Intro & Review

Question 1

Acquired disorders come before development

T or F

Answer 1

FALSE

Acquired disorders come AFTER development

Question 2

SLPs work to ______ , ______, ______, and ______ speech, language, social communication, cognitive-communication, and swallowing disorders in children & adults

Answer 2

Prevent, Assess, Diagnose, & Treat

PAD-T

Question 3

Although the setting and/or subject matter
may change (language vs. swallowing vs.
articulation…), the steps in an SLPs clinical
process are basically the same:

They include:

Answer 3

• Evaluation
• Treatment

Question 4

Reasons we perform evaluations

Answer 4

• to determine if there’s impairment
• describe, diagnose, provide prognosis of impairment
• Guides treatment goals of IDT (interdisciplinary team)
• guides development of compensatory strategies
• guides discussions with patient & family regarding discharge plans

Question 5

What to do when completing medical chart review

Answer 5

• Complete med. chart review a PRIOR to time with patient
• Find pertinent information (don’t just repeat everything)
  
  • Personal information
  • MD’s orders (SLP consult, ST Eval & Treat, etc.)
  • Medical, social, surgical & treatment history
  • Chief complaint
  • History of Present Illness
  • Current Medications
  • Test Results/Imaging
  • Function - may be complicated by side of medications
  • Imaging (e.g. MRI) may give information about site of lesion, extent of brain damage, etc.)

Question 6

Use information from your chart review to:

Answer 6

• Determine what assessments you’ll need
• Make a hypothesis about what you might expect during your evaluation

Question 7

Rationale for Physical Examination

Answer 7

• Symptoms found during the exam can help localize where the problem is in the brain
• Indirect assessment of cognition & language

Question 8

Components of Physical Examination

Answer 8

• General observations (alertness, posture)
• Vitals (respiratory rate, blood pressure, oxygen saturation rate, heart rate, temperature)
• Oral Mechanism exam
• Cranial Nerve Exam
• Vision/Hearing

Question 9

Starting Physical exam

procedures

Answer 9

• Ready needed supplies
• Check in with patient’s nurse before entering
• Introduce yourself
• state why you are there & what your plan is
  
  • may vary according to setting, hypothesis, etc.

Question 10

Considerations for selection of assessments

Answer 10

Generally more than one is necessary to make a diagnosis

• Should be based on goal of assessment:
  
  • Screening - to determine presence/absence of impairment
  • Evaluation - describe impairment and/or diagnose
  • Treatment planning
  • Formal (data driven) vs. Informal (content driven)
  • Standardized (scored in a consistent manner) vs. Nonstandardized (no uniformity in evaluation)
  • Static (one period of time) vs. Dynamic (ongoing process)
  • Instrumental (swallow studies, voice evals)
  • Modality - auditory, verbal, written, etc.
  • Reference type - norm, criterion, ipsative
  • Psychometric Properties - reliability vs. validity

Question 11

Assessment scored in a consistent manner

Answer 11

Standardized Assessment

Question 12

Assessment that has no uniformity in evaluation

Answer 12

Nonstandardized Assessment

Question 13

Static vs. Dynamic

Answer 13

• static - one period of time
• dynamic - ongoing process

Question 14

Reference Types for Assessments

Answer 14

• Norm referenced - results can be compared to normative data
• Criterion-referenced - whether test takers performed well or poorly on a given task
• Ipsative - test takers are compared to previous performance

Question 15

Psychometric Properties of Assessment

Answer 15

• Reliability - consistency of a measure; whether results can be reproduced under same conditions
• Validity - accuracy of a measure; whether it tests what it says it tests

Question 16

Evaluation vs. Screening

Answer 16

• Screen : tool to identify presence of an impairment
  
  • Usually a PASS/FAIL test
  • ex. for cognition: MOCA, MMSE
• Evaluation: true diagnostic
  
  • describes & scores the impairment; compares to normative data
  • ex. for cognition: FAVRES

Question 17

Types of Treatment

Answer 17

• Rehabilitative: intended to restore or return function
• Compensatory:
  
  • intended to minimize impairment while waiting for function to return or if function does not return

Question 18

Person centered intervention

Answer 18

• focuses on maximizing individual’s ability to participate in meaningful activities
  
  • should be personally relevant
    
    • consider cultural & linguistic background, social history, social context
    • communication needs & personal desires
  • patient can choose whether they want treatment

Question 19

Other treatment considerations

Answer 19

• try multiple strategies
• ensure materials are age-appropriate
• establish therapy routine that fits in with their schedule
• provide clear, ongoing instructions & feedback about therapy performance & progress
• ensure difficulty level is appropriate

Question 20

3 components of EBP

Answer 20

• Clinical expertise/Expert opinion
• Evidence (external & internal)
• Client/patient/caregiver perspectives

Question 21

Types of Evidence

Answer 21

Internal - data & observations collected on an individual client

• helpful in tracking a client’s performance

External - whether a treatment approach is effective in causing change in individuals

Question 22

Appraisal of Evidence

Answer 22

To determine:

• Relevance
  
  • refers to how closely connected the study’s elements (e.g., study aim, participants, method, results) are to your clinical question or fits your needs
• Limitations
  
  • refers to shortcomings or external influences for which the investigators could not/did not control

Question 23

Parts of Assessment

Answer 23

Question 24

Helpful Resources

Answer 24

• Mentors
• ASHA Website
• External Evidence
• Continuing Education courses/Conferences
• Your IDT/IPT
• Social Media