COMDIS415 UNIT 1 Flashcards
What is the difference between speech, language, and cognitive communication: Speech
How we say sounds and words
Voice, Fluency, Articulation and Resonance
Example:
Jorge is 4 years old and it can be hard to understand him when he talks because he often repeats whole words at the beginning of his sentences, prolongs individual sounds for longer than usual and his speaking rate varies a lot.
Language
The words we use and how we use them to share ideas and get what we want
What words mean
How to make new words
How to put words together
Knowing what to say at different times
Cognitive
Mental processes such as attention, memory, perception, organization, orientation, problem solving, reasoning, executive functions etc.
Example: Elise recently moved to a nursing home because she was having trouble living safely at home. She was often unable to recognize familiar faces, would get disoriented and distracted which was resulting in her forgetting to turn off water faucets and burners on the stove.
What is the scope of practice for a SLP
Screen, assess and diagnose disorders
Prevention
Plan and carry out treatment (individual, groups, in home, with families)
Manage behaviors
Counsel patients and families
Write and provide documentation
Attend plan of care IEP meetings
Provide culturally competent services (Disorder vs Difference)
What domains/areas do SLPs assess and treat
Fluency
Speech production
Language – spoken and written
Cognition
Voice
Resonance
Feeding/swallowing
Auditory rehabilitation
*Lots of co-morbidity in the real world
Bilingual service delivery overlaid on all areas
ASSESSMENT
Using tools (informal or formal) to make an informed decision whether or not treatment services are necessary
Is there a disorder?
Assessment of skills to identify strengths and weaknesses
Initial idea of direction of intervention
Which of the following options belong to the category of language disorders? Select all that apply.
DLD
Dyslexia
Screening
It is brief, can address one or more areas, and is meant to tell us if something more is warranted or if someone might be at risk.
- Pass/Fail
- Cannot come up with a diagnosis based on a screening
- Do not help with treatment effort
- Failed screenings DO NOT necessarily mean there is a problem
Examples: Hearing screening; Kindergarten screenings in communication & language, motor (fine and gross), social skills, adaptive behavior, and pre-academic skills
Purpose of screening
To tell us if an assessment is necessary if the child is at risk or if something more is warranted
Describe the various components of an assessment
- Identify potential problems
Screenings - To determine:
Diagnosis
Eligibility
Goals/Outcomes for treatment
Monitor progress - To aid in prevention
Formal Assessments
Standardized measures given to patients in the exact same manner as others taking the assessment
Informal Assessments
Non-standardized measures that is personalized to the individual
Interviewing: Ask single, open ended questions, ask for examples, avoid why questions and avoid no/yes questions
Swallow Function: Doesn’t test language skills but addresses how well the patient is swallowing
Voice
Picture naming probes
Language samples
Observations of play/classroom
Interactions with others
Behavior checklist
Not scored and compared to other samples, can be tailored to the patient’s needs, supplement scored measures, often give us ‘real world information’ in a way tests cannot, and may not have strict protocols.
Static assessment
Do not allow teaching or any help
Snapshot of a moment in time (what the child is capable of at that time)
Dynamic Testing
Allow you to see what a person is capable of doing with support
NEVER make treatment recommendations based on this form of assessment
Useful for identifying treatment goals (more than static)
Useful for people from culturally and linguistically diverse groups
To test: Select areas that were impaired from static assessment and attempt to teach this skill
Examples of Dynamic Testing
Testing them, teaching them and then re-teaching them, prompting cues
What are the pros and cons of formal assessments
Pros: Gives us scores, easy to interpret, able to see if someone is eligible for assessment, structured, comprehensively assesses a skill
Cons: People who are bilingual don’t fit into this category, variety of multilingualism, bias, misdiagnosed
Norm referenced
Compared to a group of individuals of the same sex and similar age
Used for diagnosis
Example: Peabody Picture Vocabulary Test
What comes with a test?
Stimulus materials
Test form
Test manual
Always read the manual:
To yield accurate results – since everyone takes the test the same way, it allows for the results to be scored fairly. The test book provides the score that raises the level of concern since it’s different for every test
To prevent any results from being determined as invalid – you don’t want to have to go through all that testing just for your results not to count.
Criterion referenced
Comparing a person’s knowledge and skill set to a predetermined criteria
Validity
Does it measure what it says it measures?
Reliability
Do you get the same score if you take it on a different day or with a different examiner?
Sensitivity
Ability to accurately diagnose someone that does have a disorder as having the disorder, true positive
Specificity
Ability to accurately diagnose someone that doesn’t have a disorder as not having one
TRUE NEGATIVE
The Gray Oral Reading Tests (GORT-5) was administered to probe a potential reading disorder. According to the test manual, the sensitivity of the test is 82% and the specificity is 86%. What does this mean?
The correct answers are: The test will accurately identify 82% of individuals with a reading disorder., The test is likely to miss 18% of individuals who present with a reading disorder.
Percentile Ranks
16th, 50th, 84th; 85 is 16th percentile, 100 is 50th percentile, and 115 is 84th percentile
Standard Score
85-115 within normal limits
Efficient Intervention
Done quickly, in the least amount of time
Effective Intervention
Intervention that works according to science
Feasible
Able to be done in a controlled environment and in a real world setting
ex. no one is going to have a $50,000 technology equipment in their house
Efficacy
Worked in a tightly controlled environment
Effectiveness
Worked in a real world setting
Prevention
For people who are at risk for developing a disorder
Example: Hearing ear muff guards for people that work in loud environments
Remediation
For those who have a diagnosis or a disorder
Example: Treatment disorders
Compensation
For those that have a disorder with symptoms that are unlikely to respond to treatment
Example: Modify lifestyle living with the disorder; modify schedule, modify routines
What are ASHA evidence maps
A database where you can find treatments that are effective
Long term goals
BROAD, involve results that can take months or years to achieve
Example: The patient will increase the use of expressive vocabulary from 0-25 words with familiar listeners in familiar settings to communicate a variety of pragmatic functions with minimal prompts 80% of opportunities in 4/5 consecutive sessions.
Short Term Goals
NARROW, might be achieved in a few sessions, change frequently, and are a series of small steps that help the client work towards their long-term goals
Example: With fading prompts, the patient will use 10 signs/gestures/or word approximations to request, protest, greet, and answer yes/no questions during structured therapy sessions 80% of opportunities in 4/5 consecutive sessions.
How can a goal be improved?
A goal can be improved by adding moderate to minimal cueing, dose, dose frequency
Selecting a goal
What you want that outcome of treatment to be
Selecting a procedure
How you will target that goal
Determining treatment intensity
How much treatment will be delivered
Monitoring progress
Learning
Goals are…
- Functional
- Attainable
- Measurable
Functional
Improve the person’s quality of life
Measurable
Crucial for progress monitoring
Attainable
Realistic
Purpose of progress monitoring
Ongoing assessment to document progress of your goals
Long term assessed less frequently, short term goals assessed more frequently through daily treatment data
To determine whether what you’re doing is working and whether dismissal is appropriate
Purpose of establishing baseline skills before implementing treatment
Know where they are at
Background of your client
Treatment Intensity
How often/how much treatment should you deliver
How many trials you provide in a session
Dose
What type of treatment is it?
Dose form
Number and length of sessions in a time unit (e.g., two 20-minute sessions per week)
Dose frequency
Total period of time intervention was delivered
Total intervention duration
Calculate cumulative treatment intensity
Dose x Dose frequency x Total intervention duration
Evidence Based Practice
Helps you decide what treatment to provide
– Keeping in mind effective, efficient, and feasible
Importance of the checklist: The checklist helps identify whether or not an article is good enough to be imitated on your own research.
Understand the concept of evidence-based practice (EBP). What are the three pillars of EBP? What is the fourth pillar that has been suggested for inclusion in this framework?
Client/Patient/Caregiver Perspectives:
External Scientific Evidence
Clinical Expertise/Expert Opinion
Internal Evidence
Client/Patient/Caregiver Perspectives
Discuss their approach, fits the family routine, their goals that they want for their child
External Scientific Evidence
scientific journals, peer-reviewed journal
Clinical Expertise/Expert Opinion
pillar
Internal Evidence
Data informed evaluation of the client’s performance
Treatment Efficacy
Does a treatment produce a desired result in a tightly controlled laboratory setting?
Treatment Effectiveness
Does the protocol work in real-life settings?
Understand the concept of implementation science
Look at factors that would help implement an intervention into the real world; helps us go from efficacy to effectiveness transition
Which of the following psychometric properties gives you information regarding whether a norm-referenced test measures what it says it measures?
Validity
Jenny had a stroke. She complains of a great difficulty understanding what she is reading. She also has difficulty naming common objects. Do you suspect a speech, language, or cognitive communication disorder? Select all that apply.
Language
Examples of screening
Autism screener (M-CHAT-R)
audiology screening
RICE WEXLER TEGI (Grammar)
Kindergarten screenings for motor skills, adaptive behaviors, pre-academic skills, etc.
Advance Short Term Goals: CLIENT will answer yes/no questions with 80% accuracy after listening to a 5-sentence passage given moderate cueing.
- change cueing
- change accuracy
- change task
Understand the general components of the TIDieR checklist
Used for peer-reviewed articles or journals to see if it has all the items in the checklist
- 0-1 grading system (0 does not include, 1 does) out of 12 (12=includes everything and can be imitated by other researchers)
TIDieR: 12 item checklist
four examples of what is included
- Brief name
- Brief rationale
3/ What (materials) part A: a description of the materials
What Materials part B: A statement of where to access those materials - What procedures: A description of steps involved in the treatment
Improve Short-Term Goals:
How to write a short term goal:
CLIENT WILL __what will they do___ with ____ accuracy after ___task and trials___given __cueing or no___
