Day 2 Flashcards
1st step of diagnostic process based on the scientific model
Definition and delineation of problem- constituent analysis
2nd step of diagnostic process based on the scientific model.
Develop hypothesis- clinical hypothesis
3rd step of diagnostic process based on scientific model
Research design- clinical design
4th step of diagnostic process based on the scientific model
Collection of data- clinical testing
5th step of diagnostic process based on the scientific model
Analysis of data- clinical data analysis
6th step of diagnostic process based on the scientific model
Interpretation of data- Clinical interpretation
7th step of diagnostic process based on the scientific model
Conclusions- recommendations for patient management
Define constituent analysis
Defining the problem through thorough and systematic analysis of information
2 avenues patient information is available through in performing constituent analysis
Case history form and patient interview
Define and explain: case history form
Starting point for understanding clients and
their communication problems
Typically completed by the client or parent Ideally reviewed by the clinician before initial
meeting
Enables the clinician to anticipate areas that
will require assessment, identify topics requiring further clarification and preselect appropriate test materials
Importance of the initial interview
To explore the nature and history of the patient’s presenting symptoms To establish initial contact and the patient/caregiver/clinician relationship May be the foundation for future success in therapy
3 phases of the initial interview
Opening phase, body phase, closing phase
Opening phase of interview
Introductions ¡ Describe the purpose of meeting
Body phase of interview
Discuss “statement of problem”
Client’s history and current status in depth Clarify information on case history form
Closing phase of interview
Summarize major points of discussion
Express appreciation for interviewee’s help
Indicate what will take place and the approximate length of the
session
What a good interviewer needs
Common sense
Basic knowledge of the disorder
Counseling skills
In an interview, the clinician
Assumes responsibility for conducting the interview Should not intimidate the client Should stay focused Should maintain flexibility Should be sensitive Should not express subjective personal feelings Should remain open even if the patient is hostile or
uncooperative
Should be a listener, not a talker
What the patient brings to the interview process
Anxiety
Past and present problems Previous contact with health professionals
Previous contact with educational professionals Education Personal needs Cultural background
4 types of questions
Open-ended, closed-ended, neutral, leading
Clinician’s responses to answers
Summary statements
Reflections Clarifications
Repetitions Pauses Nonverbal behaviors: head nodding, body
posturing, eye contact, touching
9 things to avoid during an interview
Yes/no questions
Either-or questions Inhibitive phrasing
Sudden shifts in the line of questioning Talking too much Stereotypical verbal habits Forgetting client’s feelings, attitudes in view of
symptoms/etiology
Providing too much information too soon Accepting superficial answers
7 pieces of info you should have by the end of the interview
Etiological factors
Previous clinical findings Developmental history
Current health status Educational/vocational history Emotional/social adjustment Family concerns
Define and explain: clinical hypothesis
Theory that could explain presenting behavior
or facts
The purpose is to guide current assessment
and intervention
3 steps to form a clinical hypothesis
Think about the causal factors based on the
constituent analysis
Narrow down possible explanations for the
clinical problem
Form priorities among the potential cause-
and-effect relationships until you have derived the most likely explanation and its causes
4 functions of the clinical hypothesis
Attempts to clarify the clinical problem
Implies a level of understanding Offers a tentative explanation to the speech
and language problem
Derives a dynamic cause-and-effect
relationship used for exploring the patient’s problem
State an example hypothesis: George (3.6 years) was reported by his mother and
pediatrician to have age appropriate skills in all areas of development except language. Information gathered at the
initial interview suggested a significant language delay. During initial play with the child, it was noted that he used only one-word utterances, but seemed to be able to follow directions
Hypothesis: George has a significant expressive language delay.
State an example hypothesis: Ann (7.5 years) has significant difficulty following
directions, using proper sentence structure and learning sight words.
Ann has a broad-based language learning disability that affects both her oral and written language skills.
State an example hypothesis: Standardized testing indicates that Evan (6.6
years) has a significant language delay. It is not clear yet whether this is part of a general global
delay, but his teacher reports that he completes some non-verbal tasks as well as his peers
Evan has a specific language impairment
State an example hypothesis: Jane had a moderate expressive language delay when
she was referred 6 months ago. Jane has been attending weekly therapy sessions and her mother
reports that she is no longer concerned with her language. You suspect that Jane now has age-appropriate language skills and want to check this out with a standardized assessment.
Jane’s language skills are now age appropriate
5 principles of good assessments
Thorough ¡ uses a variety of assessment modalities ¡ Valid ¡ Reliable
¡ Tailored to the individual client
Psychometric principles: definition and 3 things they include
Refers to the measurement of human traits, abilities,
and certain processes
Includes:
¡ Test Validity ¡ Reliability ¡ Standardization
Define: test validity
The extent to which a test measures what it is constructed to measure.
2 types of test validity
Content and construct
Define and explain content validity
Means that a test includes items that are relevant to assessing the
purported skill.
Requires an expert’s critical examination of each item’s relevance and
ability to sample the behavior under observation
3 major criteria of content validity
Appropriateness of the items included Completeness of the items sampled Way in which the test items assess the content
Define and explain construct validity
Degree to which a test measures a predetermined theoretical construct
Ex. Studies of language acquisition show that expressive vocabulary
increases with age. Therefore, a test of expressive vocabulary should yield scores that show progressive improvement with age.
Define: test reliability
Reliability means that the results are replicable
It is preferable for tests to have correlation coefficients of:
.90 or above
The closer a coefficient of reliability is to _____(
1.0, reliable
3 types of reliability
test-retest, split-half, rater
Define test-retest reliability
Refers to a test’s stability over time (over several administrations)
Define split-half reliability
Refers to a test’s internal consistency; scores from one half of the test
correlate with results from the other half of the test…comparing odd
number questions to even number questions
Define rater reliability
Refers to the level of agreement among individuals rating a test
Define: standardized tests
Standardized tests provide standard procedures for the
administration and scoring of the test
Purpose of standardized tests
Standardization is completed so that test-giver bias and
other extraneous influences do not affect the client’s performance and so that results from different people are comparable
The majority of standardized test clinicians use are _______, but _______ is NOT synonymous with ________.
norm referenced, standardized, norm referenced
Any test can be standardized as long as what 2 things are used?
uniform test
administration and scoring are used
2 general testing guidelines
Study administration and scoring directions thoroughly, practice administering the test
6 things to consider when practicing administering a test
Testing Environment ¡ Rest Periods/Breaks ¡ Encouragement and Reinforcement ¡ Repetitions ¡ Cultural Diversity ¡ Dialectal Variation
3 of Many factors that have a negative impact on test administration and
interpretation for individuals from culturally and/or linguistically
diverse backgrounds
Differences between your communication style and that of the student ÷ Lack of familiarity with item contexts (e.g., pictures, vocabulary,
topics)
÷ Items that reflect values and beliefs that are culturally specific
6 Ways to minimize potential cultural diversity problems that may require non-standardized administration
Allow extra time ÷ Increase number of practice trials ÷ Reword test instructions ÷ Continue testing beyond ceiling ÷ Ask student to explain incorrect responses ÷ Use alternative scoring procedures
Define: dialectal variation
Responses may contain regional and cultural
patterns or variations that reflect dialectical differences from mainstream American English
2 things to do when there is dialectal variation
Count variations correct if it is appropriate given the student’s
language background
¡ You must be familiar with the student’s home language
environment to determine whether a response is appropriate
Define: assessment
The process of collecting valid and reliable information,
integrating it, and interpreting it to make a judgment or a decision about something.
Assessment = _______
Evaluation
Outcome of assessment is usually a ______
Diagnosis
Define diagnosis
Clinical decision regarding the presence or absence of a
disorder and the assessment of a diagnostic label (e.g.,
expressive language disorder; childhood apraxia of speech)
6 things SLP’s do with assessment info
Make professional diagnoses and conclusions
¡ Identify the need for referral to other professionals ¡ Identify the need for treatment
¡ Determine the focus of treatment ¡ Determine the frequency and length of treatment ¡ Make decisions about the structure of treatment
4 potential structures of treatment
individual sessions, group sessions, treatment with caregivers, treatment without caregivers
2 types of tests commonly used by SLP’s
Norm-referenced, criterion-referenced
Definition and goal of norm-referenced tests
Standardized tests that compare an individual’s performance
to that of age-matched peers
¡ The goal is to rank the individual so that decisions can be
made about their opportunity for success (e.g., SAT)
Definition and goal of criterion-referenced tests
Individual’s performance is compared to a pre-defined set of
criteria or a standard
¡ The goal is to determine whether or not the individual has
mastery of a certain skill set
¡ These results are usually “pass” or “fail”
3 typical scores used with norm-referenced tests
Standard scores, percentiles, age/grade equivalent
Definition of standard scores
¡ Derived from raw scores using the normative information
gathered when the test was developed
¡ Indicate how far above or below the average (or “mean”) an
individual’s score falls, using a common scale, such as one with an average of 100.
Other uses and purposes of standardized scores
Can be used to compare individuals from different grades or
age groups because all scores are converted to the same numerical scale
¡ Most intelligence tests and many achievement tests, including
tests used by SLPs, use standard scores
Define: percentiles
A score that indicates the rank of the student compared to
others (same age or grade), using a hypothetical group of 100 students
¡ Derived from raw scores using the norms obtained from
testing a large population when the test was developed
How do percentiles differ from percents? Explain what a specific percentile score of X% means
Not the same as “percent” – a percentile of 87 does not mean
that the student answered 87% of the questions correctly
¡ A percentile of 87 indicates that the individual’s score on a test
equals or surpasses 87 out of 100 (or 87%) individuals
Define: age/grade equivalent. Frequency of use and understanding?
Indicate that the student has attained the same score (not
skills) as an average student of that age or grade
¡ Seem to be easy to understand but are often misunderstood ¡ Not used very often in formal reports
Examples of norm-referenced tests
Clinical Evaluation of Language Fundamentals-5
(CELF-5)
Test of Language Development Primary -4
(TOLD:P-4)
Preschool Language Scale-5 (PLS-5) Test of Word Reading Efficiency-2 (TOWRE-2) Comprehensive Test of Phonological Processing-2
(CTOPP-2)
Oral and Written Language Scales-II (OWLS-II) Assessment of Literacy and Language (ALL)
5 other uses of criterion-referenced tests
Used to measure mastery of educational objectives or curriculum
(absolute performance)
¡ Does not compare one student to another or rank student
¡ Focus on what the child knows or can do, not on how they compare
to others
¡ Often used as “end-of-unit” tests or as a “benchmark” to identify
areas of strength or weakness
¡ Typically use raw scores and percentages to reflect the level of
mastery of a given objective
Examples of criterion referenced tests
Assessment of Literacy and Language ¡ Specific subtests Clinical Evaluation of Language Fundamentals-4: Screening Test Rosetti Infant Toddler Language Scale Birth to Three
4 test/subtest administration procedures
- Record forms, (Fill out all identifying information,Calculate Chronological age)
- record responses (write out responses, use a tape recorder)
- score responses (Clearly indicate correct and incorrect responses, Usually indicate with 1 or 0, but varies depending on test
- start and discontinue rules
Most tests have specific _____ and ____ criteria
Starting and ending
Define starting point
The starting point is some arbitrary level judged appropriate for the individual,
usually based on age. Basal levels are determined from starting level and are the
lowest specified number of correct responses
Define ending point
The ending point is determined after the individual has missed a specified number of
consecutive questions. This is the ceiling level.
In order to save time, especially with relatively long tests, _______ and ______ levels are
established so that the entire test does not have to be administered.
basal and ceiling
All items (above/below) the basal level are counted as correct
below
All items (above/below) the ceiling level are counted as incorrect
above
Other info about basal and ceiling levels
Basal and Ceiling levels vary by test. You must refer to the examiner’s manual for this
information. This information is often on the test response form as well.
Standard scores are derived from
raw scores
Define raw score
The Raw Score is the total number of points (correct
responses) for a given subtest or test.
How to calculate raw score
Add the scores for the items administered ¡ Remember to give credit for unadministered items below the
basal
¡ Write this score at the bottom of the subtest
¡ Depending on the test, also write this number on the front of
the record form for test or subtest
Info about the Bell Curve
Standard scores and percentiles can be compared using
the “normal” or bell-shaped curve
Most tests in speech-language pathology are developed in
order to yield a standard curve of scores, where the majority of all individuals would fall within a small range (or one “standard deviation”) of the mean or average score and where 50% of all individuals would fall above and 50% would fall below the average score
Some tests do not have such “normal” distributions of
scores and these different types of scores may not be comparable
A standard score usually has a mean of _____ and a standard deviation of ____
100, 15
Plus one SD from the mean is 115 (above average…84th %ile) ¡ Minus one SD from the mean is 85 (below average…16th %ile))
Define subtest or scale score
A Subtest or Scale Score is a score that represents
one score in a battery of subtests to develop a composite score.
Many subtest have a mean score of ____ and a standard deviation of ______
10, 3
Plus one SD from the mean is 13 (above average…84th %ile) ¡ Minus one SD from the mean is 7 (below average…16th %ile)
Guidelines for interpreting composite standard scores 1
115- above = above average
86-114 = average
78-85 = below average
71-77 = poor
Guidelines for interpreting composite standard scores 2
>130 = very superior 121-130 = superior 111-120 = above average 90-110 = average 80-89 = below average 70-79 = poor
Guidelines for interpreting subtest standard scores
17-20 = very superior 15-16 = superior 13-14 = above average 8-12 = average 6-7 = below average 4-5 = poor 1-3 = very poor
Speech and language sampling: importance/purpose? Length?
Very important to determine whether a
problem exists, and if so, identifying the client’s specific deficiencies
Should be long enough to obtain a true,
representative sample of the clients speech and language
6 advantages of speech and language sampling
Assess all aspects of language
Determine strengths and weaknesses Can make descriptive summaries of
language behaviors
Can analyze specific utterances Analyze communication strategies employed
by the patient
Consider errors within a communicative
context
8 ways to obtain a reliable and valid sample
Establish a positive relationship with the client Minimize interruptions and distractions Be patient…do not talk to fill silence
Preselect materials and topics that will interest
client
Follow client’s lead in changing topics or
elaborating
Provide a variety of contexts – conversation,
narrative, response to pictures
Ask questions that require lengthier responses Can use conversation, pictures or narratives
Adults: obtaining a speech language sample through conversation
Clinician can use open-ended questions to elicit
responses
¡ This may be done during initial interview
Children: obtaining a speech language sample through conversation
With very young children, you may need to use
different activities, objects or toys to elicit speech or vocalizations
¡ With older children, use stimulus questions and
statements to elicit a sample
÷ Tell me what you would do with a million dollars ÷ Do you have a pet? Tell me about him.
3 ways to obtain a speech language sample with pictures
Pictures are useful because they provide a
known context
Important to use pictures that illustrate a
variety of activities because they provide more things to talk about
Use pictures to transition to more natural
dialogue
3 ways to obtain a speech-language sample through narrative
A narrative is a story
Narrative production differs from conversational
production in that the client must use certain
rules of organization and language sequencing to relay events that have a beginning, middle and
end
One way to do this is by telling the client a story
and having the client tell it back
3 ways conversation differs from narrative production
Dysfluencies more evident in narratives than
in conversations
Longer utterances in narratives than in
conversations
More burdens with narrative and expository
discourse than with conversation
¡ Require more planning and organization ¡ Need to organize thoughts & sequence events
4 types of hard to assess children
Who are extremely shy or quiet ¡ Who are noncompliant ¡ Who are hyperactive or impulsive ¡ With visual or other physical handicaps
Define data analysis
Somewhat of an artificial step
“The nonjudgmental organization of the ‘facts’
that have been obtained during clinical testing”
(Nation & Aram, 1984, p. 219)
It follows clinical testing (collecting of clinical
data) and precedes clinical interpretation of the data
3 stages of clinical analysis
Objectify the data
Categorize and order the new data in reference to
the clinical hypotheses
Determine the strength or significance of the data
for supporting or refuting the clinical hypotheses
2 ways to objectify the data
Scoring
¡ Responses and descriptive statements ¡ How the client performed ¡ What the client did ¡ Conditions under which data were obtained
Comparing data to normative information
Scoring results in what 2 types of data?
Quantitative (numerical) and descriptive (informational)
2 important facts about data analysis
At this stage you are only specifying the degree and
extent of the variation
You are NOT judging the absence or presence of a
speech/language deficit
3 ways to compare data to standards
Compare to normative data
Compare to your own knowledge
Compare to intra-disorder information
4 purposes of clinical interpretation
Determine the significance of the findings
Confirm or reject the hypothesis
Suggest other interpretations if rejecting the
hypothesis
Set the course for patient management
How to determine significance of results
Accumulate all the data and determine what it
means in relationship to
¡ your cause-and-effect statement ¡ your purposes for the assessment ¡ your referral’s request ¡ your patient’s statement of the problem
How to interpret all the information
Draw reasonable relationships among all the
cause-effect data
Must rely heavily on your problem-solving
abilities
Meld the information you got from the
constituent analysis task with the information from the clinical analysis step
4 mistakes in interpretation
Overreliance on test scores Incorrect cause-effect interpretations Having inadequate knowledge about correlations between the patterns of the disordered speech and language behaviors and the causal factors Lack of knowledge about the disorders
Define: statement of diagnosis
Formal, succinct statement of your diagnosis
Conveys the most logical cause-and-effect
relationship
3 sources of supporting the diagnosis
Literature ¡ Constituent analysis ¡ Clinical data analysis
Supporting the diagnosis
Basically presents the diagnostician’s reasoning
process for arriving at his diagnostic conclusion (Nation & Aram, 238)
Make good use of your negative results
Define: interpretation
The interpretation is your diagnosis and its
probable cause
Use all the knowledge you have about the
case up to this point, and your knowledge about delays, disorders and differences
Documents how you arrived at the diagnosis
4 questions to ask when determining management plan
Can the patient change his speech and/or language behavior? Is therapy necessary to effect this change? Do you need to make any referrals? Are the needed services available?
Recommendations for intervention draw directly from _________
Assessment data
3 parts contained in a recommendation
Recommendation as to whether some intervention by an SLP
is appropriate
¡ The goals established for intervention based on the assessment
data
¡ Suggestions for methods, approaches, activities,
reinforcements or any other aspects of the intervention program that the clinician feels is important
Why is it important to hold an interpretive conference?
“There is little likelihood that persons will act on
advice if they do not understand and accept the information given them.
Aspects/suggestions for
Simple, non-technical information
Review the general processes which support
communication, then give assessment results
First describe strengths, then weaknesses Use samples and analogies to clarify
Avoid superficial reassurances
6 basic principles of the post-diagnostic conference
Don’t expect client to understand everything you
say
Share options instead of giving advice
Better to be too simple, than too complex Provide a simple action to be implemented
immediately
Be pleasant, but frank Be aware of and prepared that they may focus their
hostility on you
3 characteristics of a report
Summary of the information collected
Generally follows a more or less structured format Language used should be clear and simple, but
professional
3 characteristics of clear and simple professional language
Avoid qualifiers such as “rather” and “very”
¡ Distinguish between information we gathered or observed
ourselves from information reported by the parents or others
¡ Avoid judgmental terms such as “good” and “nicely” in
describing the child’s performance
4 steps to writing a report
Constituent analysis ¡ Identifying Info ¡ Statement of the Problem ¡ Background History Clinical design/data collection/data analysis ¡ Testing and Observation Clinical interpretation ¡ Diagnostic Statement Conclusions ¡ Recommendations
Define: articulation disorders
Errors in production of individual speech
sounds
Therapy for articulation disorders
Therapy is phoneme based, combining
placement technique with sensory-‐perceptual training
Define: phonological disorder
Errors in classes of sounds
Recognizes that the sound system is a
component of the child’s language system
Therapy for phonological disorders
Therapy is focused on reorganizing the
phonological system by first improving ability to process phonological information
Define: childhood apraxia of speech
Deficit in motor planning for speech
Therapy for Childhood apraxia of speech
Treatment involves helping child learn motor
patterns to produce speech, utilize auditory/visual/kinesthetic cueing
Relies heavily on principles of motor learning
for training sound combinations (not individual phonemes)
Articulation disorders: speech sounds like, therapy focuses on
individual sound errors, teaching individual sound production
Phonological disorders: speech sounds like, therapy focuses on
patterns of sound errors, reorganizing phonological system
CAS: speech sounds like, therapy focuses on
inconsistent errors due to fluctuations in motor planning, facilitating movement capabilities
Define: Goldman Fristoe Test of Articulaiton-3
Norm-‐referenced scores for ages 2:0 through 21:11
Pictures elicit production of sounds in
¡ varying word positions (initial, medial, final, clusters) ¡ single words vs. connected speech
4 purposes of Goldman Fristoe Test of Articulation-3
Identify errors and patterns of errors Compare child’s speech to the speech of age-‐
matched peers
Numerically quantify improvement over time with
Growth Scale Values
Develop treatment objectives
3 purposes of administration of GFTA-3
Elicit production of words (not direct imitation)
Score child’s production
Give Sounds-‐in-‐Sentences subtest if necessary
How to score the GFTA-3
Count errors to calculate Raw Score
Convert Raw Score to Standard Score,
Percentile Rank, Growth Scale Value, and Age Equivalent using tables in the back of the manual
4 aspects to consider in interpretation of the test
Standard score
Age-‐equivalent
Look at errors/error patterns
Check stimulability of error sounds
5 general clinical considerations in working with children with hearing loss
• Prepare ahead • Keep detailed records • Dress appropriately • Consider all privacy issues • Every parent loves her child
5 clinician considerations in working with children with hearing loss
• Hair back • Rate of presentation • Vocal pitch • Your facial expression is important • Visual contact
Name of first school of early intervention for children with hearing loss
The McCowen School for Young Deaf Children (1883)
Sensorineural hearing loss
Sensorineural hearing loss:
• Leads to broadened auditory filters • Reduced dynamic range
•
Addition of a cochlear implant means
– Spectral resolution is further diminished
– A frequency-place mismatch exists
What is oropharyngeal swallowing?
Moving food from mouth to stomach
Kahrilas point of view of oropharyngeal swallowing: part 1
Swallowing is reconfiguring the oropharynx from a respiratory tract to a swallowing pathway (alimentary pathway) for a period of less than one second
Kahrilas point of view of oropharyngeal swallowing: part 2
Swallowing is moving the bolus into the esophagus
Posterior lingual propulsion, Pharyngeal constriction, Upper Esophageal Sphincter Opening
T/F lanryngeal airspace is CONTINUOUS with the pharynx
True
Is the velum up or down for swallowing? Why important?
Velum up for swallowing - prevents nasal breathing and nasal regurgitation (food entering nasopharynx)
6 hyolaryngeal components
hyoid, epiglottis, aryepiglottic folds, thyroid, cricoid, arytenoids
3 steps of hyolaryngeal system closund sure
- Hyolaryngeal elevation and approximation
- Epiglottic inversion
- Aryepiglottic fold “bunching”
Define when pharynx and esophagus are contiguous
Closed UES- pharynx and esophagus share a border
Define when pharynx and esophagus and continuous
Open UES- no border between pharynx and esophagus
The ______ loads the bolus immediately _______ to propelling it into the ________
tongue, prior, pharynx
What happens when the UES is open?
posterior lingual propulsion, or posterior lingual propulasion and pharyngeal constriction
Swallowing Schematic
respiratory tract —> swallowing pathway
Levers and movement of other structures
velum hyo-larynx UES
Oropharyngeal swallowing: conspicuous and indisputable ways to think about it
Essential for sustaining life
Important for quality of life Disorders may lead to serious illness or death
Function is multi-factorial and complex
Oropharyngeal swallowing: inconspicuous and disputable ways to think about it
Objective identification of pathophysiologies Objective decision-making about treatment
Monitoring progress of prescribed treatments Conclusions about efficacy of treatments
The significance of swallowing disorders is overwhelmingly (clear/unclear), but how to define and treat swallowing pathophysiology is insufficiently (clear/unclear).
Clear, clear
Define normal swallowing
Moving food from mouth to stomach with ease and without endangering the airway.
Define anatomy
Anatomy – The study of the structure of organisms and the relations of their
parts
Define physiology
Physiology – A science dealing with the functions of living organisms or their
parts
