Adult Lang Cog Assessment Flashcards
Language and cognition are ________
Recursive
What does it mean that language and cognition are recursive?
- Language is created in the mind to be used externally but is also used internally to process what we experience
- Our language greatly influences what we perceive in our specific “worlds”
- The language that we use shapes our reality
- They are intertwined with each other so if one is affected, mostly like the other one is also affected
This is a biopsychosocial model developed by WHO that shows the interaction of the disorder with the functionality, and social participation of the patient while also looking at their contextual factors
International Classification of Functioning, Disability, and Heath (ICF)
Why is the ICF framework important?
Important to use this framework to have a holistic perspective on the patient’s functioning
We are not limited to targeting the impairment when treating adults with language or cognitive deficits
Activity limitation
This refers to difficulties an individual might have in performing specific actions or tasks. It’s about what a person can or cannot do on their own. It focuses on individual abilities.
Participation restriction
This refers to problems an individual might experience in being involved in life situations or engaging in social roles. It focuses on how the individual’s environment or societal expectations limit their involvement.
What are the goals of assessment?
Identify presence or absence of language and/or cognitive problem
Identify concomitant impairments affecting communication skills
Accurately describing current cognitive and linguistic skills
Describe pragmatic abilities
Obtain a measure of the quality of life of the patient
Gauge their candidacy for treatment
Prioritization of treatment goals
Considerations when conducting an assessment
A. Manner of conducting
B. Cultural
This is maintaining an encouraging demeanor so your patient continues to respond. Refrain from showing “tells” or facial expression when they get a correct or incorrect response. Tone should be appropriate to adult clients. What consideration is this?
Manner of conducting
Modifying assessment procedures to match educational background, and primary language
Cultural
Data gathered from people familiar with the patient’s current communicative abilities and history. This may be obtained during case history taking and through interview forms: Communicative effectiveness index (short form) or stroke and aphasia QoL Scale (SAQOL-39)–self report, comprehensive tool
Reported observations
Direct observations. What are the three types of direct observations?
- Unstructured
- Moderately structured
- Highly structured
What is an unstructured direct observation?
- Describing patient’s skills on a familiar, natural setting
- Observe any attempts to fix communication breakdowns
- Assessment procedures would include observation during mealtimes with family, video recordings of a normal day for them at home.
What are moderately structured direct observations?
Use of prepared tasks or questions to observe specific language or cognitive skills
Informal assessment activities such as picture description, narrating procedures, conversation with prompts, etc.,
What are highly structured direct observations?
Use of screening tools, comprehensive aphasia batteries, and other standardized assessment tools
BDAE, WAB, CLQT
What is the Boston Diagnostic Aphasia Examination? What does it assess?
- Uses language profile to classify patient into an aphasia syndrome
Assesses: fluency, auditory comprehension, naming, repetition, automatic speech, oral reading, reading comprehension, writing
What is Western Aphasia Battery (WAB)? What does it orovide?
- Patterned on the original BDAE
- Identifying aphasia syndrome based on a computation of scores
- Provides summary scores that could be a basis for therapy outcomes when re-assessment is done
Assesses: fluency, auditory comprehension, repetition, naming, reading and writing (supplemental)
Montreal Cognitive Assessment - Philippines (MoCA-P)? What is its scores?
- A screening tools to check for presence or absence of cognitive impairment
- Maximum of 30 points and a score of 25 below indicated abnormal cognitive function
- Tests the following: visuospatial skills, executive functioning, naming, memory, attention, orientation, and language
Cognitive linguistic quick test (CLQT)
- An assessment tool designed to assess cognitive functions namely attention, memory, executive function, language, and visuospatial skills
- Can obtain standardized scores to compare patient’s performance to normative data based on age and education
What is Mini-mental examination (MMSE)?
- A screening tool used to assess extent of cognitive impairment, usually upon admission to a hospital
- Maximum of 30 pts and interpretation of severity (mild, moderate, severe) is available in the form
What is Glasgow Coma Scale (GCS)
- A tools used to measure level of consciousness
- Looks at: eye response, verbal response, and motor response
- Highest score is 15, scoring specifies performance on each task (e.g., E4V5M6)
What are informal assessments?
- A moderately structured procedures where the clinician primarily tests generated hypothesis about the language or cognitive skills of the patient
- Clinician actively seeks out effective cues for the patient to elicit a target behavior
- Present similar but modified tasks for more exemplars of the patient’s skills which will improve certainly of breakdown
What are the confounding factors to consider in informal/formal assessment:
- Unaware of their deficit
- Attention problems
- Executive function problems
- Memory problems
- Emotional volatility
- Other health issues
How do we form a hypothesis?
- Interpreting data collected
- Use of a language processing model
- Differential diagnosis
What does interpreting data collected mean?
A. Classifying observed impairment or making a diagnosis
(i) Aphasia classification - can be based on anatomical damage, syndrome based, or simply fluent vs nonfluent;
(ii) cognitive disorder diagnosis - usually “cognitive function + deficit”
B. Classifying severity -
(i) important in selecting appropriate materials for future assessment or intervention (we should know the severity of the impairment)
How do we concisely explain our findings?
Use of language processing models
What is PALPA? What is it used for?
Psycholinguistic Assessment of Language Processing in Aphasia
- A model from the PALPA assessment tool
- Used for analyzing WORD comprehension and production only
What are the processes for auditory comprehension for spoken word?
Auditory phonological analysis (Function: identifies when what is heard are speech sounds, identifies specific speech sounds are heard) → Phonological input buffer → Phonological input lexicon → Semantic system
Process for spoken word production
Semantic system → Phonological output lexicon → Phonological output buffer → Articulatory programming
What happens if there is impairment in auditory phonological analysis?
- Word sound deafness
- Difficulty discriminating words
- Difficulty in repeating words
What is the function of a phonological input buffer?
Synonymous to working memory
What is the function of the phonological input lexicon?
- Storage of word forms
- Familiar vs unfamiliar words
- No meaning yet
What is a semantic system?
Storage of word meanings activated in response to word recognition
What are the possible results of impairment in phonological input buffer?
- Possible difficulty from repeating
- Comprehension deficits
What are the possible results of impairment in phonological input lexicon?
- Word form deafness
- Difficulty recognizing words
- Higher frequency words are more likely to be recognized compared to low frequency words
What happens if there is impairment in the semantic system?
- Word meaning deafness
- In some cases, access to semantic system is impaired and therefore presenting the word orthographically will help them comprehend
- Imageability effects (concrete concepts are easier)
What is the function of the phonological output lexicon?
- A storage of spoken word forms (this is the storage of word that you have already spoken before)
What are the possible results of impairment in the phonological output lexicon?
- Anomia
- Circumlocution
- Semantic or phonemic paraphasia
- If access from the semantic system is impaired: retrieval may be inconsistent
- Frequency effect
What is the function of a phonological output buffer?
Holds spoken word form to be used by articulatory programming
What are the possible results of impairment in phonological output buffer?
- Neologism
- Phonemic paraphasia
- Conduite d’approche - successive attempts to produce a certain word become more and more precise
What is the function of articulatory programming?
Converts phonemes into neuromuscular commands
What are the possible results of impairment with articulatory programming?
Verbal apraxia
What is the process for reading comprehension?
Abstract letter identification → Orthographic input lexicon → semantic system → Orthographic to phonological conversion
What is the function of abstract letter identification
Identifies letter, letter position, converts letters into graphemes (mental representation of what the symbol mean)
What are the possible results of impairment in abstract letter identification
- Unable to recognize letters
- Impaired reading comprehension
-Length effects - longer words will be harder to read
What is the function of the orthographic input lexicon?
Storage of written word forms
Familiar vs unfamiliar
What are the possible results of impairment in the orthographic input lexicon
- Difficulty recognizing a string of graphemes as a word
- Rejects non-words not matching any stored written forms
- Frequency effects
Semantic system (reading comprehension)
Storage of word meanings activated in response to word recognition
Possible results of impairment in semantic system (reading comprehension)
- Difficulty in comprehending words even when recognized as a real word
- Imageability effects
You know the word but not the meaning, what process will it go to?
Abstract letter identification → orthographic input lexicon → phonological output lexicon
What is the process when the person does not know the word and does not know the meaning of the word?
Abstract letter identification → Letter sound rules → Phonological output buffer
What are the possible results of impairment in orthographic to phonological conversion (reading comprehension)?
- Poor reading of novel words
- Word “auto-correct” specific targets to familiar words
Written naming process in PALPA
Semantic system → Orthographic output lexicon → orthographic output buffer
Function of the semantic system in written naming
Storage of word meanings activated in response to word recognition
What is the function of orthographic output lexicon
Storage of the spelling of familiar words or written word form
Possible results of impairment is orthographic output lexicon (written naming)
- Difficulty with infrequent and irregular words
- Confusion in writing homophones
Function of orthographic output buffer
Storage of graphemic representation
Possible results of impairment in orthographic output buffer
- Length effects - easier to write shorter words
- Spelling errors: addition, transposition, substitution
Comprehension is affected (+),
speech production (+),
word retrieval is affected (+),
cognitive processes (+/-)
Aphasia
Cognitive communication disorder
Comprehension (+/-)
Speech production (-)
Word retrieval (-)
Cognitive processes (+)
Early stage of dementia
Comprehension (+/-)
Speech production (-)
Word retrieval (+/-)
Cognitive processes (+)
Testing hypothesis is usually done in _______________
Informal assessment
True or False. Continuously done even during intervention - testing hypothesis
True
True or false. Hypothesis or clinical impression can be changes as new information about the patient’s skills are observed
True
True or false. More exemplars of a specific strength or weakness will give you more reliable observation
True
The younger they are the better the prognosis is. True or False.
True
Hemorrhagic stroke has better prognosis compared to ischemic stroke. True or False.
True
Acute > chronic (acute has better prognosis compared to chronic)
t
There is poor prognosis for
- Multiple lesions
- Large language-dominant hemisphere lesion
- Lesions of temporal-basal areas
Medications - some side effects of drugs affect alertness. True or False
True
Mental health problems do not affect prognosis negatively. True or False.
Initially severe aphasic patients take longer time to recover language compared to milder aphasia cases. True or False.
True
Better prognosis if a person is unaware of deficits compared to those who are aware. True or False.
False
Patients that are more stimulable to prompts and cues have better prognosis. True or False.
True
Patient’s who are motivated to participate affect the prognosis negatively. True or False.
False. Affects the prognosis positively
Family’s willingness to help aphasic family members improve and the level of knowledge they have of the needs of aphasic patients are good prognosticating factors. True or False.
True
