Written Case Studies

The intent of the Written Case Studies is to demonstrate, as well as can be done in writing, advanced clinical competency in neurologic communication disorders.  The Candidate will prepare two distinct Written Case Studies that will include a diagnostic report, a treatment plan, results of its implementation, and analysis of the intervention for a patient with a neurologic communication disorder that the Candidate has treated or is currently treating.  The Case Studies will be submitted successively.  In other words, the second Case Study cannot be submitted until the first Case Study is deemed a “pass.”

A.   Selecting Patients for the Written Case Studies

The selection of routine, typical or classic cases is perfectly acceptable for the Written Case Studies, as is selection of a treatment that is considered standard.  It is not essential that the Candidate demonstrate that he or she sees unusual or atypical patients, or that he or she has developed a new or unique treatment for a common or an unusual problem.  This would not, however, preclude selection of an unusual case or a unique treatment.  In order to maintain compliance with HIPAA, the Case Study must not contain the patient’s name or other personal identifying information.

The two Case Studies submitted must be distinct in etiology, diagnosis, treatment approach, and neurologic considerations as is possible given the Candidate’s caseload.  The Case Studies should be chosen such that together they demonstrate depth and breadth of knowledge in the assessment and treatment of neurologic communication disorders.  Additionally, critical thinking and judgment should be evident at multiple points throughout assessment and treatment. 

B.   Content Areas

Both Written Case Studies should address the following content areas using the headings underlined below.  Content areas may be arranged in any order that the Candidate determines appropriate; however, all content areas must be addressed.

Relevant History

This section includes comprehensive demographic information (age, gender, education, occupation, etc.), relevant medical history, current clinical neurologic findings and premorbid communication status presented in a HIPAA compliant manner.

Neurologic Considerations

This section includes a discussion regarding the neurologic diagnosis and presumed underlying anatomical and physiological substrates, along with a commentary on the relationships between these substrates and the clinical signs presented by the patient.  A brief discussion of the results of any neuro-imaging studies (e.g., MRI, CAT) conducted with regard to the speech-language diagnosis should be included here if neuro-imaging data are available.  In addition the influence of the neurologic diagnosis and other relevant factors on diagnosis, prognosis, and treatment of the communication disorder should be discussed.

Assessment Methods/Tests and Results

This section includes specific standardized and/or non-standardized assessment procedures used, with rationale for their use.  Results should be summarized in a way that is succinct and easy to review, such as in tables or figures.  Include test scores and interpretation when possible.

Diagnostic and Prognostic Conclusions

This section includes information regarding differential diagnosis, as well as severity and prognosis with supporting rationale.  The Candidate should specify how the differential diagnosis of the communication disorder is consistent with or not compatible with the neurologic findings (e.g., clinical exam, neuroradiologic results).

Management Recommendations and Procedures

This section includes information regarding the management approach chosen as well as the therapy goals and procedures that were implemented.  The Candidate should indicate how the treatment approach meets standards of evidence-based practice.  The description of clinical decisions regarding frequency of sessions, stimuli content, how practice was organized within the session, how pre-/-co-existing conditions were accommodated, etc. should be made clear and include rationale.  If a treatment approach is unique (not described in the literature), it must be defined explicitly.  If the treatment represents an application of something well described in the literature, a reference to the literature will suffice, with appropriate modifications for the given patient.  In either case it is essential to include rationale for the decisions about treatment.

Data Documenting Outcome of Treatment

This section includes a brief description of the outcome measures chosen with rationale specifically stated.  If methods and procedures other than standardized instruments were utilized during the speech-language outcome, a thorough description and analysis of them must be included.  To the extent possible the Candidate should address the efficiency, effectiveness, and efficacy of the procedures used by citing appropriate empirical evidence or provide explanation of lack thereof.  Sample data from treatment tasks should be included to support outcomes.  

Rationale for Termination of Treatment and Follow-up Recommendations

This section includes a rationale for any changes in treatment as well as rationale for concluding treatment.  If the patient is still participating in speech-language intervention, the Candidate should state the criteria that will be used for termination of treatment.  A statement of recommendations for any follow up (home programs, scheduled re-evaluations, etc.) should be included.

Quality Assessment Statement

The Candidate should discuss why the treatment was or was not successful, as well as why and how he or she might have done things differently.  A brief statement of how this case was typical or atypical (diagnostically and in management) should be included.

C.   Final Checklist for Submitting the Written Case Study

    1. A Case Study that does not address all of the preceding eight content areas or fails to delete patient identifying information will be returned for appropriate revisions before the Written Case Study is sent to the examining team for review.
    2. The Written Case Study, including all tables, figures, and references should be no more than 25 double-spaced pages. 
    3. The quality of the writing is important and should meet publication standards.  The case study should be concise, yet specific.  Careful attention should be paid to organization, transitions, and referents.  The gold standard would be publication quality minus requirements for experimental rigor.
    4. The reviewers will be guided by the following questions.  It would be in the best interest of the Candidate to keep these questions in mind as they prepare the written report.
      • Have the eight content areas been adequately addressed, and have the headings been used in the document?
      • Has all patient identifiable information been deleted?
      • Does the quality of writing meet publication standards?  Is the report clear and succinct? Does it enhance the reader’s ability to understand the material?
      • Is the Written Case Study limited to 25 double-spaced pages?
      • Did the Candidate specifically cite the differential diagnosis including the relative contribution of cognitive, linguistic and motor deficits?  Were the nature of the patient’s problem and the severity of the deficit clearly conveyed?
      • Are standardized and non-standardized test results and interpretations consistent with the patient’s speech-language pathology diagnosis?  If not, are incongruities sufficiently explained?
      • Do the recommendations for management make sense given the patient’s history, the neurologic diagnosis, cognitive and physical status, and the communication disorder diagnosis?  Does the author provide sufficient rationale for decisions about intervention?
      • Are the goals and procedures of treatment explained either explicitly within the Case Study or by references to literature that explicitly explains them?
      • Does the treatment data included in the Case Study adequately document the outcome of the treatment?  Is the interpretation of the outcome consistent with the data?
      • Do follow-up recommendations follow logically from the outcome of treatment and the patient’s status at the end of treatment?
      • Does the overall content and form of the Case Study convey an impression that the Candidate has advanced knowledge of neurologic communication disorders and advanced clinical competency in differential diagnosis and treatment of neurologic communication disorders?

D.   Review Process

A three-member team, designated as the Review Team, will read the Written Case Studies.  The reviewers will have no knowledge of the Candidate’s name or other identifying information.  The Candidate, author of the Case Study, will also have no knowledge of the identity of the reviewers.  The Review Team will remain the same for both Case Studies and the Oral Presentation and Discussion.

The Review Team will evaluate each Case Study and determine either:

  • Pass – Move to the next step (Oral Presentation and Discussion).
  • Revise – Either the content or quality of writing is insufficient to determine evidence of advanced clinical competency.  The Written Case Study must be revised based on the reviewer’s comments and reviewed again by the same Review Team.
  • Does not meet standards – The Candidate cannot continue the process.

A Written Case Study that is evaluated as a “Does not meet standards” may not be resubmitted.  However, at the discretion of the Review Team, the Candidate may submit a new Case Study if the two-year time period has not been exceeded. 

E.   Sample Case Studies

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