Clinical Exam 2 Flashcards
Assessment
-information gathering
-information analysis
-information interpretation
Three primary purposes of assessment
-To determine presence of a disorder
-determining eligibility of services
-documenting progress
Diagnosis
Identification of a disease or disorder based on symptoms presented.
Prognosis
A forecast of the likely course of a disease of ailment; potential benefit from therapy of medical treatment.
Factors influencing prognosis include:
-Age
-Severity of communication disorder
-Family support
-Ongoing medical conditions
Four types of assessment tools:
-Case history interviews
-Norm-referenced tests
-Criterion-referenced procedures
-Observational Tools
Case History interviews:
Collecting information about the client and their communication disorder.
Norm-referenced tests:
Comparing a client’s performance to a sample of individuals who are similar to the client.
Criterion-referenced procedures:
Comparing client’s skills to a certain predetermined expectation.
Observational Tools:
Includes behavioral observations, structures sampling events, and dynamic assessment to gain information about clients with significant communication disorders or those who are very young.
Screening test:
A brief initial assessment procedure used to determine if an individual needs a comprehensive evaluation.
Valid Scores:
The extent to which a test measures what it claims to measure.
Reliable Scores:
When a test score remains stable, or similar, regardless of who gives the test of when the client takes it.
Norming Sample:
A group of individuals to whom a client taking a test is being compared.
Standard Score:
A derived score that has been transformed into a distribution with a known mean and standard deviation.
Standard Deviation Units:
Is the average distance that scores fall from the average.
Percentile Rank:
Is a derived score that indicates the percentage of individuals whose score falls at or below a given raw score.
Rules for standardization of a test:
- Everyone takes it under same conditions.
- Consistency in administration and scoring.
-Test manuals provide very specific instructions for administering and scoring.
-Clinicians follow these instructions in detail.
Purposes for communication sampling:
-Helpful for culturally diverse populations.
-Used with clients of all ages and all areas of speech and language problems.
-Used to demonstrate progress; that treatments make real, functional differences in clients’ lives
What are the types of nonverbal clients?
-Children who are at preverbal levels of development, not yet acquired symbolic language.
-Adolescents/adults with developmental disabilities who have precluded symbolic language learning.
-Clients who previously were typical language users but lost their skills due to injury or illness.
Principles for collecting a communication sample: nonverbal children
-For very young clients, this task will usually mean a play session with developmentally appropriate toys and a familiar person, such as a parent.
-For children with motor impairments, clinicians need to be especially careful to provide opportunities for the child to express wants, needs, and intents.
Principles for collecting a communication sample: nonverbal Adults
For older clients with severe developmental communication disorders and
adult clients with acquired disorders, it is important to choose
developmentally appropriate materials and arrange for a sampling context where communication is a large part of the activity.
Types of samples: language
-All 5 areas of language should be analyzed; and emphasis will be placed on areas of concern.
-open ended questions, parallel talk, storytelling and/or picture description, clinician’s verbiage is key
What is MLU?
Mean length of Utterances
What skills are you looking for in a speech sample?
-Clarity
-intelligibility
-Concise
-Follows story smoothly
What skills are you looking for in a language sample: morphology, syntax, semantics, pragmatics, MLU
-Correct grammar
-Correct word meanings
-Multiple sentence types
Types of Samples: Speech
1.Determining the number of articulation errors and patterns of errors
2.Providing a description of a child’s phonetic inventory = a list of all the
sounds that the child produces in a sample of speech
3.Determining intelligibility, or the total number of correctly articulated
sounds or words in the sample for clients of all ages
4.Determining the client’s stimulability for speech sound production or the
child’s ability to more closely approximate correct productions
5.Screening voice and fluency
6.Determining speech performance in a naturalistic context
Intervention
designed to teach strategies for improving overall communication.
Purpose of Intervention
-eliminate the underlying cause of the disorder.
-compensatory strategies to improve functional communication
-modify the disorder by teaching specific speech, language, cognitive, or swallowing skills
What does implementation of intervention depend on?
-Nature of disorder.
-Age and therapy history of client.
-Family situation.
-client’s learning style and preferences
Normative Approach
goals target age-appropriate norms
Client Specific Approach
teach skills that best serve client’s communicative, educational, and social needs
Principles for selecting goals/target behaviors
-socially significant
-reinforced by family members
-expand communicative skills
linguistically and culturally appropriate
Long Term Goals (LTG)
covers the full period of time that therapy intervention has been assigned
Short term goals (STG)
hierarchical small goals working toward LTG
3 Components of a behavioral objective
-do statement
-condition
-criterion
Sequence in a task sequence
Tasks move in sequential order depending on client
Continuum of naturalness
intervention activities vary in their degree of naturalness
3 factors that affect continuum of naturalness
-intervention activity itself
-the physical context in which the activity takes place
-the individuals with whom the client interacts during intervention
clinician-directed
The clinician controls all aspects of the intervention
client-centered
approaches emphasize therapy in authentic settings. Client leads intervention.
4 main types of hybrid instruction
-focused stimulation
-milieu teaching
-script therapy
-conversational coaching
script therapy
an approach in which target behaviors are taught within the context of a familiar routine or script
conversational coaching
facilitates functional communication skills of adults with aphasia through the use of conversational interactions in a structured context.
3 purposes of data collection
-Permits clinician to track the client’s progress from one session to another
-it provides documentation of the efficacy of a particular intervention strategy or set of strategies
-it maximizes clinician effectiveness
data collection systems
-video recording
-checklists
-rating scales
-graphs
-binary system
-use of multiple observers
basic principles of oral and written communication
Written: they are legal documents that may be called into legal proceedings to determine service provision and liability issues
Oral: case conferences are focused opportunities to present information to or about clients
why do we interview our clients?
-gather background information
-counseling and education
-establish a trusting relationship
maintaining professional boundaries
other topics not related to communication disorders are out of bounds and may necessitate referring the client to other sources of support
individual therapy
Done with a single client
group therapy
clients with similar communicative disorders are brought together at once
multidisciplinary model
each clinician does their own testing, doesn’t work together
interdisciplinary model
clinicians meets up after their own testing to plan ways to help each other, interacting but working separately still
transdisciplinary model
clinicians all working together, doing evaluation at the same time. Ex: cochlear implant team
