Assessment

Question 1

Define Assessment.

Answer 1

Assessment is an organised, goal directed evaluation.

Patterson and Chapey, 2008

Question 2

Purpose of assessment

Answer 2

For diagnosis:
Strengths and weaknesses
Auditory comprehension
Speech production
Reading Comprehension
Writing
Pragmatic, cognition, mood etc. if required

Determine type of aphasia.

Background and medical information should also be gathered.

Informs intervention-areas to focus on

Establish theoretical explanation of what’s gone wrong with reference to PALPA language processing model.

Information for family/carers- strengths and weaknesses, advice on how to facilitate communication.

Prognosis

Measurement of change and monitoring

Helps plan therapy

Ascertain what strategies will support them

Provide information relating to the individual’s capacity- adults with incapacity act 2000- if they are incapable? or just need AAC to convey decisions.

Question 3

What framework should we consider when assessing?

Answer 3

ICF WHO

Question 4

What does the ICF WHO consider?

Answer 4

The impact on the individual.
Components: impairment, activity and participation, personal and environmental contextual factors.
Gives us a more hollistic view of the PwA

Question 5

Impairment Based Assessment.

Comprehensive Diagnostic Batteries

Answer 5

Boston Diagnostic Aphasia Examination

Western Aphasia Battery-Revised

Question 6

BDAE

Answer 6

• performance across language modalities
• allows diagnosis of aphasia to be made.
• Normally just do little bits of it- quite big.
• does give a comprehensive picture of deficits and retained abilities.

Question 7

Western Aphasia Battery-Revised

Answer 7

• full battery and bedside screening

- differential diagnosis and aphasia type.

Question 8

When are comprehensive diagnostic batteries inappropriate?

Answer 8

Innapropriate for acute stage aphasia.

PwA should be neurologiclally stable- this is normally 3 months post stroke.

Question 9

What should be considered if doing a comprehensive battery?

Answer 9

It takes time and will require several sessions.
Fatigue
Emotional effects
PwA’s performances fluctuate and may change dramatically on a day to day basis- ideally for this reason any assessment should be completed within a week.

Question 10

What do acute stages refer to?

Answer 10

Aphasia= early days- first 4 to 6 weeks
Stroke= first week.

Question 11

What are used in the acute stages to assess?

Answer 11

Screening tests

Informal assessments.

Question 12

Name a screening test.

Answer 12

Aphasia Screening Test.

Question 13

Assessment of aphasia - informal.

Answer 13

It may not always be appropriate to use formal assessments in the hospital environment or in acute stages of recovery.
Instead SLT may use informal techniques or only use certain parts of formal assessments informally.

Question 14

If we don’t have a lot of information from the referral what should we do?

Answer 14

Over prepare for the assessment. :)

Prepare for multiple possibilities

Question 15

Screening in hospital- what is important practically?

Answer 15

It has to be practical- you can’t carry loads of stuff around the hospital-, in terms of ease and infection control.

Question 16

What may help you develop a hypothesis?

Answer 16

If the area of stroke is is provided.

Question 17

In screening- what should be assessed?

Answer 17

The 4 communication modalities at a basic level:

1. Auditory Comprehension
2. Reading Comprehension
3. Verbal Expression
4. Written Expression

Question 18

In terms of screening what should we prepare for?

Answer 18

A range of impairment severity.

Question 19

Name comprehension screening in terms of severe aphasia.

Answer 19

picture/object matching
Y/N questions
1-2-3 stage commands
single word level.

Question 20

Name comprehension screening in terms of mild aphasia.

Answer 20

complex sentence level, conversation level, higher level language abilities.

Question 21

Name expression screening in terms of severe aphasia.

Answer 21

might have none at all, use of gesture, reliable Y/N

Question 22

Name expression screening in terms of mild aphasia.

Answer 22

Conversation level expression, higher language.

Question 23

What is it not necessary to do?

Answer 23

not necessary to start at most basic level and carry on to the highest.
Causes patient distress, harms rapport and waste of time, little benefit.

Instead pitch at a level you think might be appropriate and adjust up or down.

Question 24

How can medical information be gathered?

Answer 24

From medical notes
getting to know me forms
MDT members

Question 25

What 2 things should you consider whilst screening?

Answer 25

Consider environment- busy, noisy, quiet, visitors, personal belongings to use
Consider individual- alertness, attention, distractibility, are they reading paper, facial/limb weakness, distressed, are they trying to interact with others on the ward- if so how?

Question 26

How is introductory conversation a useful part of assessment?

Answer 26

Use different types of questions and see if patient is able to respond.

Open question- hard e.g. “tell me about your family”

Y/N question- easy e.g. “are yo married”

Specific question- hard e.g. “how many children do you have”

Say wrong info and see if they agree e.g. “is your wife’s name elaine?”

Make use of pictures, cards and newspapers e.g. “who’s this?”

Typical conversation topics are good- adapt how you present them and strategies used- pictures, drawing, repetition, gestures etc.

Question 27

What is the Comprehensive Aphasia Test- CAT?

Answer 27

More detailed than a screening test, not as detailed as a battery.

Question 28

Name the 3 components of the CAT

Answer 28

3 components:

1. comprehensive assessment of language components
2. screen for associated cognitive deficits
3. brief investigation of everyday life disability

Question 29

CAT clinical application

Answer 29

Diagnosis of impairment
Overall severity
Investigates disability as well as impairments.
Indicates meaningful intervention goals
Allows monitoring
Indicates areas for further assessment.

Question 30

When is the CAT performed?

Answer 30

3-6 post onset if medically stable.

Takes 2 sessions approx 45-1 hr long.

Question 31

When assessing what’s important?

Answer 31

Encourage patient throughout.

Question 32

What is an expansion of the brief investigation of daily everyday life disability in the CAT?

Answer 32

The Communication Disability Profile.

Question 33

What does The Communication Disability Profile assess?

Answer 33

Impact.

Question 34

Name a psycholinguistic test

Answer 34

PALPA :)
assesses an area of language in depth.
performance viewed in relation to language processing model- PALPA.

Question 35

How many tests does the PALPA have?

Answer 35

60!

tests are selected based on hypothesis from screen.

Question 36

Specific function tests

Answer 36

Boston Naming Test
Reading comprehension Battery for aphasia

These assess one area of language in greater depth

Question 37

Impairment based assessment remains popular because…

Answer 37

They are reliable, valid and explicit.

Ideally they should be standardised in order to see how a pwa is performing in relation to norms.

Question 38

What should be noted in terms of performance?

Answer 38

Poor performance doesn’t always mean aphasia, could be dementia, other cognitive issues, may lack motivation or have attention and sensory difficulties.

Question 39

Assessment is only a …

Answer 39

Snapshot :) in a certain situation and time.