Assessment Flashcards
Why assess?
To reach a diagnosis
To characterise the nature of the impairment
Toe establish the severity
Individual’s needs
Impact
Use to guide intervention and treatment focus.
Measure change- outcome measures.
To make a prognosis and plan potential long-term intervention accordingly.
What is assessment based on?
ICF WHO 2001 :)
This means there is a more hollistic view of the individual- not just assessing the impairment- considering activity and participation.
What is impairment in terms of dysarthria?
Loss or abnormality of physiological, anatomical and psychological functions.
This results in slow, weak, imprecise and uncoordinated movements of speech musculature.
How is impairment assessed?
The speech subsystems are assessed: Respiration Phonation Articulation Resonance Prosody
This can be done perceptually or instrumentally.
What is participation in terms of dysarthria?
The individual’s ability to engage in communicative situations which are important to them.
How is participation assessed?
Interviews Self Report Rating Scales Quality of life/impact measurements. Carer report.
What is activity in terms of dysarthria?
This is changes in speech intelligibility and rate.
Assessment of activity includes..
Perceptual and Instrumental assessments of intelligibility and rate.
What is the most common assessment approach?
Auditory Perceptual.
Auditory Perceptual
Info.
This is the most common method of diagnosing the presence and severity of dysarthria.
Rating scales are typically used alongside clinical judgement :)
Most preffered method to make differential diagnosis and define treatment prigrammes (Murdoch, 1998).
Aswell as auditory perceptual assessment, what other perceptual assessment to we use?
Visual perceptual :)
Name some perceptual assessments that use rating scales.
The Frenchay Dysarthria Assessment (FDA)- 28 dimensions rated on scale of 1-9, under thge headings: reflex, respiration, lips, jaw, palate, layngeal, tongue and intelligibility.
The Dysarthria Profile- 8 sections designed to assess the parameters of respiration, phonation, facial musculature, diadochokinesis, reflexes, articulation, intelligibility and prosody.
What is a more valid method of assessing intelligibility, instead of global/general assessment as part of an assessment (passage- lengthy sample) or just using a list of single words?
A more detailed and comprehensive measure of intelligibility is:
The Assessment of Intelligibility of Dysarthric Speech.
it measures speaking rate and intelligibility of the speaker.
Read randomly selected words and sentences of varying length.
Apart from perceptual assessment- name other less used approaches.
Acoustic analysis- computer software used to capture and allow analysis of speech signals.
Physiological assessment- even more less used, except FEES to investigate laryngeal function.
What is a key in the screening/traditional assessment of dysarthria?
The Oromotor Exam.
This is a non-speech exam.
What does the oromotor exam measure?
Cranial Nerve functioning.
What does the oromotor exam provide?
Information based on assessment of speech subsystems in isolation.
Name the speech subsystems.
Respiration Phonation Articulation Resonance Prosody
What should the oromotor exam aim to investigate?
Muscle tone Power Coordination of speech movements/articulators Oral sensation Range Rate Strength Durability Planning Speech Movements
What is required for an oromotor exam?
May need some equipment.
May have a checklist.
May want to video them.
Also requires patient comprehension.
What is important to note when carrying out an oromotor exam?
That function in non-speech tasks may be different to function in connected speech.
What should we look for in perceptual assessment?
Respiration e.g. audible breath, speech interrupted by breath, loudness level/variation/maintenance, lung capacity- how many words can they produce in 1 breath
Phonation- pitch level/variation and steadiness.
Resonance- nasality-hypo or hyper?, nasal emission.
Articulation- precision of consonants, phoneme length, precision of vowels
Prosody- pitch, loudness, prolonged intervals, rate, strangth, phrase length
Why is perceptual assessment so good?
Helps identify type of dysarthria :)
How do we assess activity?
We assess intelligibility.
What assessment can be used to assess intelligibility and rate?
The Assessment of Intelligibility of Dysarthric Speech
In intelligibility what’s important?
That all levels of speech should be considered e.g. from singke words, sentences, passages and spontaneous speech.
What is intelligibility a measure of?
The effectiveness of speech.
What is intelligibility usually expressed as?
as a percentage of a message that is understood correctly.
Whats an informal way to test intelligibility?
Make use of contrasting vowels e.g. hat, hut, hot
Make use of place contrasts e.g. rake, raid, rate
Get patient to read word without knowing what word they have chosen and then transcribe it.
What is important to take into account when assessing intelligibility?
Contextual Factors.
e.g. consider length of utterance/spontaneity, setting e.g. quiet room/loud room, conversation partner e.g. someone that knows them well vs. stranger
Apart from SLT assessing intelligibility- what may be useful?
If you feel they have good and realistic insight they can rate their own intelligibility.
Or could maybe get conversation partner to rate it-informally :)
Apart from impairment and activity- what is an important part of assessment?
Participation.
How is participation normally assessed?
Informal Interview- asking individuals about their communicative environment and priorities.
Or use assessments such as:
Quality of Communication Life Scale
The Communication Outcomes After Stroke (COAST).
In assessment what other factors should be considered?
The individual at rest e.g. posture etc.
Medical History and Dysarthria Onset
Consider language and cognitive skills (this may require screening)
Conversatinonal analysis could also be used.
When considering the individual at rest what should we look for?
Posture- adequacy for breathing Respiration- type, depth, rate Larynx- stridor, tension Velopharynx- symmetry Tongue- symmetry, wasting, fasiculation Jaw- opening, tension Lips- opening, drooling, symmetry Facial expression Tremor Uncontrolled movements Oral hygiene and dentures Pain Structural and anatomical changes Upper limb dexterity e.g. hands
Conversational Analysis.
What does it allow?
It allows for closer scrutiny of both conversational partners than is normally possible
Listen and observe :)
Conversational analyisis.
Why is it useful?
It facilitates insight into conversational breakdown and repair.
It can guide intervention approaches that draw in on the couple’s own interaction system.
Name some assessments to use.
The Dysarthria Profile/Robertson Dysarthria Profile
The Frenchay Assessment
Dysarthria Examination Battery
The Assessment of Intelligibility of Dysarthric Speech
Newcastle Dysarthria assessment tool
How long does the Roberston Dysarthria Profile take?
Why is it good?
1 hr approx.
It’s easy to administer and score.
Frenchay Dysarthria Assessment.
Info.
STANDARDISED
30 mins to complete
clearly scored
easy to interpret as visual graph.
Why is the dysarthria examination battery good?
It measures all components of speech and there’s many different subtests so you can pick and choose.
Give 1 bit of info about The Assessment of Intelligibility of Dysarthric Speech.
It’s standardised.
Newcastle Dysarthria Assessment Tool.
Info
has oro motor exam
45 mins to 1 hr long
measure max phonation time etc.
What is the Newcastle Dysarthria Tool useful for?
Differential Diagnosis
