dictates the nature of the plasticity. ______ Plasticity in response to one training experience can enhance the acquisition of similar behaviors. ______ Neural circuits begin to degrade over time when they are not actively engaged in a task. _______ Plasticity in response to one experience can impede acquisition of other behaviors. _______ Neuroplasticity is induced when the training tasks are relevant to the patient. 9. Scenario: You get 2 clients on your caseload at an outpatient rehabilitation center. They both have had a left MCA VA in the last 6 months, but in different areas of the brain. They received SLP treatment for a month in the hospital following their stroke but haven’t received any further services since. They both express to you that they would like more help with their communication skills. During your assessment, you get a narrative language sample from each talking about the “birthday party” picture. Here are the transcripts of their language sample, which are typed without punctuation. The number of dots indicates the relative durations of pauses. *Ms. Li’s Transcript (105 words per minute) And..oh, okay…what do you call it…well guess the cat got into it and the..uh..he’s hiding under the sitter and the mother is gonna. trying to get him out of there…and he cleaned up the rug with ahm..well ….those ones there…children…boys and girls…are arriving and it’s …um not too good a deal I’d say. *Mr. Martin’s Transcript (40 words per minute) Um…um…uh…cake…and…um…and…and dog….dog ate cake..and..and…..trouble….mom is mad……and….and…um..um..kid is crying..and.and…neighbors……neighbors is coming * Source: Brookshire, R.H., (2007). Introduction to neurogenic communication disorders. Mosby. Which general treatment approach would you take with Ms. Li, restorative, compensatory, or both? Based on the case information, Ms. Li will benefit from a ______________ approach. (Please check your spelling.) 10. Scenario: You get 2 clients on your caseload at an outpatient rehabilitation center. They both have had a left MCA VA in the last 6 months, but in different areas of the brain. They received speech/language therapy for a month in the hospital following their stroke but haven’t received any further services since. They both express to you that they would like more help with their communication skills. During your assessment, you get a narrative language sample from each talking about the “birthday party” picture. Here are the transcripts of their language sample, which are typed without punctuation. The number of dots indicates the relative durations of pauses. *Ms. Li’s Transcript (105 words per minute) And..oh, okay…what do you call it…well I guess the cat got into it and the..uh..he’s hiding under the sitter and the mother is gonna…trying to get him out of there…and he cleaned up the rug with a..hm.well ….those ones there…..children…..boys and girls…are arriving and it’s …um not too good a deal I’d say. *Mr. Martin’s Transcript (40 words per minute) Um…um…uh….cake…and…um…and…and dog….dog ate cake…and…and…..trouble……mom is mad……and….and..um..um.kid is crying…and..and…neighbors…neighbors is coming * Source: Brookshire, R.H., (2007). Introduction to neurogenic communication disorders. Mosby. More specifically, which evidence-based treatments) would you select for Ms. Li and why? (Ensure the rationale is also true). Oral Reading for Language in Aphasia (ORLA) because it is a compensatory approach that will enable Ms. Li to improve both her reading skills and her drawing skills through multimodal communication. Semantic Feature Analysis (SFA) because it uses both restorative and compensatory approaches to strengthen access to semantic neural networks while also offering a way for her to independently self-cue and use an SFA chart. Semantic Feature Analysis (SFA) because it is a restorative approach in which any form of communication is accepted with a communication partner, as long as it is meaningful. Script Training because it is a restorative approach that strengthens the verb networks in the brain while also offering a compensatory tool through writing. Script Training because it provides a compensatory technique to help the client communicate through writing. 11. Select the short-term goal for Mrs. Li that includes all the components of a SMART treatment goal: Mrs. Li will label 10 different kitchen items, when pointed to by a familiar individual, with 80% accuracy. Mrs. Li will produce a complete or partially complete sentence with imperative intransitive sentence in 4/5 attempts across three consecutive sessions. Mrs. Li will produce a minimum of 3 different features, when presented with personally relevant words using semantic feature analysis, given minimal verbal prompts and a visual graphic organizer, with 80% accuracy, to improve word finding abilities and facilitate communication with her conversational partners. When asked to describe a scene picture card, Mrs. Li will demonstrate 3 strategies word retrieval strategies with minimal cues over 3 consecutive sessions. 12. Scenario: You get 2 clients on your caseload at an outpatient rehabilitation center. They both have had a left MCA VA in the last 6 months, but in different areas of the brain. They received speech/language therapy for a month in the hospital following their stroke but haven’t received any further services since. They both express to you that they would like more help with their communication skills. During your assessment, you get a narrative language sample from each talking about the “birthday party” picture. Here are the transcripts of their language sample, which are typed without punctuation. The number of dots indicates the relative durations of pauses. *Ms. Li’s Transcript (105 words per minute) And..oh, okay…what do you call it…well I guess the cat got into it and the uh..he’s hiding under the sitter and the mother is gonna…trying to get him out of there…and he cleaned up the rug with a..hm..well ….those ones there…children…boys and girls…are arriving and it’s …um not too good a deal I’d say. *Mr. Martin’s Transcript (40 words per minute) Um…um…uh…cake. and…um…and…and dog….dog ate cake…and…and…..trouble……mom is mad……and..and..um..um..kid is crying..and..and…neighbors…neighbors is coming * Source: Brookshire, R.H., (2007). Introduction to neurogenic communication disorders. Mosby. Which general treatment approach would you take with Mr. Martin, restorative, compensatory, or both? Based on the case information, Mr. Martin will benefit from a ______________________ approach. (Please check your spelling.) 13. Scenario: You get 2 clients on your caseload at an outpatient rehabilitation center. They both have had a left MCA VA in the last 6 months, but in different areas of the brain. They received speech/language therapy for a month in the hospital following their stroke but haven’t received any further services since. They both express to you that they would like more help with their communication skills. During your assessment, you get a narrative language sample from each talking about the “birthday party” picture. Here are the transcripts of their language sample, which are typed without punctuation. The number of dots indicates the relative durations of pauses. *Ms. Li’s Transcript (105 words per minute) And..oh, okay…..what do you call it…well I guess the cat got into it and the..uh..he’s hiding under the sitter and the mother is gonna.. trying to get him out of there…and he cleaned up the rug with ahm.well ….those ones there…..children…..boys and girls…are arriving and it’s …um not too good a deal I’d say. *Mr. Martin’s Transcript (40 words per minute) Um…um…uh….cake. and…um…and…and dog….dog ate cake…and…and…..trouble….mom is mad…..and..and..um..um..kid is crying..and..and…neighbors…neighbors is coming * Source: Brookshire, R.H., (2007). Introduction to neurogenic communication disorders. Mosby. More specifically, which evidence-based treatments) would you select for Mr. Martin. and why? (Ensure the rationale is also true). Verb network strengthening treatment (NeST) because it is a restorative approach that targets repetition of action words and writing skills Response Elaboration Training (RET) because it is a restorative approach that activates the preserved right hemisphere by turning functional words into automatic speech. Verb network strengthening treatment (NeST) because it is a compensatory approach that restores neural networks by allowing the patient to self-cue using gestures. Promoting Aphasics Communication Effectiveness (PACE) as this compensatory approach targets effective exchanges of information using multi-modal communication. Additionally, Script Training may be used as a restorative approach for Mr. Martin to verbally convey information in socially meaningful environments. 14. Select a short-term goal for Mr. Martin that includes all the components of a SMART treatment goal: In three months, Mr. Martin will describe a picture using humming and tapping cues/strategies with 80% accuracy over 3 sessions. Mr. Martin will increase production of canonical sentence structure with 80% accuracy and 8/10 sentence prompts across 4 consecutive sessions with moderate cueing. Mr. Martin will improve structured sentences production using subject-verb-object mapping skills when given picture supports in 8/10 opportunities across 3 consecutive sessions To increase participation in social conversations, Mr. Martin will use multimodal communication to successfully convey information with the clinician or communication partner in 8/10 opportunities with moderate visual cues. 15. Read the following interaction that Mr. Martin had with a healthcare professional during his last doctor’s visit: Nurse: Hello Mr. Martin, what brings you in today? Mr. Martin: ……um… Nurse [impatiently tries again using a louder voice] MR MARTIN…WHAT….. BRINGS…YOU…. IN….. TODAY? Mr. Martin: … [points to chest]…. Umm…uh… hee…. [keeps pointing to chest]. Nurse: Looks at Mrs. Martin, who was there with her husband for the appointment, and asks] has he been complaining about chest pain lately? List three concepts that you learned from the Supported Communication for Adults with Aphasia (SCA???) module that may help this healthcare professional interact successfully with Mr. Martin. Answer: 16. Given your knowledge about intensity, frequency, and duration of treatment, what would you suggest for plan of care development for a client with a neurogenic communication disorder? Select exactly 6 that apply. If you select more than 6, points will be deducted. Consider the relation between the patient’s prognosis and what is feasible for the amount of treatment they can receive Select a high-intensity treatment program, as this will yield better results for all patients, per evidence-based research. Consider the factors of endurance and fatigue when determining the length of a session that a patient can tolerate If the patient presents with a severe neurogenic communication disorder and is amenable to high-frequency treatment, then we may recommend treatment 2-3 times per week, versus once a week or every other week. Selecting the right treatment intensity is dependent on several factors, including, but not limited to the severity of the disorder (S), the patient’s overall health, the clinical setting, and the patient’s awareness of deficits. Selecting the treatment frequency and duration is solely dependent on the patient’s health insurance coverage. It is more appropriate to space out treatment sessions at a low frequency over a long duration than at a high frequency over a short duration of time. SLPs should engage in collaborative discussion with other members of the treatment team to determine the ideal treatment intensity across allied health disciplines. The treatment goals independently mandate the treatment intensity, frequency, and duration. Consider the unique complexities of each patient and determine a treatment plan of care with the knowledge that the intensity, frequency, or duration of treatment may need to be modified as treatment progresses. 17. How is the WHO ICF framework different from the A-FROM model? The WHO IF framework is for people with aphasia, while the A-FROM model is for people with any type of communication, cognitive, or swallowing disorder. The WHO IF framework is a medical model, solely focused on a person’s body structures and functional impairment, while the A-FROM is focused on the whole person. The WHO ICF framework and the A-FROM model are exactly the same. The A-FROM model is an adaptation of the WHO IF model, specifically for people with aphasia. 18. In what ways is AAC use relevant to the treatment of people with aphasia? Select exactly 2 that are true. If you select more than 2, points will be deducted. Communication is a human right, therefore, individuals with aphasia are entitled to tools that can provide better life participation AAC is a restorative approach that includes the whole brain, allowing the patient both physical and cognitive stimulation. AAC is a compensatory approach that can provide an alternative means of expressing basic wants and needs. AAC is not recommended for aphasia because it takes away opportunities to use speech for communication. AAC requires comprehension and cognition; therefore, it should not be used with individuals with aphasia because there is no way to assess their cognitive status. 19. Which of the following are considered to fall within the ethical roles and responsibilities of speech-language pathologists, when working with individuals with aphasia? Select exactly 4 correct answers. If you select more than 4, points will be deducted. Diagnosing a person with a lesion in a specific area of the brain Providing legal advice Conducting cultural-linguistically appropriate screenings and comprehensive aphasia assessments Diagnosing a patient with a psychiatric disorder Advocating for people with aphasia and their families, and supporting patients’ communication so that they can self advocate Offering person-centered, evidence based aphasia treatment Providing education about prevention measures and offering communication-centered counseling 20. As SLPs, it’s important for us to be aware of the psychosocial factors of aphasia. Select exactly 2 that are true. If you select more than 2, points will be deducted. People who have aphasia are more likely to present with depression, anxiety, and emotional distress than those who survive a stroke and do not have aphasia People with aphasia typically present with anxiety, but it is extremely rare that they present with depression or emotional distress. Friendships are often impacted by aphasia, but not family relationships or a person’s self-confidence. People with aphasia may socially isolate, which is a major public health risk and may lead to different negative health consequences 21. How might you, as an SLP provide effective counseling to a patient with a neurogenic communication disorder who is facing psychosocial challenges? Select exactly 4 that apply. If you select more than 4, points will be deducted. By enrolling in continuing education courses to gain counseling knowledge By reading books about counseling and life coaching Only through enrolling in a clinical psychology program can one gain these competencies By finding a mentor with expertise in counseling and coaching, to support your ongoing professional development By reading evidence-based research about the integration of counseling and coaching in the context of speech-language pathology treatment By entirely relying on your clinical instincts and providing counseling to your friends/family as a means of practice. 22. Scenario: Sarah is a 33-year-old female who had an ischemic attack secondary to embolization 2 years ago. A CT scan indicated a large infarction in the posterior-lateral margins of the frontal lobe and temporal-parietal lobes on the left. A speech therapy examination revealed some right-side facial asymmetry. She followed one-step commands. Orientation was difficult to determine due to limited language output. Her attempts at speech were characterized by groping and off-target sound selection. She was intelligible when she produced single-word monosyllabic words. However, beyond this, her speech was characterized by errors such as sound and syllable transpositions, articulatory groping, and sound additions. Her presentation is consistent with Broca’s aphasia and moderate-severe apraxia of speech. Sarah is married with three girls and worked in insurance sales until she had the CVA. Her husband is very involved with her care but often gets frustrated with not being able to communicate with her. She has been receiving speech/language therapy ever since the incident. However, her doctor recently told her that she is unlikely to make any further improvements in her communication skills. QUESTION: If you were her SLP, would you agree with this prognosis and discharge her from therapy? (Choose the BEST answer and ensure the rationale is also true). Yes because the doctor is the medical professional and knows more about communication prognosis. No because someone with severe deficits should always have therapy. Yes because it has been two years, which means the patient is in the chronic stage. Also, it is clear that the patient has tried absolutely every type of treatment. No because patients in the chronic stage can show improvement, even several years after their stroke. Also, the patient has other positive prognostic factors, such as her age. 23. Scenario: Sarah is a 33-year-old female who had an ischemic attack secondary to embolization 2 years ago. A CT scan indicated a large infarction in the posterior-lateral margins of the frontal lobe and temporal-parietal lobes on the left. A speech therapy examination revealed some right-side facial asymmetry. She followed one-step commands. Orientation was difficult to determine due to limited language output. Her attempts at speech were characterized by groping and off-target sound selection. She was intelligible when she produced single-word monosyllabic words. However, beyond this, her speech was characterized by errors such as sound and syllable transpositions, articulatory groping, and sound additions. Her presentation is consistent with Broca’s aphasia and moderate-severe apraxia of speech. Sarah is married with three girls and worked in insurance sales until she had the VA. Her husband is very involved with her care but often gets frustrated with not being able to communicate with her. She has been receiving speech/language therapy ever since the incident. However, her doctor recently told her that she is unlikely to make any further improvements in her communication skills. QUESTION: Which prognostic indicators would inform your decision to continue with SLP treatment or not? Select exactly 5 that apply. If you select more than 5, points will be deducted. A consideration of different aspects of recovery, specifically those that have not been explored in treatment yet, but which have a positive prognosis. Sarah’s gender Sarah’s willingness to learn and practice compensatory strategies. Sarah’s stimulability and willingness to learn how to use multimodal communication/AAC to support verbal communication. Sarah’s facial asymmetry. Social support from Sarah’s husband/family. Sarah’s pre-onset factors (including age and educational status) and post-onset status (e.g.. awareness of deficits, tolerance for treatment, motivation) Sarah’s coordination and ambulation abilities. 24. Scenario: Sarah is a 33-year-old female who had an ischemic attack secondary to embolization 2 years ago. A CT scan indicated a large infarction in the posterior-lateral margins of the frontal lobe and temporal-parietal lobes on the left. A speech therapy examination revealed some right-side facial asymmetry. She followed one-step commands. Orientation was difficult to determine due to limited language output. Her attempts at speech were characterized by groping and off-target sound selection. She was intelligible when she produced single-word monosyllabic words. However, beyond this her speech was characterized with errors such as sound and syllable transpositions, articulatory groping, and sound additions. Her presentation is consistent with Broca’s aphasia and moderate-severe apraxia. What type of assessments/measures were given to yield these diagnostic findings? Select exactly 4 that apply. If you select more than 4, points will be deducted. Motor speech evaluation Quick Assessment for Aphasia, as an initial screening to determine if a formal evaluation is required Goldman Fristoe Test of Articulation Apraxia Battery for Adults Western Aphasia Battery-Revised Weschler Adult Intelligence Scale Progressive Aphasia Severity Scale 25. Sarah is a 33-year-old female who had an ischemic attack secondary to embolization 2 years ago. A CT scan indicated a large infarction in the posterior-lateral margins of the frontal lobe and temporal-parietal lobes on the left. A speech therapy examination revealed some right-side facial asymmetry. She followed one-step commands. Orientation was difficult to determine due to limited language output. Her attempts at speech were characterized by groping and off-target sound selection. She was intelligible when she produced single-word monosyllabic words. However, beyond this, her speech was characterized by errors such as sound and syllable transpositions, articulatory groping, and sound additions. Her presentation is consistent with Broca’s aphasia and moderate-severe apraxia. She is married with three girls and worked in insurance sales until she had the VA 2 years ago. Her husband is very involved with her care but often gets frustrated with not being able to communicate with her. She has been receiving speech/language therapy ever since the incident. However, her doctor recently told her that she is unlikely to make any further improvements in her communication skills. QUESTION: If you decided to continue SLP services, which of the following practice and feedback conditions would you apply, based on the motor speech principles reviewed in Maas et al. 2008? Select exactly 6 that apply. If you select more than 6, points will be deducted. Large practice amount: high number of practice trials or sessions Small practice amount: low number of practice trials or sessions Distributed practice: practice a given number of trials or sessions over longer period of time Massed practice: practice a given number of trials or sessions in small period of time. Constant practice: practice on the same target, in the same context (e.g., syllable-initial /f/) Variable practice: practice on different targets, in different contexts (e.g., syllable-initial and final /f/, /z/, /b/ ) Random practice schedule: different targets practiced in intermixed fashion (e.g., practice on /f/ and /z/ in each session) Blocked practice schedule: different targets practiced in separate, successive blocks or treatment phases (e.g., treatment on /f/ before initiating treatment on /z/) Internal attentional focus: focus on bodily movements (e.g., articulatory placement) External attentional focus: focus on effects of movements (e.g., acoustic signal) Immediate feedback: feedback immediately following attempt at production Delayed feedback: feedback provided with a delay (e.g., 5 s) Fill in the Blank. 26. A compensatory treatment approach in aphasia, where individuals may use any mode of communication desired to convey a message. The aim of this approach is to communicate effectively versus to communicate perfectly. This approach is called ___________________________. (Please do not abbreviate.) 27. A treatment approach for people with severely restricted verbal output, involving a hierarchy of tasks ranging from simple gesturing, to the use of pictures paired with gestures and objects, to gesturing without real or picture stimuli, is called _______________________________. (Please do not abbreviate.) 28. A treatment approach involving the collaborative development and intensive practice of personally relevant material in monologue or dyad form is called ____________________________ (Please do not abbreviate.) 29. A specific treatment approach focused on increasing verbal production abilities through the use of humming, singing, hand tapping, exaggerated intonation and prosody, and sprechgesang is called _________________________________. (Please do not abbreviate.) 30. A loose training program involving the expansion of utterances and the use of increased linguistic variety. Clients are shown pictures and then asked to talk about thoughts that come to mind that they associate with the picture. The clinician responds and encourages continued comments from the client. This treatment approach is called ________________________ (Please do not abbreviate.) 31. ______________________ is a treatment approach designed to improve lexical retrieval using a “graphic organizer” to compare features of objects and meanings of object names to those of other terms that fall in the same category or class, increasing the level of activation within semantic networks. (Please do not abbreviate.) 32. ______________________ is a restorative approach where clients are unable to use compensatory modalities. Instead, they must use the modalities that are most impaired, in order to stimulate and improve these abilities. (Please do not abbreviate.) 33. ________________________ is a treatment method for people with dyslexia associated with any form and severity level of aphasia. This treatment fosters recovery of reading comprehension skills through unison and solo reading practice, using phonological and semantic routes and associated feedback. (Please do not abbreviate.) 34. A treatment approach in which a person with dysgraphia copies words directly, writes target words corresponding to pictures, and writes words through recall (if possible) is _________________________. (Please do not abbreviate.) 35. How does apraxia of speech differ from aphasia? Apraxia of speech is a cognitive impairment while aphasia is a language impairment. Aphasia is a language impairment while apraxia of speech is a motor speech impairment. Aphasia is an expressive language impairment while apraxia of speech is a pragmatic language impairment. Apraxia of speech is synonymous with aphasia 36. This apraxia of speech treatment approach emphasizes correct articulatory positions and uses tactile, kinesthetic, and pressure cues to the client’s face and neck to assist with speech production. Contrastive Stress Drill Integral Stimulation Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Sound Production Treatment Naturalistic Gesture 37. This apraxia of speech treatment is an articulatory approach that incorporates modeling, repetition, minimal pairs, integral stimulation, articulatory placement cues, and clinician feedback. Contrastive Stress Drill Signing Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Augmentative and Alternative Communication (AAC) Sound Production Treatment 38. Imagine that you have a patient with a neurogenic communication disorder who is presenting with new signs and symptoms that you suspect are consistent with depression. What should you, as an SLP, do? Select exactly 2 best choices. If you select more than 2, points will be deducted. Discharge the p

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