Assessment/Diagnosis Flashcards
Differences in Testing Tools
Practicality
Test nature: what are they testing and how
Procedural issues
Philosophy: some are based on clinical issues, some on psychometrics, psycholinguistics, neurolinguistics
Types of Assessment Tools
Screening tools - these have died out because people can design their own, Help us do very basic things
Comprehensive tests - less practical because they take lots of time
Progress evaluating tests - can be done over time
Tests for patient counseling
Screening Tools
Only thing these tell us is if the pt. is impaired or not
Limited clinical accuracy
Little info about:
- lang. functions
- functional living of the pt.
Comprehensive Assessment Tools
Evaluation for strengths/weaknesses
Initial severity assessment - this is important bc its associated with recovery potential
Sampling of all potentially disturbed linguistic areas - takes a long time, not very practical
Identification of types and deficits
Philosophy reflection
Requirements for Diagnostic Tests
Standardization
Reliability
Validity
Range of item difficulty
Standardization
Key to any testing
Procedure formalization for administration
- scoring and time
- controlled procedures to minimize measurement errors such as cueing, prompting, time limit
Provides consistency and objectivity of how tests are administered and scored
Establishes norms
- range of scores from a reference group
- controlled subjects/normal as well as pts.
- mean and median
- high/low distribution of scores
- scaled value - percentile or SD scores
Reliability
The degree to which an assessment tool produces stable and consistent results
On repeated administration, similar results from the same subjects
Demonstration of reliability through
- alternate test forms at same/subsequent sessions
- odd/even test items
- comparing with normal/healthy subjects
Unaffected by
- pt. to pt. testing
- time to time variability
- examiner to examiner differences
Validity
The extent to which a test measures what it says it measures
The degree to which evidence supports the interpretations of test scores
Demonstrated by
- predictor validity - discrimination from normal
- construct validity - performance correlation with other known test
- content validity - adequacy of sampling from the domain of behaviors to be measures; rigid selection of test items, well reasoned content areas, range and diversity of test content
Range of Item Difficulty
From very easy to very high
Homogenous test items ordered
Difficulty range rise in a linear fashion
Rating Scale Options
Mild/moderate/severe (subjective)
Pass/fail (doesn’t take into account responses in other modalities)
Descriptions (impractical)
Multidimensional (best but fewer available, allows you to capture other behaviors like pauses before responses)
Ideal Aphasia Test Attributes
Explores all potentially disturbed modalities
Employs subtests that discriminate among various clinically meaningful types of aphasia
Includes graded (hierarchical) test items to examine a representative range of severity
Contains enough items to eliminate day to day and test to test learning
Represents practical length for its administration in one sitting
Minimizes effects of intelligence and education to measure language
Discrimination between normal subjects from patients with aphasia and dementia
Has internal consistency and comparability of scores
Wechsler Adult Intelligence Scale - Third Edition
WAIS-III
Categories:
Picture completion
Vocab
Digit symbol
Similarities
Block design
Arithmetic
Matrix reasoning
Digit span - how many digits the pt. can remember
Information - Factual info. Pt. answers questions about factual, general knowledge
Picture arrangement - sequencing
Comprehension
Symbol search - Sustained attention - TBI and R Hemisphere
Letter-number sequencing
Object assembly
Boston Diagnostic Aphasia Examination - General Info
Identification of aphasic syndromes
Time duration of 1-2 hours for original version
Based on psycholinguistic model with neurolinguistic interpretation
First test battery to evaluate spontaneous verbal output
There are 3 Forms
- Short form (optimal, takes 30 minutes)
- standard form (detailed, takes 1-2 hours)
- extended form (research version)
Tests: Conversational and expository language auditory comprehension verbal expression reading writing praxis
Boston Diagnostic Aphasia Examination - Severity Rating
0 level: no communication
1 level: only limited communication
2 level: familiar comm
3 level: unassisted comm
4 level: moderate aphasia
5 level: minimal aphasia
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Melodic line
Phrase length
Articulatory agility
Grammatical form
Paraphasia in running speech
Word finding
Repetition and auditory comprehension
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Melodic Line
Sentence intonation extending the entire sentence
ranges from word-by-word or aprosodic, to sentence imitation limited to short phrases, to normal melody for full sentences
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Phrase Length
Wernicke’s do very well here
Rate 1 word, 4 words, 7 words
longest occasional uninterrupted run of words in 10 starts (not the mean number of words)
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Articulatory Agility
Rate from 1-7
facility at phonemic and word level (groping for initial sounds, simplifications, distortions, delays, moving sounds within words, Broca’s will be at low end and Wernicke’s will be high)
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Grammatical Form
Variety of grammatical constructions, use of grammatical morphemes
Ranges from no syntactic word groupings to simplified or incomplete forms to normal range of syntax
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Paraphasia in Running Speech
Rate if phrase length is more than 4
Ranges from paraphasia present in every utterance, 1-2 utterances per minute of conversation, to absent
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Word Finding
Relative to frequency
Ranges from fluent but empty speech, informational words proportional to fluency, to output primarily content words
Boston Diagnostic Aphasia Examination - Speech Profile Rating
Repetition & Auditory Comprehension
Different subtests
Score conversion to percentiles
Western Aphasia Test Battery - General Info
Classification of syndromes based on 3 performance tests and 4 language tests
Goals are diagnosis, recovery, and treatment efficacy
Testing areas include conversational and expository language, auditory comprehension verbal expression reading writing praxis
Western Aphasia Test Battery - Quotients
Aphasia quotient : Summary of 4 subtests (spontaneous speech, conversation, repetition, naming); rated from 1-100
Language quotient : Composite of all language functions including reading and writing
Performance quotient : Reading, writing, apraxia, and construction
Cortical quotient : All test performance
Neurosensory Center Comprehensive Examination for Aphasia (NCCEA)
Goal is not to determine typologies
No spontaneous speech sample - a weakness for us, but this wasn’t developed for SLPs, very few SLPs use this test
20 subtests
Standardization : normative data for children, mean score for all ages, linear effects of age
This is the only test battery that tells us if a pt. has a problems with the corpus callosum
Minnesota Test of Differential Diagnosis
No one uses this test anymore
Based on pt’s potential to recover
To determine strengths and weaknesses within all modalities
A guide for treatment
No differentiation of disorder types
Additional dx of perceptual and motor disorders
Degree of deficit-percentage of errors
Classification of aphasia plus sensorimotor disorders - 5 Groups with recovery potentials
Minnesota Test of Differential Diagnosis - Classification
Group 1 = simple aphasia - most potential for recovery
Group 2 = aphasia is complicated by “central involvement of visual processes”
Group 3 = simple aphasia + sensorimotor involvement
Group 4 = simple aphasia + visual involvement and dysarthria
Group 5 = Global aphasia
Porch Index of Communicative Ability (PICA) - General Info
Provision for repeated testing for residual functions, language recovery
Portrayal of performance in a numerical format (1-10)
Processing test
Recovery documentation with precision
Ideal for plotting recovery
Conforms to psychometric procedures for reliability
Requires certification to give - Worst part about this test
Liked by VA SPPA clinics
Multidimensional scoring on 1-16 scale - Best part about this test
PICA - Areas and Subtests
3 areas and 18 subtests: verbal (4), gestural (8), graphic (6)
10 objects for homogeneity
Sequentially arranged test items
Looks at several input and output modalities for central language processing
PICA - Five Dimensions of Response
Accuracy (degree of correctness)
Responsiveness (ease with which an appropriate response is elicited)
Completeness (extent to which the task is entirely carried out)
Promptness (degree of immediateness in the response)
Efficiency (proficiency of production)
PICA - Data
There are 18 subtests with 10 items each - 180 items
Data is transformed into:
Test means (means for each subtest)
Modality means (mean for each of the 3 modalities)
Overall performance score (divide the 18 subtests into the 9 highest and the 9 lowest, then find the mean of each)
Tests of Specific Aspects of Language
Token Test
CADL
Boston Naming
Word Fluency test
Raven’s Progressive Matrices (part of the WAB)
Ross Information Processing Assessment (R Hemispheric lesions and cognitive impairments)
Cognitive Linguistic Quick Test (TBI)
Token Test
A test battery for auditory comprehension
Short test
least intellectual difficulty
considerable linguistic weight
20 tokens of 2 sizes & shapes, and 5 colors
no cues from SLP
gestural responses to verbal commands (no speech required)
Reporter’s Test
Used as a research test
just like the Token Test but for expressive language
incorporates Token Test stimuli and commands
Pt. commentates on what the SLP is doing
Communicative Abilities of Daily Living (CADL)
Focus on functional communicative ability
Performance in simulated activities of daily importance (phone calls, shopping)
Emphasis on communication rather than language
Responses in any mode of communication
Construction : 68 items
Scoring:
Correct = 2
Adequate = 1 (giving a false age bc you think its rude someone asked)
Wrong = 0
35 mins.
Boston Naming Test (BNT)
Standard version has 60 pictured objects, short version has 15 items
mark correct response, response latency (time), verbatim incorrect response
start at item 1 for young children and aphasics, start at item 30 for older children and non-aphasics
discontinue after 8 consecutive failures
Cues:
Stimulus cues provided, if the subject is still unsuccessful proceed to phonemic cueing
Word Fluency Test
Good indicator of intact brain function - quick bedside assessment
One of the most sensitive tests for brain injuries
Normal is 10 words/min (must be done in 1min)
Semantic fluency (name as many foods in one min)
Phonemic fluency (give a phoneme and list all words that start with that sound)
Raven’s Progressive Matricies
Test of nonverbal reasoning
Non-controlled so we can give it
Focuses on intelligence and reasoning with lower verbal load
Patient has to choose the missing piece of the pattern
Normative data for adults and kids
Ross Information Processing Assessment (RIPA)
Not a true IQ test
Can be given in a very short amt. of time
Looks at:
Information organization
Auditory processing and retention
Subtests: immediate memory (repetition of numbers and sentences)
recent memory (how long have you been in the hospital)
temporal orientation (current year, season)
spatial orientation (what state/city/building)
orientation to environment (who am I? name?)
recall of general info (president)
problem solving (if you run out of gas)
Scores:
Confabulation, denial, delayed, error, irrelevant, perseveration, self-connect, tangential
Cognitive Linguistic Quick Test
Tests: Personal facts symbol cancellation confrontation naming clock drawing story retelling auditory comprehension symbol trails generative naming design memory design generation
Additional Issues in Assessment
Pre-morbid language and intelligence
Socio-cultural habit of communication
Ethnic influence
Bilingualism
- Second language testing
- Pre-morbid language ability in native language
- motivation/attentiveness
Bilingual Tests
Bilingual Aphasia Test
Multilingual Aphasia Exam
BDAE and Token Test and WAB and CADL in other languages
Report Writing Format
first sentence should include lots of info self description of symptoms
Referral
developing picture (medical history, educational history, vocational and social history)
testing results
impressions/classifications
summary (most revealing)
2 most important parts of report: Developing picture and summary
