Exam 1 (Assessment Part 1) Flashcards
describe the CAPD eval team
audiologists
SLPs
psychologists
social workers
parents
physician
audiologists role
manage & coordinate evaluations; performs audiologic assessment to rule out peripheral hearing loss
SLP role
assesses receptive/expressive language skills, phonological skills & written language abilities
psychologists role
assesses cognitive skills & capacity for learning
social worker roel
serves as a liaison between home and school if needed
parents role
proved prenatal and neonatal history, informational about developmental milestones, auditory behavior and medical and academic history
physician role
rules out a medical pathology that may affect learning abilities
Who is responsible for evaluating and diagnosing CAPD?
audiologists
is it best to use a test battery or one test for diagnosing CAPD
test battery
Why should CAPD testing use a test battery and not a single sensitive diagnostic test?
CAPD is not one disorder
Clinical presentations can vary resulting from a number of mechanisms and auditory processes affected
Different measures are required for accurate assessment of central auditory processes
Multiple assessment measures can also help to establish more appropriate management for CAPD
what is a test battery
Includes a # of tests used to diagnose a certain condition
Questions to ask to ensure diagnostic accuracy & usefulness
Does the battery improve sensitivity & specificity over using individual tests
How many tests are needed to obtain optimal sensitivity/specificity
How many tests are needed to obtain optimal sensitivity/specificity
Max sensitivity requires 2-3 tests in a CAPD test battery
lax criteria
better sensitivity and poor specificity
strict criteria
better specificity and poor sensitivity
what is the reason behind lax criteria
As the test batter sizes increases it leads to a greater probability that a PT will fail any single test
It improves sensitivity but can undermine specificity as normal patients have an increased chance of being incorrectly identified
for ex: PT is more likely to fail one test when a battery has 10 tests as compared to when it has 2-4 tests
reason behind the strict criteria
As the test battery size increases there is less probability that a PT will fail all tests
Good to detect normal function & improves specificity but can undermine sensitivity as PTs w/ abnormal function will be less likely to fail the entire battery when more tests are included
For example, a patient is more likely to fail all tests when a battery has 2 to 3 tests as compared to when it has 10 tests
intermediate test criteria
Most reliable criteria
Abnormal performance on at least 2 tests (> 2 SD below mean)
Abnormal performance on at least 1 test (> 3 SD below mean)
tests with relatively low sensitivity/specificity are useful diagnostic indicators of CAPD
false
not useful
CAPD Test Battery Considerations
tests with relatively low sensitivity/specificity are not useful diagnostic indicators of CAPD
tests should demonstrate test-retest consistency and age-appropriate norms
tests requiring extensive training, time & client practice are not appropriate for most clinical settings
age appropriate
Shouldn’t be test driven but motivated by the referring complaint and relevant info available to use
Be sensitive to language development; motivational level; fatigability; attention and other cognitive factors; the influence of mental age; cultural influences; native language; and socioeconomic factors
Individuals who are medicated successfully for attention, anxiety, or other disorders that may confound test performance can be tested when on medication
true
ASHA recommends other tests
Discrimination and electrophysiologic tests like OAEs, ARTs, & AERs
dichotic processes tests
dichotic digits
competing sentences
SSI0CCM
SSW
temporal processes tests
gaps in noise
random gap detection
duration pattern test
pitch pattern test
binaural interaction tests
auditory fusion
masking level difference
monaural low redundancy speech/auditory closure processes tests
NU6 filtered words
time compressed sentences
SSI-ICM
speech in noise tests
dichotic processe
Different speech stimuli is presented to each ear simultaneously (CVC, monosyllabic words, digits, or sentences
Can assess binaural integration or binaural separation
Sensitive to lesions of CC (if CC is involved) & cerebral cortex
divided attention
repeat stimuli heard in both ears
selective attention
ignore what is heard in one ear and repeat back what is heard in the target ear
free recall
used to prevent attention factors from contaminating results
repeating words back without regard to which ear heard it
Temporal processes & pattern tests
Monotic presentation used to assess each ear independently
Stimulus is usually tones not speech
Temporal processing also includes temporal resolution
assess pattern perception & temporal functioning abilities
Temporal pattern tests assess pattern perception & temporal functioning abilities including
Feature detection abilities
Frequency/duration discrimination
Acoustical pattern and contour recognition
Temporal pattern tests are more sensitive to
compromised right hemisphere
If the test requires a verbal response it is then sensitive to
left hemisphere lesions
Binaural interaction/fusion processes
Binaural - stimuli is presented to each ear at the same time
Each ear cannot be independently assessed
presented in either a non-simultaneous, sequential manner or only a portion of the message is presented to each ear
assess integration between two ears
auditory brainstem plays a key role in combining and processing different pieces of auditory information into a cohesive and unified perception
true
binaural fusion
Monaural low redundancy speech/auditory closure processes
These speech tests involve modification (distortion) of the acoustic (extrinsic) signal to reduce the amount of redundancy
The degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristics to reduce redundancy
These tests are not sensitive to brainstem lesions
The degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristics to reduce redundancy and are
Sensitive to auditory closure abilities
Moderately sensitive to cortical lesions
Speech is a redundant signal
true
how to decide which tests to include in a test battery?
tests that provide the best diagnostic value individually and in combination should be included
what are clinical decision analysis
statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
what is clinical decision analysis (CDA)
statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
what does CDA include
sensitivity and specificity, receiver operant curves (ROC) & factor analysis
what is factor analaysis
technique used to reduce a large number of variables into fewer numbers of factors
what is a gold standard
Best test considered the current preferred method of diagnosing a particular disease
CAPD and gold standard
CAPD - gold standard group has the disorder & control group doesn’t
Logic - if CAPD is a disorder of CANS then it is inferred that individuals with lesions to the system should perform poorly on CAPD tests - reductionist model
what is the reductionist model
CAPD - gold standard group has the disorder & control group doesn’t
Logic - if CAPD is a disorder of CANS then it is inferred that individuals with lesions to the system should perform poorly on CAPD tests - reductionist model
Children suspected of CAPD don’t have diagnosed neurological lesions of the CNS as seen in the experimental group
true
what was the bruton conference
Concluded that 3 test domains for CAPD should be measured using behavioral tests
what were the 3 test domains for CAPD
Auditory pattern/temporal ordering (APTO) tests
Monaural separation closure (MSC)
Binaural integration/binaural separation (BIBS)
what was Binaural integration/binaural separation (BIBS)
can you separate and integrate information from the left and the right ear
what was Auditory pattern/temporal ordering (APTO) tests
pitch pattern sequence test (frequency discrimination), gap detection
what was Monaural separation closure (MSC)
Can you close (noise in the environment) in individual ears
what is Multiple Auditory Processing Assessment (MAPA)
Test battery that was developed in an effort to develop a quas-behavioral gold standard for CAPD
CAPD behavioral tests in 4 important auditory processing areas
Dichotic processes, temporal processes, binaural interaction, & monaural low redundancy speech/auditory closure processes
what are the recommended eval for CAPD
Case hx
Pre-test standardized questionnaires
CHAPS; SIFTER; Fisher etc.
Behavioral measures
Pure tone audiometry
Speech audiometry
CAPD behavioral tests in 4 important auditory processing areas
Other tests as needed like SIN tests
Electrophysiological measures
Immittance audiometry (including acoustic reflex thresholds)
Otoacoustic emissions (TEOAEs or DPOAEs) - done to rule out anything else or if there are issues in the inner ear
ABR, mid- and late-latency auditory evoked responses
Psychoeducational evaluation
Speech and language evaluation
Prenatal and postnatal
Developmental
Medical
academic
failed grades
current academic performance
areas of strength/weakness
special education services
Family
e.g., genetic, medical, first degree relatives with developmental disorders
Social
shy, aggressive, friendly etc.
plays/interacts comfortably with peers; prefers younger children/adults
Results of other evaluations, for example,
psychoeducational; s/l evaluation
Work history; if patient is an adult