(5) Assessment Flashcards
Chapter 5
Aphasia Assessment
Quantitative & qualitative data-gathering process of circumscribing an individual’s communicative function & activity limitations, understanding participation restriction, & devising appropriate rehabilitation objectives
Tools and Procedures
-Establish a diagnosis & prognosis
-Describing & understand all components of language functioning & related functions
-Gathering background information regarding individual with aphasia & family
-Seek input from the person with aphasia & family about assessment & rehabilitation goals
-Supporting initial communication interactions with the individual with aphasia
Assessment Administration
Procedures are divided into formal (administration of standardized tests) & informal (strategies employed by the clinician)
What type of test: encompasses many variables and usually yields quantitative results?
Formal assessments
Formal Assessment
Used as a synonym for a test
-Encompasses many variables
-Usually yields QUANTITATIVE results
Informal Assessment
Refers to the process of gathering information & observing patient’s behavior to make clinical decisions
-Usually yields QUALITATIVE results
Patient-related factor:
Where within the care continuum the individual with aphasia is receiving services
Purpose of formal assessment procedures
-establish the current level of communicative and cognitive functioning in the individual with aphasia
- identifying the presence, type and severity of aphasia
- delineating specific language and cognitive strengths and weaknesses
What does the ICF model construct?
-Loss of body function and structures
-Restrictions in activity participation
-Person factors
-Environmental factors
ICF Model
-ICF model constructs
Loss of body functions & structures
Restrictions in activity participation
Personal factors
environmental factors
-Assessment protocols should go beyond traditional focus & include additional formal & informal procedures to identify ACTIVITY & PARTICIPATION ISSUES and INFLUENTIAL ENVIRONMENTAL PERSONAL FACTORS
Standardization refers to
extensive sample of individuals who represent the population with whom the test will be used
Types of validity
- Content
- Construct
- Ecological
- Criterion related (predictive)
The process of administering a test to an extensive sample of individuals who represent the population segment on whom the test will be used
Standardization
Evidence-Based Practice
-Useful in guiding selection & administration of aphasia assessment procedures
-Clinicians should keep alongside advances in tests and procedures for QUANTIFYING and QUALIFYING aphasia & also critically evaluate these advances in terms of their VALIDITY & APPLICABILITY
Provides info pertaining to the degree with which a test yields similar data across repeated administrations under similar testing circumstances
Reliability
How would a clinician identify the most approapriate test for a client?
- consider the specific goals of the assessment
- review the psychometric characteristics of each test
Provides info on how well a test measures the skills or function that it contends to measure
Content validity
Boston Naming Test Spanish
developed to evaluate confrontation naming in Spanish Speakers, ensuring that culturally loaded items from the original BNT were excluded and items were reordered to reflect naming difficult in Spanish versus English
A type of criterion-related validity that indicates how well clients test scores reflect their behavior in their typical environments during their daily activities and interactions
Ecological validity
EBP Guidelines
-Utilizing aphasia test procedures that have been evaluated & found appropriate in the research literature
-Administering aphasia test procedures in the manner with which they were empirically verified
-Considering their own clinical knowledge & skills, the best available evidence in professional literature, & specific client’s needs & preferences
reflects the accuracy with which a test determines a client has a deficit
Criterion related validity (also known as predictive validity)
Give a future direction needed to further the development of formal tests?
-Improvement of psychometric qualities
-Assessment of every domain of the ICF model
-Consideration of the restricted assessment times that often lead to rushed evaluations
-Telerehabilitation as an emerging viable service delivery model for individuals with aphasia who don’t have access to therapy
Formal Assessment Purpose
-Establish current level of patient’s communicative & cognitive functioning
-Identify presence, type, & severity of aphasia
-Delineating specific language & cognitive strengths & weaknesses
-Utility of formal assessment results
*Establish pre therapy performance level, info is fundamental to decisions regarding diagnosis and prognosis
*contribute to distinguishing and prioritizing treatment goals
*Inform decisions regarding the need to continue, modify, or discontinue treatment
Fundamental psychometric properties that require discussion int he test manual include..
- standardization
- reliability
- validity
T/F
For bilingual individuals unless there is a formal test battery in a target language, all assessment will be informal in nature
True
Psychometric
Relating to or deriving from psychometry or psychometrics
Standardization (psychometric property)
Process of administering a test to an extensive sample of individuals who represent the population segment on whom the test will be used
True or False: individuals with aphasia who use more than one language must be assessed in each of their languages?
True
Reliability (psychometric property)
Provides information pertaining to the degree with which a test yields similar data across repeated administrations under similar testing circumstances
If the clinician themself is not bilingual or bicultural what is the only alternative?
To assess the person indirectly by recruiting help of a translator/interpreter
Refers to the pretherapy measurement or probing of clinical objectives
Baselining
Validity (psychometric property)
Degree of theoretical and empirical support a test has
Content Validity of a Test
Provides information regarding how well a test measures the skills or functions that it contends to measure
Ecological Validity
Type of criterion-related validity that indicates how well clients’ test scores reflect their behavior in their typical environments during their daily activities and interactions
Criterion-related validity (AKA predictive validity)
Reflects the accuracy with which a test determines a client has a deficit
-Sensitivity and specificity
Aphasia Batteries
-Western Aphasia Battery- Revised
-Scales of Cognitive & Communicative Ability for Neurorehabilitation
-Boston Diagnostic Aphasia Examination-3
-Aachen Aphasia Test
Aphasia Batteries SEVERE Cases
-Scenario Test
-Assessment of Communicative Effectiveness in Severe Aphasia
Screening tests (presence or absence of aphasia)
-Shortened forms of WAB-R
-BDAE-3
Tests of specific linguistic skills (in-depth evaluation of a linguistic process)
-BNT
-Northwestern Assessment of Verb and Sentences
-Psycholinguistic Assessments of Language Processing in Aphasia
Discourse Sampling and Analyses
-connected speech or discourse is examined either minimally or not at all by most formal aphasia or language tests
-need to throughly examine connected speech or discourse at the activity participation level of the ICF model
-Assessment of certain language skills (e.g. turn taking) that pertain to discourse
-sensitive and thus useful for quantifying more modest treatment-related improvements
Tests of cognitive skills
-individuals with aphasia frequently have concomitant cognitive deficits
-cognitive deficits may negatively affect language abilities, treatment outcomes, quality of life, and caregivers’ level of burden
-cognitive test performances of individuals with aphasia cannot always be predicted based on their aphasia severity
-research with the stork patient population has found that informal evaluation alone will miss a significant number of cognitive symptoms
-assessment of attention, memory, and executive function abilities
Assessing Activity Participation
-structured communication activities, similar to those encountered in typical, daily activities, are used to provide information about the communication-related Activity Participation
-may use rating scales that either individuals with aphasia and/or individuals familiar with the individual with aphasia (e.g. clinician, family member) complete
-measure of participation in conversation (MPC) scale is used for individuals with aphasia who struggle to complete self-report measures
Assessing Environmental Factors
-Comprehensive aphasia assessment should extend to include evaluation of the family or close caregivers
-family and caregivers can provide valuable information not only pertaining to changes in the individual with aphasia subsequent to its onset but also to the identification of potent Contextual Factors
Caregiver Evaluation
-perspective of caregivers and other daily communication partners is essential, particularly when attempting to determine the impact of Environmental Factors
-Family and caregiver perspectives may be fundamental when evaluating individuals with aphasia who have more severe comprehension impairments or decreased insight
Assessing Personal Factors
-examination of how aphasia and the concomitant impairments affect individuals’ perceptions of themselves and their overall QOL or well-being
-some individuals with aphasia will still be unable to provide their own QOL ratings because severe linguistic or cognitive impairments confound their comprehension of test items or their awareness of their symptoms
*spouse, family member, or other person who knows them well will need to serve as a proxy rater
QOL measurements
designed to evaluate feelings, experiences, attitudes, and beliefs that may positively or negatively influence an individual’s ability to participate and take pleasure and satisfaction in life
Formal Assessment: Logic, Purposes, and Procedures
-a crucial intermediary step between formal testing and therapy and a process of seeking answers rather than a process of steps
-good observation skills and critical thinking to select appropriate clinical goals according to the formal testing results
-more functional tests or questionnaires in the domains of Activity Participation, Personal Factors, and Environmental Factors of the ICF model
-Clinicians should develop pertinent hypotheses and answer them effectively (dynamic assessment)
4 Questions that need to be asked in informal assessment
- What is the extent of the problem?
- Where does the behavior break down?
- What helps the behavior?
- What is/are the underlying cause of the difficulty?
