Final Flashcards
9 Rehabilitation goals of PWA
- Return to pre-stroke life and communication
- Express opinions, feelings, and ideas
- Learn about stroke, aphasia, and resources
- Get speech therapy
- Greater autonomy
- Regain physical health
- Be treated with dignity and respect
- Engage in social, leisure, and work activities
- Help others
6 Goals of the PWA’s Family members
- Learn about stroke, aphasia, prognosis, and recovery
- How to communicate with PWA
- Participate in the rehab process
- Need hope
- General support and counseling
- Time and space for themselves
6 Goals Family Members have for the PWA
- Survival
- Independence (especially during emergencies)
- Communication ability
- Participate in stimulating and meaningful activities
- Engage Socially
What are the two models of disability within the ICF biopsychosocial approach to aphasia rehabilitation?
Medical Model & Social Model
What is the medical model of disability?
The disability is described in terms of language impairment, communication activity limitations, and participation restrictions
Which biopsychosocial model does the ICF’s Body Function and Structures fall under?
The medical model of the biopsychosocial approach
What is the social model of disability?
The extent to which a disability is handicapping and impacted by personal and environmental factors, including premorbid activities and preferences/participation
The social model of the biopsychosocial approach corresponds with which ICF components?
Activities, Participation, Environment factors, and Personal factors
Which of the two biopsychosocial approach models is associated with improving a patient’s quality of life?
The social model improves patient’s QOL
What are the 6 factors in the ICF model? Describe each
Health condition- the actual condition
Body functions and structures- physical impairment due to condition
Activities- physical limitations due to condition (speaking, walking, jumping, running)
Participation- activity restrictions (social, work, athletic, hobbies, roles)
Environment factors- outside factors influencing (living conditions, work barriers, seating arrangements, transportation, community, climate)
Personal factors- involving the individual (age, comorbidities, personality, health, ethnicity, gender, marital status, SES)
What is ASHA’s definition of evidence-based practice of an SLP?
Optimizing individuals’ ability to communicate & swallow, improving their QOL utilizing an approach in which current, high-quality research evidence is integrated with practitioner expertise, along with the client’s values and preferences
What are the characteristics of high-quality research? (5)
Good reliability
Good validity
Good research design (must-know experiment population, control group, hypothesis, methods, and outcomes)
Peer-reviewed by a set of informed people
Published
Ways research disseminates information
Publications
Forums
Webinars
Conferences
5 Framework Goals of SLPs
Prevention
Diagnosis
Habilitation
Rehabilitation
Enhancement
What are the 2 basic treatment approaches?
Behavioral Modification
Cognitive Stimulation
How does behavioral modification from cognitive stimulation?
Behavioral modification treats the WHOLE deficit & the goal is to modify behavior, not specifically language
Cognitive stimulation is a more general treatment. It treats the UNDERLYING cognitive deficit that is causing the behavioral deficit
If an aphasic person has a naming deficit what would a behavioral modification versus a cognitive stimulation treatment approach be?
BM: Generate naming tasks and activities for treatment session to help them improve naming abilities (TARGET: naming)
CS: Screen the patient to see if they have a cognitive deficit, their memory may be influencing naming difficulties. Therapy focuses on treating memory impairment to eventually improve the naming deficit
What would type of therapy would impairment-based therapy be?
Direct therapy
What is direct therapy?
Direct contact with individual 1:1 treatment of communication deficit with focus on specific areas of language impairment
Clinician directly stimulates specific listening, speaking, reading, and writing skills to improve language functions
3 Examples of direct therapy
CIT (constraint-induced therapy)
MIT (melodic intonation therapy)
Tele-rehabilitation
What type of therapy would communication-based therapy be?
Indirect therapy
What is indirect therapy?
SLP works with PWA communication partners (teacher, parent, spouse)
Teaches communication partner strategies that will improve communication skills
Goal: increase spontaneous use of communication skills/behavior across many settings & with many communication partners
4 examples of indirect therapy approaches
PACE (promoting aphasics’ communicative effectiveness)
Conversational coaching
Aphasia Scripts
Supported conversation/Conversation Therapy
4 general steps of therapy
- Start therapy
- Provide feedback
- Programmed stimulation
- Measurement and generalization
In general, when starting therapy, what should you do?
Choose a single approach
Begin with what the patient can already do (building confidence and motivation)
What type of therapy does the following sentence demonstrate: “Antecedent event is the driving force to improve responses”
Explain
Cognitive stimulation
By targeting the underlying process you are targeting the antecedent, which is the driving force to improve responses
In general, feedback during therapy should consider what
Choose an appropriate stimulation/plan that does not elicit multiple responses
Use appropriate stimulation so restimulation (feedback in response to an errored response) isn’t needed
A patient with anomia has difficulty retrieving the word dog
What would appropriate stimulation be & why?
This is a pet and it is also something that barks
‘Barks’ elicits the response 100% of the time, decreasing the chance of the client failing which avoids restimulation
What is programmed stimulation?
Identify the 4 components
The therapy plan for progressing toward the goal
- Initial behavior- the starting point of treatment
- Terminal behavior- the end point of treatment
- Program- steps from initial to terminal behavior
- Response criterion- criterion level (percent of accuracy in STG) basis for going to the next step
Define criterion level
Percent of accuracy based on clinical judgement and persons performance at baseline
What does measurement mean during therapy?
Progress must be documented during treatment
3 ways to measure progress
Chart performance during therapy tasks
Repeated standardized tests (pre/post testing)
Regular probing with a specific goal
In general, what is the goal of therapy?
Generalization
Generalization is not automatic, so we want therapy targets to be generalized to other objects
In general, what is the goal of therapy?
Generalization
Generalization is not automatic, so we want therapy targets to be generalized to other objects
Explain functional treatment
Functional tx encompasses a whole-person approach (rather than narrow/impairment-based) which improves patient QOL
Goal would be targeting improved communicative interactions within community INSTEAD OF improving naming skills with 80% accuracy
3 Reasons for the shift from impairment-based to functional approaches
Healthcare demands (bridging clinical and functional demands in shorter period of time)
Promotes changes in communication ability
Facilitate generalization
There are 20 factors that influence prognosis, name a few
Patient age
Premorbid language and literacy skills
Education and occupation
Nature of neuropathology (extent and lesion location)
Medical, neurological, and behavioral status
Hearing ability
Visual status
Motor skills
Aphasia severity
Timing of Tx initiation
Accuracy of Tx application
Tx length
Tx intensity
Family involvement
Improvement or deterioration in general health during Tx course
Spontaneous recovery
Past experiences with healthcare
Culture
Co-morbidities
When is spontaneous recovery most likely?
0 to 6mo post insult has the maximum neuro and behavioral plasticity
Define behavioral mechanism of recovery: Restoration
Return of a behavior through the same system used premorbid
Aka: restitution, reactivation
Define behavioral mechanism of recovery: Reconstitution
Premorbid functional system supporting behavior is modified and adapted system supports behavior
Aka: reorganizatio, substitution
Define behavioral mechanism of recovery: Functional compensation
The original functional system cannot recover, so a different (intact) functional system is modified to support the lost behavior
Maggie has a stroke at 60 years old & now has aphasia. She is no longer able to speak. Give an example of the 6 Behavioral plasticity mechanisms of recovery
- Restoration: after 6 days, she regained ability to speak again
- Reorganization: she used to speak in longer sentences pre-stroke, but now uses simple sentences or phrases
- Compensation: she tries to speak as she is able, and uses AAC device when having trouble
- Habituation: She makes it a habit to use AAC device when needing to communicate
- Substitution: Complete compensation- religiously uses AAC device when communicating
- New learning: maggie learns something new
3 components of EBP
Clinical expertise/expert opinion
Client/caregiver perspectives
External scientific evidence (quality research)
4 levels of evidence
- well-designed experimental study with randomization
1a: well-designed meta-analysis of 1+ randomized controlled trial
1b. well-designed randomized controlled study - Well-designed experimental study without randomization
2a: well-designed controlled study without randomization
2b: well-designed quasi-experimental study - well-designed non-experimental study (correlation or case study)
- Expert committee report, conscensus conference
Considerations when planning a treatment approach
Use EBP to select the appropriate treatment
Use checklist for obtaining best evidence
Therapy targets should involve the primary stakeholder (PWA) & focus on goals & ensure generalization
Utilize A-FROM
Extralinguistic cognitive considerations
Metacognitive considerations
Cultural considerations
List the 13 questions on checklist for obtaining best evidence
- Is there plausible rationale for study?
- Evidence from an experimental study?
- Presense of control group or condition?
- Use of randomization?
- Specified methods and participants?
- Clear descriptions of treatment with consistent implementation?
- Dependent variables measured using valid and reliable measures?
- Outcome measures/evaluated using blinding/masking? (participants blinded)
- What confounds could have distorted the results?
- Are the results statistically significant? (P <.05)
- Importance of the finding? Ecological validity?
- Was the finding precise?
- Was there a cost-benefit advantage? Outcomes/Results worth the participation?
List the 13 questions on checklist for obtaining best evidence
- Is there plausible rationale for study?
- Evidence from an experimental study?
- Presense of control group or condition?
- Use of randomization?
- Specified methods and participants?
- Clear descriptions of treatment with consistent implementation?
- Dependent variables measured using valid and reliable measures?
- Outcome measures/evaluated using blinding/masking? (participants blinded)
- What confounds could have distorted the results?
- Are the results statistically significant? (P <.05)
- Importance of the finding? Ecological validity?
- Was the finding precise?
- Was there a cost-benefit advantage? Outcomes/Results worth the participation?
Define ecological validity
Degree to which the results are generalizable to real-life/naturalistic setting
Define ecological validity
Degree to which the results are generalizable to real-life/naturalistic setting
Therapy goals should aim to do what 3 things?
Improve communication functions
Reduce the diability
Increase ability to participate in social activities
What does A-FROM stand for & what is it?
Living with Aphasia- Framework for Outcome Measurement
A-FROM is a version of the ICF adapted for aphasia interventions ensuring outcomes with real-life impacts for individuals and families living with aphasia
What are the 4 domains of A-FROM
- Participation in life situations- actual involvement in relationships, roles, and activities of choice that form part of daily life
- Personal, identify, feelings, and attitudes- inherent characteristics of the person, feelings, and emotions
- Language and related impairments- equivalent to ICFs ‘Impairment’ and includes traditional areas such as talking, understanding, reading, and writing
- Communication and language environment- anything outside of the person that facilitates and/or acts as a barrier to communication (individuals/societal attitudes, partner attributes, physical factors, language barriers)
When should the 4 A-FROM domains be considered/utilized?
From initial contact with the patient
Survey the PWA’s current life participation and goals
Establish barriers to communication with the environment
Learn about personal characteristics that may influence progress
T/F: Aphasia severity predicts cognitive abilities
False- Aphasia severity does NOT predict cognitive abilities
Aphasia is a language disorder, not a disorder of cognition, intellect, thought, etc. Impaired or spared cognition can accompany aphasia
Potential cognitive deficits that could accompany aphasia
Attention
Memory
Executive functioning
Visuospatial processing
Potential cognitive deficits that could accompany aphasia
Attention
Memory
Executive functioning
Visuospatial processing
Aphasia therapy involves ___.
Learning
If extralinguistic cognitive deficits are present, you may consider a referral to which professionals?
Neurologist
Occupational therapist
Neuropsychologist
What are 5 metacognitive considerations to keep in mind during therapy?
Self-awareness and insight
Motivation
Self-monitoring
Self-initiation
Goal-oriented behavior (tied to executive functioning)
What are 5 metacognitive considerations to keep in mind during therapy?
Self-awareness and insight
Motivation
Self-monitoring
Self-initiation
Goal-oriented behavior (tied to executive functioning)
Why should culture be considered in planning therapy?
Culture influences QOL and impacts persons view of health and their disability
Why should culture be considered in planning therapy?
Culture influences QOL and impacts persons view of health and their disability
Why should culture be considered in planning therapy?
Culture influences QOL and impacts persons view of health and their disability
Why should culture be considered in planning therapy?
Culture influences QOL and impacts persons view of health and their disability
Why should culture be considered in planning therapy?
Culture influences QOL and impacts persons view of health and their disability
Why should culture be considered in planning therapy?
Culture influences QOL and impacts persons view of health and their disability
Explain the development of cultural competence
It is an ongoing process involving:
Self-awareness
Cultural humility
Recognition of what you don’t know about the languages and cultures of individuals/families/communities you are serving
Seeking out culture-specific knowledge and expertise
Define cultural humility
Being open to aspects of cultural importance to others
Involves 3 principles:
1. lifelong learning and self-reflection of how one’s own background may influence teaching, learning, research, etc.
2. Mitigating power imbalances
3. institutional accountability
Explain the cultural iceberg & its components
Says there are two levels to knowing a culture:
The surface level, which is what many people know about the culture (food, music, language, festivals, dances, holidays, fashion)
The deep level, represents what the culture actually is & to truly understand one’s culture, this level of evaluation is necessary
Deep level involves: 1. communication styles and rules; 2. notions of certain concepts like manners, leaderhip, beauty, friendship; 3. Concepts of family, time, self, past/future, justice; 4. Attitudes towards seniors, children, rules, work, age, death, authority; 5. Approaches to religion, courtship, raising children, marriage, decision-making, problem-solving
4 things every therapy needs
- Timeline: clear start and end of therapy services
- Dose: frequency and intensity
- Purpose of therapy: what is being targeted/improved through services
- A 5-step process: gather and share information > collaborative goal setting > pre-treatment assessment > therapy > Reassessment
