Assessment Flashcards

0
Q

What is the role of the speech and language pathologist?

A

The role of the speech and language pathologist is :

  1. Identification and selection of clients
  2. Assessment
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1
Q

What are six different intervention settings?

A
Intervention Settings:
Hospitals
Rehabilitation centers
Skilled nursing facilities
Nursing home
Private offices/centers
Patients home 

Limited to what the insurance company will provide in all settings
Be sure notes are very detailed to provide information to insurance co.
Impact on abilities going forward in life is what will convince them to give more sessions
“At risk for” “re entering hospital”

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2
Q

What are the different ways to identify and select clients?

A
Selecting and Identifying clients:
Screenings
Physician referral 
Team member referral 
Potential trial for progress (no adult returns to complete normal, but can progress for years and years.  Excellent, fair, guarded)
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3
Q

What are six different aspects of assessment?

A
Intervention 
Administration (insurance, soap notes, plans)
Consultation (swallowing, hearing test)
Counseling
Education
Research
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4
Q

What are the areas that we assess?

A
Hearing (always do when possible)
Speech (voice articulation and fluency)
Language (speaking, listening, reading, writing, printed form)
Reading 
Writing
Nonverbal communication (social issues, do/understand expressions and gestures)
Cognitive functioning (in all patients)
Swallowing  (screen)
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5
Q

What are the two types of assessment?

A

Standardized

Functional

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6
Q

What are some cultural considerations when planning assessment?

A

Select tools that have included clients ethnic/cultural group
Avoid tests with known bias(research if a specific population consistently does poorly on a test)
Interpret data cautiously (only a brief snippet in time)
Use content oriented assessment
Learn about clients culture (view toward medical community, beliefs about health care, disease, disability, and disorder)

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7
Q

What are characteristics of standardized tests?

A

Allow comparison to other individuals with aphasia or normal population
Allow quantitative monitoring of progress (insurance: client was here now is here)
Good for research (administrative rules, reproducible)
Can assist with classification of type and severity of disorder
May be biased (ethnocentric)

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8
Q

What are characteristics of functional assessment?

A

Look at every day skills
Less biased
Document changes in fu city all skills which is really the goal of therapy
Extensive systematic observations
Required: relate what you are doing back to functional every day life

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9
Q

What are the general purposes of assessment?

A

Determine patient performa cd in speaking, listening, reading, and writing, cognition, functional communication (primary goal)
Identify areas of strength and weakness
Determine type of communication disorder
Gather information to plan intervention

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10
Q

What are the legal purposes of assessment?

A

Competency hearing (elder law) (can client care for himself?)
Compensation-degree of disability
Malingering- faking it
Must be thorough, never know if that client is go g to apply for disability

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11
Q

What are our possible diagnosis?

A

Dysarthria (type and severity)
Dysphasia (stage and severity, oral or pharyngeal)
Apraxia (presence/absence, severity, childhood/adult acquired)
Aphasia (expressive/receptive, severity)
Cognitive-linguistic deficits- type and severity

*functional impact on communication functioning

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12
Q

The purpose of assessment changes by setting. In acute care we:

A

In a cute care we:
Discharge planning (make a diagnosis, plan for when they leave you.)
Can the client go home?
Do they have language and cognitive skills to say basic needs and remember that they turned the stove on?

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13
Q

The purpose of assessment changes by setting. In rehabilitation we:

A
In rehabilitation we:
Plan treatment 
Confirm diagnosis
Look to see if they have made progress since diagnosis
Plan treatment and goals
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14
Q

The purpose of assessment changes by setting. In home care we:

A

In home care we:
Plan treatment
Functional communication to meet daily needs
Plan treatment to make them functional in that environment

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15
Q

Cautions of assessment:

A

Don’t rely on test results only (test scores could be low because of depression)
Look for. Other possible reasons patient isnt communicating (sometimes don’t want to interact in front of children, embarrassment)
Observe patient with family and familiar partners

16
Q

Three approaches to assessment

A

Impairment oriented
Disability (activity) oriented
Handicap (participation) oriented

In most cases we do a combined approach of all three. All three need to be addressed for a good report.

17
Q

Impairment oriented assessment

A

Identify neuropsychological strengths and weaknesses

Standardized neuropsych batteries, aphasia tests, motor speech tests

18
Q

Disability (activity) oriented assessment

A

Identify possible effects of neuropsychological problems on real world function
Standardized functional scales-observation of daily activities

19
Q

Handicap (participation) oriented assessment

A

Identify limitations on education, vocational, social, or familial participation
Identify environmental modifications to enhance participation
Identify strengths and needs of everyday communication partners

20
Q

Outline of assessment t

A
  1. Detailed case history (premorbid skills)
  2. Orofacial examination including screening for dysphasia (cranial
    Nerve)
  3. Hearing screening
  4. Assessment of verbal skills
    Speech- fluency, voice, articulation
    Language- phonological, morphological, semantic, syntactic,
    Pragmatic
  5. Assessment of nonverbal communicative skills
  6. Assessment of cognitive skills
  7. Intellectual skills (academic abilities in children)
  8. Assessment of functional execution of daily living skills
  9. Assessment of visuospatial, visuomotor, visuoconstructional abilities
21
Q

Assessment of expressive and receptive verbal skills

A
Repetition
Naming
Auditory comprehension
Oral expression
Reading
Writing 
Automatic speech
Singing
Humming 
Prosody, intonation, story telling organization
22
Q

Assessment of nonverbal skills

A

Expression through gestures/pantomime
Comprehension of gestures/pantomime
Recognition of facial expression and intonation/prosody

23
Q

Cognitive assessment

A

Dependent on clients current status
Varies y level of severity for TBI patients and stage of recovery
Is ongoing
May initially consist of observations both direct and indirect until a patient reaches a point of participation

24
Q

Cognitive areas

A
Level of alertness/response
Orientation X3 (person, place, condition, time and general information)
Attention skills
Immediate working and long term memory
Categorizations
Organizations
Logic reasoning problem solving
Story telling
25
Q

Behavioral observations

A
Agitation
Confusion
Fearfulness
Inappropriateness
Denial
Lethargy lability manic
Uncooperative 
Confabulation
Impulsivity 

TBI have a lot of these behaviors that interfere with success

26
Q

Speech language assessment instruments

A

Boston diagnostic aphasia examination
Boston naming test
Brief test of head injury
Cognitive linguistic quick test
Communication abilities in daily living
Logical memory subtest of weschler memory scale
Ross information processing assessment
Scales of cognitive ability for traumatic brain injury
Weschler adult intelligence scale r
Western aphasia battery
Cell 5 for kids with language delays used with TBI and aphasia

27
Q

Standardized aphasia screenings

A
Aphasia language performance scales
Sklar aphasia scale 
Aphasia screening test
Bedside evaluation and screening test
Aphasia screening test
Quick assessment for aphasia 

Screenings can not be used for diagnosis
Doesn’t give enough information To plan therapy

28
Q

Agraphia

A

Loss of writing ability

29
Q

Anomia

A

Loss of naming ability

30
Q

Alexia

A

Loss of reading ability

31
Q

Agnosia

A

Inability to recognize through the senses

32
Q

Confabulation

A

False stories and beliefs

33
Q

Differential diagnosis

A

Patient’s history important
Results of medical examinations (neuro, where the damage is, type, severity, make sure that the diagnosis fits the medical)
Detailed adequate sampling of communicative behaviors (verbal and non-verbal)
Language and communication are not mutually exclusive (Aphasia are good communicators even though they are bad with language.)
Individuals with aphasia, TBI, are different (heterogenious)
Symptoms change overtime (repeat evals)
Scores don’t describe behavior, WE have to describe what they can and can’t do (characterized by…. Anomia, telegraphic speec etc.)
Diagnosis is multifaceted
Rule out other forms of communicative problems (dementia, psychiatric disorders)
Aphasia can co-exist with dysarthria, apraxia, dementia, etc.

Charts from Hegde, 1998.